Transcript Extensively Resisitant Tuberculosis

The Edgar Laurent Foundation
Established on the 31th December 1951
Sir Edgar Laurent
Sir Edgar Laurent - Biography
 Born in 1885 at Cluny Grand Port
 Brilliant Studies at Royal College Curepipe
 Started Theological studies at Ahmedabad, India
 Changed his mind quickly and went to Paris,
France for Medical Studies
Sir Edgar Laurent - Biography
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Came back in 1914 and started his medical practice at 58,
Desforges Street and stayed there far more than 50 years.
Went into Politics in 1915, has been several times mayor
of Port-louis and member of the legislative Council. He
retired from Politics in 1946
In 1950, he received ‘La Legion d’Honneur from the
French government and in 1951 was Knighted by the
British government.
Sir Edgar Laurent - Biography
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In his last years, he retired completely from public life and
devoted himself to the practice of Medicine. He also
became a Devout Anglican.
Apart from the creation of the Tuberculosis foundation, Sir
Edgar helped in the setting up of the St.Andrews College,
the Clinique Mauricienne and the Esplanade at of Marie
Reine de la paix.
He Died on the 16th of July 1968 at the age of 83 in his still
existing house at Brown Sequard St, Port-Louis (another
famous Mauritian Medical pratitioner.
The Objectives of the Foundation
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To further prevention and control of tuberculosis and the
treatment, after-care and rehabilitation of the Tuberculous
patient
To improve the environmental conditions which favour the
development and spread of tuberculosis
To help to set up and maintain an organisation of
voluntary welfare workers to assist the government
Medical and welfare services to fight against tuberculosis.
Who are the members?
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For the purpose of managing the foundation and
exercising any of the powers vested in the foundation by
the provisions of this Ordinance, there was established a
board which consisted of 6 members.
Nowadays, the board of trustees consists of the following
members:
 Chairman
 Consultant in charge – chest disease
 P.M.O curative
 2 other members
NEW ASPECTS OF TUBERCULOSIS
Dr.R.Donat
Are you breathing ?
Then you can get tuberculosis – a
disease that kills 5000 people
everyday – nearly 2 million last year.
Global Status of TB
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Tuberculosis (TB) kills 1.6 million people a year
 0.2 million people infected with HIV
 98% of these deaths occur in the developing world.
Close to 9 million new cases develop every year and
about one third of the world’s population is infected with
Mycobacterium tuberculosis.
 TB is a major cause of death among people with
HIV/AIDS and infection is the most potent risk factor for
the conversion of latent TB infection to active TB.
Global status of TB
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Multidrug-resistant TB (MDR-TB) has emerged in nearly
every country of the world. Extensively drug-resistant
TB (XDR-TB) has been identified in 17 countries and in
all geographical regions.
While the TB incidence rate is stable or in decline in all
six WHO regions, and has reached a peak worldwide,
the total number of new TB cases is still rising slowly as
the case load continues to grow in the African, Eastern
Mediterranean and South-East Asia regions.
Global status of TB
TB is the second leading infectious cause of death in
the world, after the HIV
 In 1997, 8 million new cases of TB & RATE OF
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136 / 100,000
3 million deaths per year
< 40% of cases are reported to WHO
24 % of all preventable life-years lost annually
due to TB
Cont’d…
80 % of all cases worldwide occur in S S Africa and
SE Asia
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Biggest burden in SE Asia
3 million TB cases / YR in SE Asia
3 million/YR occur in S S Africa
> ¼ million cases / YR in East Europe
Case and deaths increasing in former Soviet
Union
The burden of illness
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Usually 1 in 10 people infected by TB bacteria
will ever fall ill with the disease. But you are
at greater risk if you are poor, malnourished
or burdened with other illnesses. If you fall ill,
early diagnosis and treatment is critical.
Without treatment, there is more than a 50%
chance TB will kill you
Prevalence Rate
Development lagging behind…WHY?
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Today’s first-line anti-TB medicines are more than 40
years old and must be taken for 6-9 months. Erratic or
inconsistent treatment generates drug resistance.
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Today’s most commonly used diagnostic tool, the light
microscope, is more than 100 years old and is relatively
insensitive (particularly in the presence of HIV co
infection), giving no indication of drug susceptibility.
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Today’s vaccine, bacilli Calmette-Guerin (BCG), is more
than 85 years old and provides acceptable protection only
against disseminated forms of disease in infants and little,
if any, protection beyond childhood.
Tuberculosis- The Basics
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TB is caused by an organism called Mycobacterium
Tuberculosis
TB is spread from person to person through the air
Transmission is the spread of an organism, such as
M.tuberculosis, from one person to another
 Not everyone who is exposed to an infectious TB
patient becomes infected.
Tuberculosis - The Basics (continued)
 Infection begins when TB organisms in the
droplet nuclei reach the small air sacs of the lung
called alveoli
 TB infection means that tubercle bacilli are in the
body but the immune system is keeping them
under control
 People who have TB infection but not TB disease
are NOT infectious
What factors affect the infectiousness of a TB patient?
 The infectiousness of a TB patient is directly
related to the number of tubercle bacilli that he or
she expels into the air
 Usually, only people with pulmonary or laryngeal
TB are infectious
 Patients who have a cavity in the lung may be
expelling tubercle bacilli if they are coughing
 Patients expel more tubercle bacilli if they have a
cough that produces a lot of sputum
What factors affect the infectiousness of a TB patient?
 Patients who do not cover their mouths when
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they cough are more likely to expel tubercle
bacilli
The presence of tubercle bacilli on a sputum
smear indicates that the patient may be expelling
tubercle bacilli
Patients who have not been receiving adequate
treatment are much more likely to be infectious
than patients who have been receiving adequate
treatment
Infectiousness appears to decline very rapidly
after adequate treatment is started, but how
quickly it declines varies from patient to patient
Bactèriologie
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Phénomène de résistance
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Les examens – Direct – ZN- Détection des bacilles AcidoAlcoolo Résistants
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Culture- Antibiogramme
I.
Lowenstein – Jensen- Milieu solide lecture aprés 4 – 6
semaines
II.
Middlebrook- Milieu gélosé- lecture aprés 3 semaines
III. Bactec- Milieu liquide- Méthode radioactive- lecture ā partir
de 8 jours
IV. PCR- Méthode Génétique- amplification géonomique- lecture
24-48 heures
Drug Resistance
 Résistance Secondaire ou Acquise
 Traitement Inadéquat
 Résistance Primaire
 Contamination par un porteur de bacilles
résistants
 Résistance Naturelle
Phenomene Fall & Rise
108
Bacilles
Bacilles
sensibles
résistants
106
104
100
4
Traitement par
INH seul
8
12
16
18
24
Semaines de
traitement
Is TB curable ?
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Yes, through the cost effective Tb control
strategy known as DOTS. Drugs for a six
month course of treatment under DOTS costs
as little as USD 10. DOTS saves lives and
also prevent the disease from spreading.
Treatment
(1)Les médicaments antituberculeux Majeurs
On associe toujours au moins 3 anti TB
(2)Les médicaments anti-tuberculeux mineures
 Ethionamide
 Prothionamide
 Kanamycine
 Cycloxerine
 Capreomycine
 Viomycine
 PAS
 Thiacetazone
 Fluoroquinolones
 MDR TB
 XDR TB
What is MDRTB?
 Multi-drug resistant TB, usually called MDRTB, is
TB that is resistant to at least the two most
important anti-TB drugs, isoniazid and rifampicin.
This means those two drugs do not effectively
treat the TB disease.
What is XDRTB?
Extensively drug resistance TB is TB that is
resistant to the two most important anti-TB drugs,
isoniazid and rifampicin + resistance to an
injectable aminoglycoside + esistance to a
Fluoroquinolone
Why is MDRTB a problem?
 Because the two most important anti-TB drugs
are not effective in treating MDR-TB, treatment
requires drugs which are more toxic, more
expensive, take longer to work and that do not
work as well (called “second line” drugs). Also,
these second line drugs are not widely available
in resource-limited settings.
MDR TB – some figures
 Taux de mortalité de 40%
 Résistance aquise ā l’INH et RMP- 2 anti TB Majeurs
 Résultat de Traitement mal conçus, mal surveillés,
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mal suivis
Pays ā forte prévalence- Chine, Estonie, Iran- 35%
France 6 %
Hollande 1 %
 Médiane mondiale 9 %
 Risque d’épidémie en millieu hospitalier carcéral
 TT utilisés- 5 Anti TB pendant au moins 18 mois
What causes MDRTB?
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MDRTB is the result from poor anti-TB treatment
adherence or by incorrect treatment.
If the wrong drugs or the wrong combinations of drugs
are prescribed, or providers fail to ensure that they are
taken correctly on schedule, the bacteria causing TB
may develop resistance to the drugs.
When this happens, the patient who initially had nonresistant TB develops drug-resistant TB. If the patient
who has MDRTB spreads TB to others, they will have
MDRTB as well.
How is MDRTB prevented?
 MDRTB is a condition that can be prevented by following the
international TB control strategy called DOTS, which stands for
Directly Observed Treatment, Short-course.
 Health care providers should always adhere to the National
Tuberculosis Program Guidelines and use only the
recommended anti-TB treatment regiments, drug combinations
and drug dosages.Anti-TB drugs, preferably Fixed Dose
Combinations of high quality should be available in regular and
sufficient quantities.
 Adherence to anti-TB treatment must be ensured with support,
encouragement and monitoring of adherence by a relative,
community volunteer, or a clinic nurse.
How do we know if a patient has MDRTB?
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The diagnosis of MDRTB can only be made in a
laboratory that can test sputum specimens for the
presence of M.tuberculosis (the TB germ isolated by
culture) and then test those TB isolates for drug
resistance.
Patients who report interrupted treatment for TB, or
failure to have symptoms improve after one to two
months of TB treatment, may have drug-resistant TB,
and should be separated from persons with HIV
infection until their condition is evaluated.
Products in the pipeline
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What is in TB pipeline?
 New anti-TB medicine
 CLINICAL TESTING
 Gatifloxacin
 Moxifloxacin
 Diamine(SQ-109)
 Nitrodihydro-imidazooxazole derivative OPC67683
 Pyrrole LL3858 (Sudoterb)
 Diarylquinoline (TMC-207)
 Nitroimidazole (PA-824)
What is in the TB pipeline?
 PRECLINICAL
 Dipiperidine (SQ-609)
 Synthase inhibitor FAS200313
 Translocase I inhibitors
 Discovery Stage
 Quinolones
 AstraZeneca Portfolio
What is in the TB pipeline (continued)
 New TB diagnostics
 REFERENCE LABORATORY
 Liquid culture system for case detection and
drug susceptibility testing (DST)
 Speciation Test
 Phage-based DST
 Manual nucleic acid amplification DST
 Automated nucleic acid amplification test DST
 Urinary nucleic acid amplification
What is in the TB pipeline?
 PERIPHERAL LABORATORY
 Same-day sputum smear microscopy
 Low-cost fluorescence microscopy
 Bleach digestion of sputum
 LED fluorescence microscopy
 First-generation isothermal nucleic acid
amplification
 HEALTH POST
 Urinary antigen detection
 Antibody detection tests
What is in the TB pipeline?
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New Anti-TB vaccines
 VIRAL VECTORED VACCINES
 MV A85A
 Aeras-402
 MODIFIED-RECOMBINANT BCG
 M72
 HyVac 4
 Hybrid-1
 BACTERIA-VECTORED VACCINES
 Aeras-X05
The call to stop TB
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Because each year nearly 2 million people die and 9
million people become sick with TB, and because TB
infects one-third of the world’s population.
Because TB is a global pandemic and an emergency in
Africa and the European region.
Because TB is the biggest killer of people with
HIV/AIDS and multi-drug resistant forms of TB are a
threat around the globe
Because TB is curable.
The Call to stop TB
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Because the Stop TB strategy is getting results
Because 14 million more lives can be saved over the
next 10 years
Because treating and curing people with tuberculosis
prevents the spread of the disease, reduces poverty,
strengthens health systems, engages all care providers
and empowers those affected.
Because new vaccines, drugs and diagnostics to stop
TB are urgently needed.
The Call to stop TB
 Because access to TB treatment is a human
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right.
Because TB can be eliminated by 2050 if we take
action now
For these 10 reasons, we commit ourselves,
through our actions, to a world free of TB.
Thank you