Mycobacterium tuberculosis: Difference between revisions
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::* Initial phase | ::* Initial phase | ||
:::* Preferred regimen: [[Isoniazid]] 300 mg PO (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg PO (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g PO (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO (15 mg/kg/day), each drug daily for 8 weeks | :::* Preferred regimen: [[Isoniazid]] 300 mg PO (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg PO (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g PO (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO (15 mg/kg/day), each drug daily for 8 weeks | ||
:::* Alternative regimen: [[Isoniazid]] 300 mg/day PO for 2 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO for 2 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g/day PO for 2 weeks (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO for 2 weeks (15 mg/kg/day), followed by [[Isoniazid]] 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g/day PO twice weekly for 6 weeks {{and}} [[Ethambutol]] 1.6 g PO for 2 weeks (15 mg/kg/day) | :::* Alternative regimen (1): [[Isoniazid]] 300 mg/day PO for 2 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO for 2 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g/day PO for 2 weeks (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO for 2 weeks (15 mg/kg/day), followed by [[Isoniazid]] 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g/day PO twice weekly for 6 weeks {{and}} [[Ethambutol]] 1.6 g PO for 2 weeks (15 mg/kg/day) | ||
:::* Alternative regimen (2): [[Isoniazid]] 300 mg/day PO thrice weekly for 8 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day P.O thrice weekly for 8 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2g/day PO thrice weekly for 8 week (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO thrice weekly for 8 weeks (15 mg/kg/day) | |||
::* Continuation phase | ::* Continuation phase | ||
:::* Preferred regimen (1): [[Isoniazid]] 300 mg daily PO (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg daily PO (10 mg/kg/day) for 18 weeks | :::* Preferred regimen (1): [[Isoniazid]] 300 mg daily PO (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg daily PO (10 mg/kg/day) for 18 weeks | ||
:::* Preferred regimen (2): [[Isoniazid]] 300 mg PO twice weekly (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks | :::* Preferred regimen (2): [[Isoniazid]] 300 mg PO twice weekly (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks | ||
:::* Alternative regimen: [[Isoniazid]] 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day) | :::* Alternative regimen (1): [[Isoniazid]] 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day) | ||
:::* Alternative regimen (2): [[Isoniazid]] 300 mg/day PO thrice weekly for 18 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO thrice weekly for 18 weeks (10 mg/kg/day) | |||
==References== | ==References== | ||
Revision as of 13:48, 9 July 2015
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Tuberculosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Mycobacterium tuberculosis On the Web |
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American Roentgen Ray Society Images of Mycobacterium tuberculosis |
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Risk calculators and risk factors for Mycobacterium tuberculosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Synonyms and keywords: M. Tuberculosis
Overview
Mycobacterium tuberculosis is the bacterium responsible for tuberculosis. It is an aerobic, non-encapsulated, non-motile, acid-fast bacillus. M. tuberculosis belongs to the Mycobacterium tuberculosis complex, that also includes bacteria, such as M. bovis and M. africanum. The bacterium has a very slow rate of replication, and its genetic variations account for the different strains and the growing drug resistance. M. tuberculosis has tropism for different kinds of human cells, with preference for cells of the lung. It may infect different species, yet human beings are its frequent natural reservoir.
Taxonomy
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Cellular organisms; Bacteria; Actinobacteria; Actinobacteria; Actinobacteridae; Actinomycetales; Corynebacterineae; Mycobacteriaceae; Mycobacterium; Mycobacterium tuberculosis complex; M. tuberculosis[3]
Biology
Mycobacterium tuberculosis belongs to the Mycobacterium tuberculosis complex. This complex includes M. tuberculosis, M. bovis, M. africanum, M. canetti, and M. microti.[4]
M. tuberculosis is an obligate aerobe, non-encapsulated, non-motile, acid-fast bacillus. Slender, straight or slightly curved bacillus with rounded ends, occuring singly, in pairs or in small clumps. It does not form spores and its ideal growing environment includes tissues with high levels of oxygen. It cannot be considered gram-positive or gram-negative due to the high lipid content of the cell wall, which is impermeable to the dyes used until combined with an alcohol. On microscopic examination of sputum samples, the bacteria cannot be distinguished from other acid-fast bacteria, such as Nocardia spp.[4] M. tuberculosis has a very slow rate of replication, taking about 15 to 20 hours to divide. This characteristic, added to its ability to remain in the latent state for long periods of time, account for the long treatment duration required.[4]
Genetic variances in the M. tuberculosis genome lead to important phenotypical changes. There are many different strains of the bacteria, 6 of which have specific geographical distribution. Three strains, the Beijing family, strain W and the W-like strains, were noted to be associated with resistance to treatment drugs.[5][6]
Tropism
M. tuberculosis does not have specific tissue tropism and is capable of infecting almost all human tissues. However, M. tuberculosis strives most in tissues with high oxygen levels, hence the high rate of pulmonary tuberculosis. [4]
Natural Reservoir
Human beings are the main natural reservoir for M. tuberculosis, however, the bacteria may infect other species.[4]
Treatment
Antimicrobial regimen
- Standard Regimens for New Patients
- Adult
- Initial phase
- Preferred regimen: Isoniazid 300 mg PO (5 mg/kg/day) AND Rifampicin 600 mg PO (10 mg/kg/day) AND Pyrazinamide 2 g PO (25 mg/kg/day) AND Ethambutol 1.6 g PO (15 mg/kg/day), each drug daily for 8 weeks
- Alternative regimen (1): Isoniazid 300 mg/day PO for 2 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO for 2 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO for 2 weeks (25 mg/kg/day) AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day), followed by Isoniazid 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO twice weekly for 6 weeks AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day)
- Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 8 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day P.O thrice weekly for 8 weeks (10 mg/kg/day) AND Pyrazinamide 2g/day PO thrice weekly for 8 week (25 mg/kg/day) AND Ethambutol 1.6 g PO thrice weekly for 8 weeks (15 mg/kg/day)
- Continuation phase
- Preferred regimen (1): Isoniazid 300 mg daily PO (5 mg/kg/day) AND Rifampicin 600 mg daily PO (10 mg/kg/day) for 18 weeks
- Preferred regimen (2): Isoniazid 300 mg PO twice weekly (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks
- Alternative regimen (1): Isoniazid 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day)
- Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 18 weeks (10 mg/kg/day)
References
- ↑ "http://phil.cdc.gov/phil/details.asp". External link in
|title=(help) - ↑ "http://phil.cdc.gov/phil/details.asp". External link in
|title=(help) - ↑ "Mycobacterium tuberculosis".
- ↑ 4.0 4.1 4.2 4.3 4.4 Lawn SD, Zumla AI (2011). "Tuberculosis". Lancet. 378 (9785): 57–72. doi:10.1016/S0140-6736(10)62173-3. PMID 21420161.
- ↑ Smith NH, Hewinson RG, Kremer K, Brosch R, Gordon SV (2009). "Myths and misconceptions: the origin and evolution of Mycobacterium tuberculosis". Nat Rev Microbiol. 7 (7): 537–44. doi:10.1038/nrmicro2165. PMID 19483712.
- ↑ Gagneux S, Small PM (2007). "Global phylogeography of Mycobacterium tuberculosis and implications for tuberculosis product development". Lancet Infect Dis. 7 (5): 328–37. doi:10.1016/S1473-3099(07)70108-1. PMID 17448936.