Tuberculosis, incidence

Dolin PJ, Raviglione MC, Kochi A. Global tuberculosis incidence and mortality during 1990-2000. Bull WHO 1994 72(2) 213-220. 

The initial phase must contain three or more of the following drugp isoniazid, rifampin, and pyrazin-amide, along with either ethambutol or streptomycin. The CDC recommends treatment to begin as soon as possible after the diagnosis of tuberculosis. The treatment recommendation regimen is for the administration of rifampin, isoniazid, and pyrazinamide for a minimum of 2 months (8 weeks), followed by rifampin and isoniazid for 4 months (16 weeks) in areas with a low incidence of tuberculosis. In areas of high incidence of tuberculosis, the CDC recommends the addition of streptomycin or ethambutol for the first 2 months. 

The application of vaccine technology forms a core element of modern medicinal endeavour. It plays a central role in both human and veterinary medicine and represents the only commonly employed prophylactic (i.e. preventative) approach undertaken to control many infectious diseases. The current (annual) global vaccine market stands at in excess of US 3 billion. Immunization programmes, particularly those undertaken on a multinational scale, have served to reduce dramatically the incidence of many killer/disabling diseases, such as smallpox, polio and tuberculosis. 

Even when a disease has been effectively treated in a conntry, retention of the disease in small isolated pockets can act as a source for future infection. This can readily occnr when movement of even a small nnmber of infected people into a population in which the immnne system is impaired can lead to the spread of this new disease to areas that were previously free of it. Chronic illness due to malnutrition can weaken the immune system which then facilitates the spread of an infection. This is a particular problem if malnutrition is accompanied by a chronic illness. Althongh malnutrition and accompanying diseases are associated with developing countries, the phenomenon also occurs in developed countries, for example, in the very poor, the homeless, drug abusers and the elderly. It is now considered to be a major factor in the increased incidence of tuberculosis in these gronps. 

The polio vaccine is administered in three doses at 1-month intervals, starting from the age of 2 months. The pertussis vaccine is given in combination v/ith the diphtheria and tetanus vaccines as a 3-in-l vaccine, the DTP vaccine. The DTP vaccine follows the schedule of the polio vaccine, so at 2 months, the DTP and the polio vaccine are given. Both are repeated at 3 months of age and at 4 months of age. In areas where the incidence of tuberculosis is not greater than 40 per 100 000, the BCG vaccine is not usually recommended for infants of 0-6 months. 

Changes in serum ALT may not aWays be indicative ofa true hepatotoxic response. Mild dose-related ALT elevations (2x to 3x ULN) are observed in some patients taking lovastatin as a result of an adaptive response [139]. As another example, isoniazid, an anti-tuberculosis agent, leads to a high incidence of ALT and AST elevations, but is tolerated chronically without severe hepatotoxicity. This suggests that more specific and sensitive biomarkers are still needed to predict serious liver injury. 

Berghoff, Sandall, Hueper.31 Gilchrist,22 Gilchrist and Matz,2 and the U.S. War Department2 all reported on this. No increased incidence of tuberculosis was found. 

Little Is known about possible long-term effects of CS Inhalation. This is due In part to the fact that short-term experiments with experimental animals, carried out for from several days to a month and using much higher (In some cases, nearly lethal) concentrations of CS, showed that ocular, respiratory, and cutaneous alte-. rations were mild and readily reversible, whereas necropsy findings failed to reveal any evidence of systemic alterations. Retrospective studies performed by the Hlmsworth committee at the request of the British Parliament after the extensive use of CS in Northern Ireland showed that no adverse effects of CS use were observed, with respect to eye burns, residual respiratory tract injury, Increased death rate in the elderly, exacerbations of mental Illness, increased Incidence of strokes or heart attacks, or incidence of tuberculosis. At exposure concentrations reported by the Hlmsworth committee (about 90 mg-min/m ), no persistent or notably adverse health effects were observed. 

About 30% of patients develop rashes with the first 1000 mg treatment this incidence decreases to about 10% with the second infusion and progressively decreases with each course of therapy thereafter. These rashes do not usually require discontinuation of therapy although urticarial or anaphylactoid reactions, of course, preclude further therapy. Immunoglobulins (particularly IgG and IgM) may decrease with repeated courses of therapy and infections can occur, although they do not seem directly associated with the decreases in immunoglobulins. Rituximab has not been associated with activation of tuberculosis, nor with the occurrence of lymphomas or other tumors (see Chapter 55). Other adverse effects, eg, cardiovascular events, are rare. 

No respiratory effects were associated with exposure to 2,3,7,8-TCDD-contaminated herbicides in a group of Vietnam Air Force veterans involved in Operation Ranch Hand examined more than 10 years after the war (Wolfe et al. 1985). In the 1987 follow-up (USAF 1991), no association was found between the initial or current serum level of 2,3,7,8-TCDD and incidences of asthma, bronchitis, pleurisy, pneumonia, or tuberculosis abnormal spirometric measurements were often associated with CDD blood levels, but according to the authors (USAF 1991), the differences in the mean level between high- and low-exposure subjects were not clinically important. The authors suggested that these findings may have been related to the association between 2,3,7,8-TCDD and body fat because obesity is known to cause a reduction in vital capacity. 

Mycobacteria (members of the Mycobacterium genus), in the diseases they cause, remain serious problems. Tuberculosis, the magnitude of whose worldwide incidence is enormous—estimated at 2.9 million deaths and 8 million new cases... 

The antipsychotic chlorpromazine is a prototype heptotoxicant for production of cholestasis. Pleiotropic effects of chlorpromazine on membrane permeability and associated ion gradients and microfilament-mediated canalicular contraction have been attributed to detergent effects. Valproic acid, an anticonvulsant, is associated with microvesicular steatosis. Inhibition of mitochondial fatty acid (S-oxidation is an important component of this toxic effect and is apparently related to carnitine availability as evidenced by the protection afforded by L-carnitine supplements. The hypolipidemic drugs clofibrate, fenofibrate, and gemfibrozil are peroxisome prolif-erators in rodent liver, but not in humans. Isoniazid, an antibiotic used to treat tuberculosis, exhibits an approximately 1 % incidence of hepatotoxicity. Although toxicity is known to be metabolism-dependent and protein adduction has been well-... 

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