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Issn: 2455-7080 ISSN: 2455-7080 Contents lists available at http://www.albertscience.com ASIO Journal of Experimental Pharmacology & Clinical Research (ASIO-JEPCR) Volume 1, Issue 1, 2016, 01-07 AN OVERVIEW OF TUBERCULOSIS MANAGEMENT: MECHANISM AND THERAPEUTIC APPLICATIONS Nidhi Singh Joint Replacement Surgery Research Unit, Fortis Escort Hospital, Jaipur, Rajasthan, India ARTICLE INFO ABSTRACT Tuberculosis infections have exceptional virulence factors compared to other Review Article History pathogens and they infect host cell and persist inside phagosomes. First Received: 29 October, 2015 symptoms of active pulmonary TB can include weight loss, night sweats, fever, Accepted: 05 January, 2016 and loss of appetite etc. The infection can either go into remission or become more serious with onset of chest pain and coughing up bloody sputum. The exact Corresponding Author: symptoms of extra-pulmonary TB vary according to the site of infection in the body. The Mantoux tuberculin skin test, also called as the PPD (purified protein Nidhi Singh derivative) test, is primarily used to identify TB infection. According to their clinical utility the anti-TB drugs can be divided into, two categories; one is first Joint Replacement Surgery line, these drugs have high anti-tubercular efficiency as well as low toxicity; are Research Unit, Fortis Escort used routinely, as for examples- Rifampin (R), Isoniazid (H), Streptomycin (S), Hospital, Jaipur, Rajasthan, India Pyrazinamide (Z), Ethambutol (E) and another is second line, these drugs have either low anti-tubercular efficacy or high toxicity or both; are used in special circumstances only. There are six classes of second-line drugs likes amino Email: [email protected] glycosides, fluoro quinolones, polypeptides, thioamides, cycloserine, p-amino salicylic acid. Another group of scientists found that a newly identified protein with carboxy-esterase activity is required for the virulence of Mycobacterium tuberculosis. Preliminary treatment for tuberculosis involved eats nourishing food and have plenty of fresh air. Keywords: TB, Mantoux, symptoms, anti-TB drugs, Mechanism of Actions. © www.albertscience.com, All Right Reserved. INTRODUCTION Tuberculosis is a chronic infectious disease caused by the source of nutrient, the utilization of glycerol by M. tubercle bacillus (Mycobacterium tuberculosis) and tuberculosis is inhibited. Therefore, it’s been shown that currently, the World Health Organization estimates that glutamate, and not glucose, is actually the main source of over 13 million people globally develop active TB and nutrient for initiating growth [4]. M. tuberculosis has about 1.7 million die each year from the disease. circular chromosomes of about 4,200,000 nucleotides long. Tuberculosis most commonly affects the lungs (pulmonary The genomes contain about 4000 genes. M. tuberculosis TB). Tb can also occur outside the lungs (extra has a tough cell wall that prevents passage of nutrients pulmonary), most commonly in the central nervous, into and excreted from the cell therefore giving it the lymphatic, or in the bones and joints [1-2]. characteristic of slow growth rate. Cell envelope contains Tuberculosis infections have unique virulence factors polypeptide layer, a peptidoglycan layer and there is also a compared to most pathogens and they infect host cell and complex structure of fatty acids such as mycolic acids, cell persist inside phagosomes where there are limited wall also contains lipid complexes such as acyl glycolipids nutrients [2-4]. Mycobacterium tuberculosis is an acid fast and beneath the cell wall there are layers of arabino- bacterium, which can form acid-stable complexes when galactan and peptidoglycan. certain aryl-methane is added [4]. All species of mycobacterium have rope like structures of peptidoglycan Classification- that are arranged in such a way to give them properties of Domain-Bacteria an acid fast bacterium [4]. Most commonly used strain of Phylum- Actinobacteria M. tuberculosis is the H37Rv strain. One way to study M. Class- Actinobacteria tuberculosis in culture is to collect samples of Order-Actinomycetales mononuclear cells in peripheral blood samples from a Family-Mycobacteriaceae healthy human donor and challenge macrophages with the Genus-Mycobacterium MTC. Their acid fast property is the strongest when there Species- M. africanmum, M. bovis, M. canettii, M. microti, 1 is glycerol around. However, when glucose is the main M. tuberulosis Page dids no.: 03.2016-35559215, dids Link: http://dids.info/didslink/03.2016-24581951/ Nidhi Singh / ASIO Journal of Experimental Pharmacology & Clinical Research (ASIO-JEPCR), 2016, 1(1): 01-07 Symptoms mammalian species as well as humans; M. bovis BCG, a Early symptoms of active pulmonary TB can include variant of M. bovis and M. canettii, a pathogen that infects weight loss, night sweats, fever, and loss of appetite [1]. human [8]. M. tuberculosis first infected humans 10,000- The infection can either go into remission or become more 15,000 years ago. It has been found in early hominids serious with onset of chest pain and coughing up bloody originating in East-Africa. Therefore, studying the sputum [5]. The exact symptoms of extra-pulmonary TB population structure of the species might provide insights vary according to the site of infection in the body. about Homo sapiens’ migratory and demographic history. Transmission In 1993, the World Health Organization declared TB a TB is spread through the air from one person to another. global public health emergency. A new dimension got Microscopic droplets that contain the bacteria may be added in the 1980s due to spread of HIV with high expelled when a person who has infectious TB coughs or prevalence of tuberculosis a Mycobacterium avium sneezes. They can remain suspended in the air for several complex (MAC) infection among these patients and India hours, depending on the environment. When a person has large load of HIV infected subjects and these patients breathes in M. tuberculosis, the bacteria can settle in the are especially vulnerable to serve forms of tubercular lungs and begin to grow. From there, they can move infection [9]. While lately the increase in TB case rate through the blood to other parts of the body. Tb in other associated with HIV infection has been halted in the USA, parts of the body, such as kidney or spine, is not infectious no such trend is apparent in India. Remarkable progress [1]. has been made in the last 60 years since the introduction Risk groups of Streptomycin in 1947 for the treatment of TB and its full Anyone can get TB. However, some groups are at higher therapeutic potential could be utilized only after 1952 risk to get active TB disease. when isoniazid was produced to accompany it [9]. The People at high risk include those [6]: discovery of ethambutol was in 1961, and rifampin was in With HIV infection. 1962. In close contact with those known to be infectious The sanatorium movement for treatment of with TB. Tuberculosis With medical conditions that make the body less able Until the discovery of tubercle bacillus, TB was treated in to protect itself from disease (for example: diabetes the home and doctors prescribed a variety of treatments or people undergoing treatment with drugs that can including snake oil and wearing a beard [3]. The suppress the immune system, such as long-term use sanatorium made its first appearance in the 1850s in of corticosteroids) Germany. The idea was developed by Herman Brehmer From countries with high TB rates after he was apparently cured by living in the Himalayan Who work in or are residents of long-term care climate [10-14]. Sanatoria treatment was reserved for the facilities (nursing homes, prisons, some hospitals) middle and upper class due to the costs associated with Who are malnourished? providing the 24 hours care, surgeries, and resort type Who are alcoholics or IV drug users? activities found at these institutions. Diagnosis The Prince Albert Sanatorium was the largest and most The Mantoux tuberculin skin test, also known as the PPD modern sanatorium in Saskatchewan, it opened in 1930 at (purified protein derivative) test, is used to detect TB Prince Albert, Saskatchewan. Part of idea behind Sanatoria infection. It is performed by injecting a small amount of was patient education and educational programs taught tuberculin, a complex of purified M. tuberculosis proteins, the infected what was known about the disease, new into the skin of the arm. A positive reaction for TB only health habits and how to live with and protect others [15]. reports that a person has been infected with TB bacteria. It After treatment was completed Sanatoria was offered does not tell whether or not the person has active disease rehabilitation to assist patients in achieving a satisfactory [7]. Other tests including a chest x-ray are often seen in the economic status. Rehabilitation involved slowly apical segments of the upper lobe or in the upper segments introducing occupational therapy into the treatment of the lower lobe. Chest x-rays may be used to rule out the regimen. Preliminary treatment for tuberculosis involved possibility of pulmonary TB in a person who has a positive following two rules [16]. reaction to the tuberculin skin test and no symptoms of Absolute and utter rest of mind and body, no bath, no disease. Person suspected of having pulmonary TB will movement except to toilet once a day, no sitting up have sputum specimens examined by acid-fast bacilli except propped by pillows and semi-reclining,
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