mcgill tb research group
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McGill TB Research Group. Madhukar Pai, MD, PhD Associate Professor [email protected]. What is TB?. Tuberculosis is an infectious disease Patient is sick, contagious We call this ‘TB’ Mycobacterium tuberculosis is name for the bacteria that causes TB - PowerPoint PPT PresentationTRANSCRIPT
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What is TB?
• Tuberculosis is an infectious disease– Patient is sick, contagious– We call this ‘TB’
• Mycobacterium tuberculosis is name for the bacteria that causes TB
• Most infected people do not develop the disease– These people are not contagious– We call this ‘latent infection’
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Clinical manifestations of TB
• General– Fever, weight loss, weakness– “Consumption”, “Phthisis”
• Organ specific– Lungs: cough, spitting up blood– Others:
• Scrofula: swollen lymph nodes• Spine: ‘hump-back’ • Etc.
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Chest x-ray in pulmonary TB
Cavity represents collection of millions of bacteria that are transmitted by cough
TB is reason why X-rays are done with immigration
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TB disease and infection: Natural History
Infection
Infection without disease – 90%
Person with active TB
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TB disease and infection: Natural History
Infection
Progression to active TB disease - 10%
Infection without disease – 90%
Person with active TB
Preventive treatment: Isoniazid
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Global epidemiology
• Tuberculosis disease– ~9 million new cases per year– 1.5 million deaths per year• Every 15 seconds
• Latent infection– 2 billion persons infected• One person infected each second
– If 10% progress, 200 million future cases
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0 - 2425 - 4950 - 99100 - 299
No estimate300 or more
Estimated new TB cases (all forms) per 100 000 population
TB incidence per 100,000 people
Source: WHO
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0 - 9991000 - 999910 000 – 99 999100 000 - 999 999
No estimate1 000 000 or more
Estimated number of new cases (all forms)
TB cases
Source: WHO
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TB in Canada has declined to low levels, but it remains an important concern in immigrants and
Aboriginals
April 2011
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Globally, incidence rates falling after peak in 2004, but only at <1%/year
Peak in 2004
Incidence (all forms, incl. PLHIV)
TB Notifications
Incidence TB in PLHIV
shaded area = uncertainty band
Notification gap
Courtesy: WHO Stop TB Department
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http://www.worldcarecouncil.org
TB elimination is impossible with current tools
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Diagnostic tools that Robert Koch used…
Microscopy Culture Tuberculin test
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are still in use today!
• Active TB– Sputum microscopy [1882]– Mycobacterial culture [1882]– Chest X-rays [1896]
• Latent TB (LTBI)– Tuberculin skin test [1890]
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We desperately need new TB vaccines and drugs
BCG: 1920s
Rifampin: 1950s
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Host genetics and strain variations
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New TB diagnostics
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New TB drug regimens
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Global health and TB
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Modeling and cost-effectiveness
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Social determinants
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Statistical methods and approaches
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Knowledge translation and policy
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Sources of funding
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Thank you!