Life Without Tuberculosis

Pulmonary Tuberculosis is transmit by Aerosol droplets nuclei. Pulmonary tuberculosis is an airborne disease. The mechanism of the disease or pathogenesis was started with the bacilli Mycobacterium tuberculosis enter, and live in the alveoli macrophages. Depend on the immunity ,the bacilli may increase growth and multiply and induce the immune response increase or blow up. These imbalance immune response destruct pulmonary tissue till necrosis, and rupture bronchi, ending with the manifestation of the pulmonary tuberculosis. Base on this pulmonary Tuberculosis pathogenesis, the principle to protect from this disease are:

1. All of the pulmonary tuberculosis patients must be threat with adequate-therapy e.g. standard anti tuberculosis drugs in complete regimens, 6 – 8 months period.
2. All of the people with tuberculosis suspect must be diagnose with base on laboratory result and immediately threat properly. The pulmonary tuberculosis suspect e.g. purulent producing cough more than 3 weeks; fever or sweat in the night; nausea and decreasing body weight.
3. Hygiene sanitation of the environment must be hold to release aerosol droplets nuclei. The living house with enough ultraviolet shines from the sun. The ventilation of the room is the best. The room is dry, not moist.
4. The immunity must be care in the optimal condition, intake the best nutrition e.g. contain optimal protein, carbohydrate, lipid ,vitamin, and mineral; decreasing physic and psyche stressor with optimal resting time.

I hope this healthy ways can protect our life from pulmonary Tuberculosis. God bless you.

Written by Prof.Dr.Ni Made Mertaniasih.dr.Sp.MK.

Comparison TB and HIV by WHO

Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.

In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to “wall off” the bacteria. The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is treatable with a six-month course of antibiotics.

Tuberculosis is an airborne infectious disease that is preventable and curable. People ill with TB bacteria in their lungs can infect others when they cough. An estimated 1.5 million people died from TB in 2006. In addition, another 200,000 people with HIV died from HIV-associated TB. If TB disease is detected early and fully treated, people with the disease quickly become non-infectious and eventually cured. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), HIV-associated TB, and weak health systems are major challenges.

WHO is working to dramatically reduce the burden of TB, and halve TB deaths and prevalence by 2015, through its Stop TB Strategy and supporting the Global Plan to Stop TB.

Article from World Health Organization

Tuberculosis Reported Cases In 2008

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Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006, of which 0.7 million cases and 0.2 million deaths were in HIV-positive people. Population growth has boosted these numbers compared with those reported by the World Health Organization (WHO) for previous years. More positively, and reinforcing a finding first reported in 2007, the number of new cases per capita appears to have been falling globally since 2003, and in all six WHO regions except the European Region where rates are approximately stable. If this trend is sustained, Millennium Development Goal 6, to have halted and begun to reverse the incidence of TB, will be achieved well before the target date of 2015. Four regions are also on track to halve prevalence and death rates by 2015 compared with 1990 levels, in line with targets set by the Stop TB Partnership. Africa and Europe are not on track to reach these targets, following large increases in the incidence of TB during the 1990s. At current rates of progress these regions will prevent the targets being achieved globally.

The Stop TB Strategy is WHO’s recommended approach to reducing the burden of TB in line with global targets. The Global Plan of the Stop TB Partnership details the scale at which the six components of the strategy should be implemented if the global targets are to be achieved. To date, progress has been mixed. The first component of the strategy – the detection and treatment of new cases in DOTS programmes – fares best. Globally, the rate of case detection for new smear-positive cases reached 61% in 2006 (compared with the target of at least 70%) and the treatment success rate improved to 84.7% in 2005, just below the target of 85%. Progress in the implementation and planning of other parts of the strategy ranges from major – with provision of TB/HIV interventions for TB patients in the African Region – to minor – with a need for improved guidance on advocacy, communication and social mobilization (ACSM) activities, and more ambitious planning for treatment of patients with multidrug-resistant TB (MDR-TB), in the European, South-East Asia and Western Pacific regions.

Available funding for TB control in 2008 peaked at US$ 3.3 billion across 90 countries (with 91% of global cases) that reported data, up from less than US$ 1 billion in 2002. Nonetheless, these same countries reported funding gaps totalling US$ 385 million in 2008; only five of the 22 high-burden countries reported no funding gap. The gap between the funding reported to be available by countries and the funding requirements estimated to be needed for the same countries in the Global Plan is larger still: US$ 1 billion. This is mainly due to the higher funding requirements for collaborative TB/HIV activities, management of MDR-TB and ACSM in the Global Plan, compared with country reports.

Progress in case detection slowed globally in 2006 and began to stall in China and India. The detection rate in the African Region remains low in absolute terms. Budgets stagnated between 2007 and 2008 in all but five of the 22 high-burden countries. Incidence rates are falling slowly compared with the 5–10% decline annually that is theoretically feasible. Renewed effort to accelerate progress in global TB control in line with the expectations of the Global Plan, supported by intensified resource mobilization from domestic and donor sources, is needed.

Reported by WHO

Tuberculosis Attack Asia and Africa

Tuberculosis is a common and often deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis.Tuberculosis usually attacks the lungs but can also affect the central nervous system,the lymphatic system,etc.Now almost every country in Asia and Africa infected by it.This the example video about Tuberculosis disease in India.

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The Role Of TB Cadre Institution

Action research purpose was,to increase the coverage of the passive case finding of the lung tuberculosis suspect in the community,throught increasing the knowledge and participation the people or "Posyandu cadres in 10 villages of Mojoagung subdistric".

Action research was conducted to revitalize the Posyandu function and to train the cadres using nominal focus group discussion technique,ZOPP method.34 cadres from 10 Posyandu of the 10 villages,guilding by the facilitation to create to problem and the dicision free model related to tuberculosispassive case finding problem,developed working groups and setting the planning and organizing their own programs.

The Objective of the program are "be able to early detection of the lung Tuberculosis suspect,to increase and to motivate the suspects for coming to health center for sputum examination,subsequently with managing and treatment its problem.

To reach the objective,in the first step in this research;established working groups among cadres;namely "The cadres supporting lung tuberculosis control" in the future,the second step of the research would continue to guide and supervise the working groupthrought measuring,monitoring and evaluate their activity by using carel method : That is to measure capacity,accesibility,readiness,expansion and leverage.Succesfull outcome parameter is improvement Tuberculosis passive case finding in Mojoagung health care.Expectedoutcome that there was important to expand od these action to the other widely areas.

Written by Prof.Dr.Ni Made Mertaniasih. dr.MS.Sp.MK

Andrographolide Kill Mycrobacterium Tuberculosis

 Phatogenesis of tuberculosis based on the immunopathologic,as defect control immune response to M.tuberculosis infection.Interaction of macrophage with M.tuberculosis is the central to all stages of tuberculosis.Therefore the immunomodulator may have an important role in the intracellular killing activation of macrophages.

The aim of this research to prove the effect of andrographolide (AND1)- Sambiloto (Andrographis paniculata) on the macrophages intracellular killing activation to M.tuberculosis infection in vitro.Experiment study,one group of the macrophages culture from pheripheral blood of tuberculosis patients and healthy people with AND1 treatment are infected by M.tuberculosis ,to proveon intracellular killing activation effect of the macrophages;compare with control group wiyhout treatment.The macrophages intracellular killing measure by CFU (Colony Forming Unit) per ml.

Using T-test and ANOVA analysis showed that among tuberculosis patients macrophage cultures, pre and post AND1 treatment were significant different (p=0,00),there were after treatment decreasing of CFU/ml at 7 days incubation;on the other hands,among immunized healthy individuals macrophages culture ,pre and post treatment have CFU/ml significant difference at 72 hours and 72 days incubation (p=0,00 and p=0,001).

The result demonstrate that macrophages intracellular killing activation to M.tuberculosis with AND1 more effective than without AND1.Therefore the immunomodulator finding may important on tuberculosis therapy development.

Written by Prof.Dr.Ni Made Mertaniasih. dr.MS.Sp.MK

Mycrobacterium Tuberculosis Detected by PCR-SSCP

One Hundred-eighty Mycrobacterium tuberculosis isolates from sputum of pulmonary tuberculosis patients in Surabaya were examined to detect rifampicin resistance using the Polymerase Chain Reaction-Single Strand Conformation Polymorphism (PCR-SSCP) and the culture standart proportion method.

Chromosomal DNA of Mycrobacterium tuberculosis were extracted by sonication and boiling from mycobacterial suspensions as the simplified technique.The extracted DNA were used as a template and the specificprimers falnking the rpo B gene region as a locus of rifapicin risitance were amplified by PCR.The identification of nucleotide mutations by SSCP analysis of the amplification products were determined by DNA migration patterns which are different from that control strain M.tuberculosis H37rv due to the conformational variability of single-stranded DNA,and the DNA migration patterns were visualized by silver straining.

The result of the PCR-SSCP analysis were concordant with the rifampicin resistance detection by the culture standart proportion method.There is no significance difference between the result of these techniques, by the Mc Nemar test (p=0,6873).The Polymerase Chain Reaction - Single Strand Conformation Polymorphism technique had the sensitivity of 84.61% for rifampicin resistance detection ,the specificity was 98.70%.The detection of mutation in the rpo B gene region of M.tuberculosis by PCR-SSCP would be used to determine rifampicin resistance.The simple technique would reduce the time required for resistance testing from approximately 4 to 10 weeks to 48 to 72 hours.The rapid detection technique allowed multiple samples to be processed safely and effeectively for routine use at the referal laboratory.

Written by Prof.Dr.Ni Made Mertaniasih. dr.MS.Sp.MK

Ziehl Neelsen Method and Kinyoun Method

The objective of this research want to know the validity of microscopic acid fast bacilli detection using Ziehl Neelsen methode that compare to Kinyoun methode.The sensitivityand specivity of Ziehl Neelsen and Kinyoun methode compare to convensional culture standart as a gold standart.This laboratory observasional research has done 120 sputum samples from tuberculosis patients in DR.Soetomo Hospital in Surabaya,during June 2003 up to October 2003.The result of validity test a Ziehl Neelsen sensitivity 81.81% ,Kinyoun 84.9% ,and specitivity of Ziehl Neelsen and Kinyoun is the same 84.37%.

Written by Prof.Dr.Ni Made Mertaniasih. dr.MS.Sp.MK

Antimicrobial Activities Of Andrographolide Paniculata and Propolis

In the present study we investigated the co-stimulant action of Andrographolide paniculata and propolis associated with bactericidal activity on macrophages.Incubation of monocytes derived macrophages of healthy participants with the extract of A.Paniculata and propolis activited bactericidal activity against intracellular Mycrobacterium tuberculosis ,but no significant effect on the macrophages of tuberculosis patient.These findings suggest that andrographolide and propolis may have a limited effect on bactericidal activity in tuberculosis patient.

Written by Prof.Dr.Ni Made Mertaniasih. dr.MS.Sp.MK