Professional Documents
Culture Documents
TB DD
TB DD
2 ()
2 ()
ISBN :
2539 8,200
() 2543 5,000
974-663-404-6
..
.
.
.
..
..
.
.
.
..
.
..
..
.
.
..
.
..
.
.
..
..
.
..
..
14-15 .. 2539
2 23
2542 (N.T.P.)
(DOTS)
,
40
.. 2534
.. 2541
1,900
7-8
2-3
95
.. 2535
.. 2536
.. 2510-2511
.. 2534
10
75,000-100,000
50-60
2.53
.. 2539-2541
.. 2534
Mycobacterium
tuberculosis
10
2-3
2
1)
3
2)
3)
3.1
Ziehl Neelsen
3
2 2
4o . 1
3.2
4)
5)
Polymerase chain reaction (PCR), Ligase chain
reaction (LCR), Transcription mediated
amplification (TMA)
PCR
Adenosine
deaminase activity
(Regimen)
(Regimen),
1)
1.1
1
1.2
2
2)
2.1
3
2.2
Robert Koch
.. 2425
.. 2487 A. Waksman
.. 2487 .. 2489 J. Lehman
,
.. 2495
.. 2515
(American
Thoracic Society .. 2537)
(British Thoracic Society .. 2540)
(WHO Tuberculosis Unit .. 2540)
International Union Against Tuberculosis and Lung
Disease (IUATLD .. 2540)
100%
50
()
35
50-70
1)
2) TB Registered book ( 1 .04) /
/
2 , 7
3)
4)
2
3 4 (Fixed-dose combination)
Bioavailability
5)
/
6)
(
)
7)
8)
(Fully supervised therapy)
(Directly
observed treatment short course-DOTS)
1)
2)
( 1)
10(8-12)
./.
10(8-12)
./.
50 .
1 /
< 50 .
0.75 /
20-30
././
15(12-18)
././
15(12-18)
./.
25(20-30)
././
35(30-40)
./.
15-25
././
15(15-20)
././
30(25-30)
./.
300 ./
Rifampicin (R)
50 .
600 ./
< 50 .
450 ./
Streptomycin (S)
Ethambutol (E)
5(4-6)
././
10(8-12)
././
Isoniazid (H)
Pyrazinamide (Z)
3
()
** : . =
. =
( 2)
10
2 ()
1) Thiacetazone
2) Amikacin
3) Kanamycin
4) Ofloxacin
5) Levofloxacin
6) Ciprofloxacin
7) PAS
8) Cycloserine
** : . =
150 ./
15 ././
15 ././
400-600 ./
400-600 ./
750-1000 ./
8-12 /
500-750 ./
. =
DOTS (Directly
Observed Treatment, Short Course)
Fully supervised therapy
DOT=Directly Observed Treatment
DOTS (Directly Observed Treatment, Short Course)
4 (Strong
Commitment) ,
,
DOTS
100
1. DOTS
1.1
1.2
DOTS
(smear positive)
2. Observers (accountability) ,
(accessibility)
(acceptance)
2.1
11
DOTS ()
-
DOTS
DOTS
-
2.2 .
2.3
DOTS
DOTS
2.2
2.3 DOTS
3. DOTS
3.1
3.2
3.3
3.4
4.
4.1 DOTS
(
DOTS
)
4.2
DOTS
4.3
Observer
( Observer )
DOTS
DOTS
- Observer
- Observer 2.2
2.3
DOTS
4.4 packet blister
pack 2 , 3 ,
4 (Fixed-dose combination)
(DOTS card) treatment card
12
()
Observer
4.5
4.6
Observer
DOTS
DOTS
4.7
5. DOTS
5.1 check list DOTS card
5.2
5.3 cohort analysis
DOTS DOTS WITH A
SMILE (S=supervised, M=medication, I=in,
L=loving, E=environment)
1.
( 1 )
2
(intensive
phase)
(maintenance phase)
(relapse)
1.1
1.1.1) 6
2HRZE(S)/4HR 2HRZE(S)/4H3R3
1.1.2) 8
2HRZE(S)/6HE
1.1.3) 9
2HRE/7HR
:
1) 6
4
INH
2HRE/7HR
2)
Directly
observed treatment, short coutse (DOTS)
3) 3
4) 2
DOTS
5)
6)
7)
Rifampicin
13
2-3 (Fixed-dose
combination)
Bioavailability
1.2
1.2.1 new smear-positive
pulmonary tuberculosis 6
1.2.2
(smear negative)
10 .. 6
2HRZ/4HR
2.
(Retreatment)
2.3 Default
2
relapse, default
treatment failure
1.
(Relapse)
2.
(Default)
(MDRTB) RMP
2HRZES/1HRZE/5HRE
1.1.1 1.1.2
DOTS
3 (
2)
12
DOTS
1)
()
14
3
2
(conversion
rate) 5
(cure rate)
2
2)
3) 2
7
1)
2)
3)
9-12
INH rifampicin ethambutol 3
streptomycin
pyrazinamide
15
B6 10 ./
haemodialysis
streptomycin
ethambutol
creatinine clearance
1)
2)
2.1 SGOT SGPT
3 2HRE(S)7HR
9
2.2 SGOT SGPT
3 2HES/ 16HE
3) acute hepatitis
jaundice streptomycin ethambutol
jaundice INH
rifampicin active
tuberculosis
quinolone ( ofloxacin)
streptomycin ethambutol 2-3
ofloxacin, streptomycin
ethambutol
SGOT SGPT 2
:
bilirubin, SGOT, SGPT
1) Cutaneous lesion
antihistamine
(maculopapular rash)
challenge 1 1
INH , , 1, 2, 3
ethambutol 2
rifampicin 3
2) Severe skin lesion Stevens Johnson
Syndrome Exfoliative dermatitis
challenge
INH, ethambutol streptomycin
1
16
3) Hepatitis
3.1 Fulminant hepatitis
Streptomycin,
ethambutol ofloxacin
3.2 Non-fulminant hepatitis
rifampicin pyrzinamide
jaundice liver function test
SGOT SGPT 3
INH, ethambutol
streptomycin INH, rifampicin
ethambutol challenge INH
rifampicin
:
jaundice
1.2 MDR-TB
1.2.1
3-4
18-24
1
1.2.2 (surgical resection)
localized disease
(sputum conversion)
:
-
- 3-4
1 3
4-6
-
- DOTS
typical tuberculosis
(extrapulmonary
tuberculosis)
17
(cavity)
2HRZE/4HR
rifampicin ()
protease inhibitors (PI)
non-nucleoside reverse transcriptase inhibitor
(NNRTI) rifampicin
PI NNRTI
1.
NRTI PI
2.
PI NNRTI
3.
PI NNRTI
PI
NNRTI
2SHZE/7S3H3Z3 2HSE/16HE 2HZE/16HE
( rifampicin)
INH chemoprophylaxis
INH
INH
INH TB
Clinic
INH
INH
DOPT=(Directly Observed Preventive
Therapy) INH
5
INH 300
6-12
(Tuberculosis in Children)
18
(cavity)
ethambutol
1. 1.1
2
1.1
1.2 10 . (
5 .)
15 .)
1.3
military
1.4
1.5
2.
definite diagnosis
10-20
(new laboratory techniques)
antigen, antibody, radiometric assay,
polymerase chain reaction
1)
50
2) (Extrapulmonary
Tuberculosis)
(increased intracranial
pressure)
19
sterile abscess
hematuria, sterile pyuria
miliary
intermittent regimen
ethambutol
15 ././
Directly observed therapy, short course (DOTS)
Intensive short course chemotherapy 3
regimens
1. 3 2HRZ/4HR
cavity
2. 4 2HRZS(E)/4HR
cavity
extensive lesion
, miliary,
, , ,
HIV
3. relapse, treatment failure
drug resistant disease
source case
1-2
80 3
90 4 1012 6
2-3
steroid
95% Relapse 1%
20
1.
1,200
50
64
78
primary,
reactivation exogenous TB
cellwall antigen recombinant
technology
100
HIV infection
HIV
high prevalence
( 40/100,000 )
.. 2535 83/100,000
2.
(Chemoprophylaxis)
.. 2524-2528
5
12.5
.. 2539-2540
9
2.1)
INH 5 ././ 6
5 (
)
5
15 .
5 .
HIV
5 . ( 1 )
INH 3
< 5 .
>
5 .
6
21
2.2)
(>10 .
>15 . ) INH
5 ././ 6
< 5
steroid immunosuppressive drugs
HIV ( > 5 .)
2 (recent converter)
old fibrotic lesion
22
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
23
14. .
:
.
2530 ; 2 : 55-63
15. Pharaoh PD, Watson JM, Sen S. Selective on
universal neonatal BCG immunization ; what
policy for a district with a high incidence of
tuberculosis? Public Health 1996 ; 119 : 179-83
16. MJ Bannon, BCG and tuberculosis. Arch Dis
Child 1999 ; 80 : 80
17. , ,
.
2526 ; 4 : 7-14
24
2121644
5803423
.. 4197062-3
2794420