Description:
Mycobacterium tuberculosis is a rod-shaped bacterium that can cause disseminated disease but is most frequently associated with chronic pneumonia. Transmission occurs when a contagious patient coughs, spreading the bacilli through the airborne route to a person sharing the same air space. The exposed person may acquire latent infection (sometimes abbreviated LTBI) or, depending on host factors, tuberculosis disease. Both conditions can usually be treated successfully with medications (1).
Multi-drug resistant or MDR-TB is TB resistant to at least two of the most effective drugs, isoniazid and rifampin (also called first-line drugs). XDR-TB is resistant to at least these two drugs and three of the six second-line drugs used to treat MDR-TB.
Occurrence
In many other countries, tuberculosis is much more common than in the United States, and it is an increasingly serious public health problem (2). Although MDR-TB occurs globally, it appears to be rare compared to drug-sensitive TB. XDR-TB is of particular concern among HIV-infected or other immunocompromised persons (see Maps 4-13, 4-14).
Risk for Travelers
To become infected, a person usually has to spend a relatively long time in a closed environment where the air was contaminated by a person with untreated tuberculosis who was coughing and who had numerous M. tuberculosis organisms (or tubercle bacilli) in secretions from the lungs or larynx. Infection is generally transmitted through the air; therefore, there is virtually no danger of its being spread by dishes, linens, and other items that are touched, or by most food products. However, it can be transmitted through unpasteurized milk or milk products (e.g., some cheeses) obtained from infected cattle (1). Documented sites of XDR-TB include crowded hospitals, prisons, homeless shelters, and other settings where susceptible persons come in contact with infected persons with TB disease.
Travelers who anticipate possible prolonged exposure to tuberculosis (e.g., those who could be expected to come in contact routinely with hospital, prison, or homeless shelter populations) should be advised to have a tuberculin skin test or QuantiFERON TB-Gold test (QFT-G) before leaving the United States (1,3). If the result is negative, they should have a repeat test approximately 8-10 weeks after returning (4,5). Because persons with HIV infection are more likely to have an impaired response to the test, travelers should be advised to inform their physicians about their HIV status. Except for travelers with impaired immunity, travelers who have already been infected are unlikely to be reinfected (1).
Travelers who anticipate repeated travel with possible prolonged exposure or an extended stay over a period of years in an endemic country should be advised to have a baseline two-step tuberculin test or a single-step QFT-G (4). If the baseline test is negative, annual screening would identify recent infection, which should prompt medical evaluation to exclude disease and treatment for latent infection.
CDC and state and local health departments have published the results of six investigations of possible tuberculosis transmission on commercial aircraft. In these six instances, a passenger or a member of a flight crew traveled on commercial airplanes while contagious with tuberculosis. In all six instances, the airlines were unaware that the passengers or crew members had tuberculosis. In two of the instances, CDC concluded that tuberculosis was probably transmitted to others on the airplane. The findings suggested that the risk of tuberculosis transmission from an infectious person to others on an airplane was greater on long flights (8 hours or more). The risk of exposure to tuberculosis was higher for passengers and flight crew members sitting or working near an infectious person because they were more likely to inhale droplets containing M. tuberculosis bacteria (6).
Based on these studies and findings, WHO issued recommendations to prevent the transmission of tuberculosis in aircraft and to guide potential investigations. The risk of tuberculosis transmission on an airplane does not appear to be greater than in any other enclosed space. To prevent the possibility of exposure to tuberculosis on airplanes, CDC and WHO recommend that persons known to have infectious tuberculosis travel by private transportation (that is, not by commercial airplanes or other commercial carriers), if travel is required. CDC and WHO have issued guidelines for notifying passengers who might have been exposed to tuberculosis aboard airplanes (6). Passengers concerned about possible exposure to tuberculosis should be advised to see their primary health-care provider for evaluation.
read more http://wwwn.cdc.gov/travel/yellowBookCh4-TB.aspx
Tuesday, May 13, 2008
Prevention of Specific Infectious Diseases
The Power of Positive Reinforcement
When you're faced with a challenge, a little positive self-talk goes a long way. Learn how to find your own success mantra.
Studies back up the benefits of positive self-talk: Research suggests that consistently replacing negative thoughts with optimistic ones may improve your outlook, reduce stress and lift your self-esteem. Here's how to come up with a motivating personal mantra you can rely on again and again:
1. First, envision your ideal life, then come up with an encouraging phrase that makes it sound as if what you desire is already a reality. Instead of "I hope tomorrow is better," try "I believe that tomorrow will be a better day."
2. Repeat your mantra whenever you start to badmouth yourself ("I'm such a loser!"). You'll retrain your brain to focus on the positive, not the negative. Share your successful mantras on our Happiness forum.
3. Can't think of a mantra that doesn't make you feel silly? Try one of these:
"I choose to love and appreciate myself and others."
"I am grateful for the good and wonder in my life."
"I can make healthy choices and be the architect of my future."
"I forgive my flaws and celebrate my strengths."
Source: http://health.yahoo.com/
Treatment of Tuberculosis
The recommendations in this document are intended to guide the treatment of tuberculosis in settings where mycobacterial cultures, drug susceptibility testing, radiographic facilities, and second-line drugs are routinely available. In areas where these resources are not available, the recommendations provided by the World Health Organization, the International Union against Tuberculosis, or national tuberculosis control programs should be followed.
What's New In This Document
* The responsibility for successful treatment is clearly assigned to the public health program or private provider, not to the patient.
* It is strongly recommended that the initial treatment strategy utilize patient-centered case management with an adherence plan that emphasizes direct observation of therapy.
* Recommended treatment regimens are rated according to the strength of the evidence supporting their use. Where possible, other interventions are also rated.
* Emphasis is placed on the importance of obtaining sputum cultures at the time of completion of the initial phase of treatment in order to identify patients at increased risk of relapse.
* Extended treatment is recommended for patients with drug-susceptible pulmonary tuberculosis who have cavitation noted on the initial chest film and who have positive sputum cultures at the time 2 months of treatment is completed.
* The roles of rifabutin, rifapentine, and the fluoroquinolones are discussed and a regimen with rifapentine in a once-a-week continuation phase for selected patients is described.
* Practical aspects of therapy, including drug administration, use of fixed-dose combination preparations, monitoring and management of adverse effects, and drug interactions are discussed.
* Treatment completion is defined by number of doses ingested, as well as the duration of treatment administration.
* Special treatment situations, including human immunodeficiency virus infection, tuberculosis in children, extrapulmonary tuberculosis, culture-negative tuberculosis, pregnancy and breastfeeding, hepatic disease and renal disease are discussed in detail.
* The management of tuberculosis caused by drug-resistant organisms is updated.
* These recommendations are compared with those of the WHO and the IUATLD and the DOTS strategy is described.
* The current status of research to improve treatment is reviewed.
read more http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm
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