结核病有效诊断，治疗和控制英文.pptVIP

World Health Report, 1999 Effective Diagnosis, Treatment, and Control of Tuberculosis World Health Organization Regional Office for South-East Asia New Delhi South-East Asia accounts for nearly40% of all tuberculosis cases TB is the leading single infectious cause of death in South-East Asia TB is a Leading Killer of Women Tuberculosis A Global Emergency TB kills 5,000 people a day – 2-3 million each year One third of the world’s population is infected with TB TB kills more young women than any other disease More than 100,000 children will die needlessly from TB this year Hundreds of thousands of children will become TB orphans this year TB and AIDS Diagnosis of Pulmonary Tuberculosis Three specimens optimal Spot specimen on first visit; sputum container given to patient Early morning collection by patient on next day Spot specimen during second visit Reporting on AFB Microscopy Role of Chest X-ray No chest X-ray pattern is absolutely typical of TB 10-15% of culture-positive TB patients not diagnosed by X-ray 40% of patients diagnosed as having TB on the basis of x-ray alone do not have active TB Prompt treatment of infectious cases reduces spread of tuberculosis Smear-positive patients usually seek care Smear-positive patients are 4-20 times more infectious Untreated, a smear-positive patient may infect 10-15 persons/year Smear-positive patients are much more likely to die if untreated Treatment Categories Recommended treatment regimens Doses of first-line anti-TB drugs Role of Isoniazid Mainstay of anti-TB treatment Life saving in TB meningitis Bactericidal for rapidly dividing organisms Prevents emergence of resistance to other drugs Intermittent treatment more effective than daily treatment in animal model and equally effective in clinical trials Safe and effective for preventive treatment Role of Rifampicin Necessary for short-course treatment Essential for at least first 2 months of regimens of 6-9 month duration Bactericidal for rapidly dividing a