<br><span class="gmail_quote">From: <b class="gmail_sendername">Vern Weitzel</b> <<a href="mailto:vern.weitzel@gmail.com">vern.weitzel@gmail.com</a>><br>crossposted from : "[health-vn discussion group]" <<a href="mailto:health-vn@cairo.anu.edu.au">health-vn@cairo.anu.edu.au</a>><br>
<br></span>From: Arlene Cohen <<a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:arlenegcohen@gmail.com" target="_blank">arlenegcohen@gmail.com</a>><br><br>Because MDR TB is in the news I thought you might be interested in the<br>
following health information resources. Feel free to share this<br>information with others who might be interested.<br>========================<br><br>
<blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid">From the CDC Fact Sheet: Multidrug-Resistant Tuberculosis (MDR TB) <<br></blockquote><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.cdc.gov/tb/pubs/tbfactsheets/mdrtb.htm" target="_blank">http://www.cdc.gov/tb/pubs/tbfactsheets/mdrtb.htm</a>><br>
<br>What is multidrug-resistant tuberculosis (MDR TB)?<br> Multidrug-resistant TB (MDR TB) is TB that is resistant to at<br>least two of the best anti-TB drugs, isoniazid and rifampicin. These<br>drugs are considered first-line drugs and are used to treat all persons<br>
with TB disease.<br><br>How is TB spread?<br> Drug-susceptible TB and MDR TB are spread the same way. TB<br>germs are put into the air when a person with TB disease of the lungs or<br>throat coughs, sneezes, speaks, or sings. These germs can float in the<br>
air for several hours, depending on the environment. Persons who<br>breathe in the air containing these TB germs can become infected.<br><br>TB is not spread by<br> . shaking someone's hand<br> . sharing food or drink<br>
. touching bed linens or toilet seats<br> . sharing toothbrushes<br> . kissing<br><br>[Long term contact is needed, for example an eight hour airplane flight.<br>- Dr. A. on K-57]<br><br>What should I do if I think I have been exposed to someone with TB<br>
disease?<br> If you think you have been exposed to someone with TB disease,<br>you should contact your doctor or local health department about getting<br>a TB skin test or the QuantiFERONR-TB Gold test (QFT-G), a blood test.<br>
And tell the doctor or nurse when you spent time with this person.<br><br>=======================<br><br>Clinical Practice Guidelines endorsed by the Infectious Diseases Society<br>of America<br>< <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.idsociety.org/content.aspx?id=4432#ttb" target="_blank">http://www.idsociety.org/content.aspx?id=4432#ttb</a> ><br>
<br>Basic FAQ on "Health Care Workers and Tuberculosis "<br>(American Academy of Family Physicians)<br><<br><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://familydoctor.org/online/famdocen/home/healthy/safety/work/875.htm" target="_blank">http://familydoctor.org/online/famdocen/home/healthy/safety/work/875.htm</a><br>
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<blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid"><br></blockquote><br><br>Patient education information:<br>MEDLINEplus<br>< <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.nlm.nih.gov/medlineplus/tuberculosis.html" target="_blank">http://www.nlm.nih.gov/medlineplus/tuberculosis.html</a> ><br>
<br><br>====articles of interest==============<br><br>1. Management of multidrug-resistant tuberculosis: Update 2007.<br>Yew WW, Leung CC.<br>Respirology. 2008 Jan;13(1):21-46. PMID: 18197909<br><br>Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China.<br>
<<a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:yewww@ha.org.hk" target="_blank">yewww@ha.org.hk</a>><br><br>Multidrug-resistant tuberculosis (MDR-TB) with bacillary resistance to<br>at<br>least isoniazid and rifampicin in vitro is a worldwide phenomenon. Hot<br>
spots<br>of the disease are found scattered in different continents. Prevention<br>of<br>its development through good tuberculosis control programmes operating<br>under<br>the directly observed therapy, short-course (DOTS) strategy is of<br>
paramount<br>importance. However, with established MDR-TB, treatment with alternative<br>and<br>specific chemotherapy is necessary to achieve a beneficial outcome. Such<br>an<br>approach on a programme basis is currently known as the 'DOTS-Plus'<br>
strategy. Second-line (reserve) drugs utilized in the treatment of<br>MDR-TB<br>are generally less potent and more toxic, perhaps with the notable<br>exceptions of some fluoroquinolones and injectable agents. Surgery has a<br>
distinct adjunctive role for the management of MDR-TB in selected<br>patients.<br>The emergence of extensively drug-resistant tuberculosis (XDR-TB), that<br>is,<br>MDR-TB with additional bacillary resistance to the fluoroquinolones and<br>
injectables, has provided a very alarming challenge to global health, as<br>the<br>disease currently has a low cure rate and high mortality. In order to<br>combat<br>XDR-TB, strengthening of DOTS and DOTS-Plus programmes is mandatory,<br>
especially in the face of surging HIV infection. Furthermore, more<br>attention needs to be focused on developing new drugs with potent<br>bactericidal and sterilizing activities and low side-effects, and above<br>all,<br>
drugs that are affordable for communities worldwide.<br><br><br>2. MDR-TB--its characteristics and control in Asia-Pacific rim<br>symposium in<br>USJCMSP 10th international conference on emerging infectious diseases in<br>
the<br>Pacific rim.<br>Mori T.<br>Tuberculosis (Edinb). 2007 Aug;87 Suppl 1:S5-9. Epub 2007 Jun 21. PMID:<br>17588496<br><br>Leprosy Research Center, National Institute of Infectious Diseases,<br>4-2-1,<br>Aobacho, Higashimurayama-shi, Tokyo 189-0002, Japan.<br>
<br>The strategy of directly observed treatment, short course (DOTS) is<br>achieving substantial progress in coverage and quality improvements<br>worldwide. However, the problem of multi-drug-resistant tuberculosis<br>(MDR-TB) has emerged as a new challenge to TB control in both developing<br>
and<br>industrialized countries. The effort of various countries of the Pacific<br>Rim<br>to fight this problem, one of the negative progenies from the 20th<br>century,<br>was a major theme of the conference. Asia, WHO's Southwest Asia and<br>
Western<br>Pacific Regions, combined, account globally for almost 60% of the newly<br>occurring MDR-TB cases. However, the problem has likely been overlooked,<br>as<br>it was masked by taking averages for countries or wider regions. In this<br>
way, we may have lost sight of "hot zones" with extremely high<br>prevalence of<br>MDR-TB in smaller areas or in population segments. The problem was<br>basically<br>a result of the low-quality treatment program, but recently it may be<br>
amplified in some areas by the HIV epidemic that is another new<br>challenge to<br>TB strategies. So far, developing countries have not been taking active<br>measures to manage this problem. However, some countries, such as the<br>
Philippines and Peru, have undertaken aggressive efforts, supported<br>technically and financially by the new international mechanisms, such as<br>the<br>Stop TB Partnership and the Global Fund to fight AIDS, TB and Malaria.<br>
These<br>efforts would be more effective if there were further technical<br>innovation<br>in diagnosis and treatment, supported by a strong political commitment.<br><br><br>3. The clinical management of drug-resistant tuberculosis.<br>
Furin J.<br>Curr Opin Pulm Med. 2007 May;13(3):212-7. PMID: 17414129<br><br>Brigham and Women's Hospital, Division of Social Medicine and Health<br>Inequalities, Harvard Medical School, Boston, Massachusetts 02120, USA.<br>
<<a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:jfurin@partners.org" target="_blank">jfurin@partners.org</a>><br><br>PURPOSE OF REVIEW: Drug-resistant tuberculosis is a growing problem,<br>with<br>
almost half a million cases worldwide. In spite of the difficulty in its<br>management, drug-resistant tuberculosis can be successfully treated,<br>even in<br>poor settings.<br><br>RECENT FINDINGS: This article will review key findings in the areas of<br>
epidemiology, diagnosis and management of drug-resistant tuberculosis,<br>including new antituberculous drugs. The issue of extensively<br>drug-resistant<br>tuberculosis will also be reviewed and discussed. Finally, novel<br>
approaches<br>to the management of drug-resistant tuberculosis in populations with<br>HIV, as<br>well as in pediatric populations, among pregnant women, and among<br>patients<br>requiring surgical therapy, will be reviewed.<br>
<br>SUMMARY: New advances in the diagnosis and management of drug-resistant<br>tuberculosis allow for excellent clinical outcomes to be achieved, even<br>in<br>difficult-to-treat populations. This is possible with timely diagnosis<br>
of<br>disease and rapid initiation of appropriate therapy in supported<br>settings.<br><br><br>4. Management of active tuberculosis.<br>Potter B, Rindfleisch K, Kraus CK.<br>Am Fam Physician. 2005 Dec 1;72(11):2225-32. PMID: 16342845<br>
<br>University of Wisconsin Medical School, Madison, Wisconsin, USA.<br><<a onclick="return top.js.OpenExtLink(window,event,this)" href="mailto:bepotter@wisc.edu" target="_blank">bepotter@wisc.edu</a>><br><br>Although the overall incidence of tuberculosis has been declining in the<br>
United States, it remains an important public health concern,<br>particularly<br>among immigrants, homeless persons, and persons infected with human<br>immunodeficiency virus. Patients who present with symptoms of active<br>
tuberculosis (e.g., cough, weight loss, or malaise with known exposure<br>to<br>the disease) should be evaluated. Three induced sputum samples for<br>acid-fast bacillus smear and culture should be obtained from patients<br>
with<br>findings of tuberculosis or suspicion for active disease. If the patient<br>has<br>manifestations of extrapulmonary tuberculosis, smears and cultures<br>should be<br>obtained from these sites. Most patients with active tuberculosis should<br>
be<br>treated initially with isoniazid, rifampin, pyrazinamide, and ethambutol<br>for<br>eight weeks, followed by 18 weeks of treatment with isoniazid and<br>rifampin<br>if needed. Repeat cultures should be performed after the initial<br>
eight-week<br>treatment.<br><br>It is available online at:<br>< <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.aafp.org/afp/20051201/2225.html" target="_blank">http://www.aafp.org/afp/20051201/2225.html</a> ><br>
<br>================<br><br>Teaching guides for community health workers from Partners in Health<br>Units 11 & 12 from their "Accompagnateurs Curriculum" (a.k.a. community<br>health workers)<br><br>Unit 11: Tuberculosis<br>
< <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://model.pih.org/node/514" target="_blank">http://model.pih.org/node/514</a> ><br>Unit 12: Tuberculosis Treatment and Side Effects<br>< <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://model.pih.org/node/515" target="_blank">http://model.pih.org/node/515</a> ><br>
<br>The entire curriculum is here<br>< <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://model.pih.org/accompagnateurs_curriculum" target="_blank">http://model.pih.org/accompagnateurs_curriculum</a> ><br>
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