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Molecular Basis of Disease > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What are the ‘three big killers’?

A

HIV

Malaria

TB

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2
Q

What is TB strongly associated with?

A

HIV

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3
Q

How many deaths happen per year due to TB?

A

1.4 million

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4
Q

How many new cases of TB arise per year?

A

8.7 million

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5
Q

What percentage of cases of TB happen in Africa?

A

90%

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6
Q

What percentage of HIV patients have TB?

A

13%

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7
Q

What fraction of TB deaths are associated with HIV?

A

2/3

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8
Q

What type of people normally suffer from TB?

A

Vulnerable population

Homeless, refugees

No access to appropriate health care

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9
Q

How can TB rates be used to assess a country?

A

TB rates can be used as a marker to determine the effectiveness of the health care system in a country

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10
Q

Why were TB rates so high 100 years ago?

A

Many reasons

One were the tight living quarters in households

Allowed airborne disease to spread easier from one individual to the next

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11
Q

What caused the spike of TB in the 80s?

A

AIDS

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12
Q

Why are HIV and TB so closely related?

A

Both affect the same cells

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13
Q

What has happened to the rates of TB?

A

Decreased

But TB has become more of a global problem due to the globalization of the world and increased population in cities

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14
Q

What is the TB capital of Europe?

A

London

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15
Q

What has caused London to be the TB capital of Europe?

A

Immigrant population that has settled in the city

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16
Q

What are strains of TB specific to?

A

Populations

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17
Q

Current treatments are adequate at tackling the TB epidemic

TRUE or FALSE

A

FALSE

Though effective, these drugs are inadequate at tackling the global TB epidemic

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18
Q

What are the problems of current therapies for TB?

A

Need to take the drugs for a long time

The therapies are too complex, since it requires a combination of drugs

TB drugs interact with HIV drugs

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19
Q

Examples of drugs used in TB

A

Rifampicin

Isoniazid

Streptomycin

Ethambutol

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20
Q

What strategies have been developed to tackle the complications of current drug treatments?

A

DOTS involves making the patients film themselves, attend a clinic or be supervised by a friend whilst taking a drug to make sure the patient is undergoin therapy

21
Q

Current TB therapies are the same as in the 60s

TRUE or FALSE

A

TRUE

22
Q

Why are some TB therapies not effective?

A

TB expresses epitopes shared with other mycobacteria

Many people have been expressed to these epitopes, they will have garnered resistance to these trains

23
Q

What is wrong with the current drug development system?

A

Not effective at propagating the discovery of new drugs

Long process that takes lots of phases of development

24
Q

What are the two types of resistant TB?

A

Multidrug resistant TB

Extensively resistant TB

25
Q

What drugs must a TB strain be resistant to in order to be a MDRTB?

A

Resistant to Risampicin and Isoniazid

26
Q

How many people develop MDRTB

A

500 000

27
Q

What proportion of MDRTB sufferers are diagnosed?

A

1/4

28
Q

How many cases of MDRTB are successfully treated?

A

1 in 9

29
Q

What drugs must a TB strain be resistant to in order to be a extensively resistant TB strain?

A

Rifampicin

Isoniazid

Fluoriquinolone

At least one of the three injectable drugs

30
Q

How does TB spread?

A

Aerosols

31
Q

What does TB infection look like?

A

TB leads to lung infection

Resolution of the disease leads to local scarring due to the damage caused

Miliary spread

Can either lead to local infection or spontaneous resolution

32
Q

Why are immunocopromised patients more at risk of TB infection?

A

T cells protect the host from the dissemination of the disease

33
Q

What is the risk of reactivation of TB?

A

10%

34
Q

What are the big challenges in terms of the bacteria itself, that makes treating TB difficult?

A

Cell wall

Slow growth

Persistence to antibiotics

Granuloma

35
Q

What about the cell wall of M. tuberculosis makes TB hard to treat?

A

TB is neither gram positive nor gram negative

Thick lipid bilayer prevents entry of the drug into the bacterium

36
Q

What about the slow growth of M. tuberculosis makes TB hard to treat?

A

Difficult to model

Doubling time is 24 hours

37
Q

What about the persistence of M. tuberculosis makes TB hard to treat?

A

It can spread to surrounding bacteria

38
Q

How does the granuloma make TB harder to treat?

A

The core of necrotic tissue makes it difficult to target the bacteria since the host can’t recognise them

39
Q

TB populations remain in the host even after effective drug treatment

TRUE or FALSE

A

TRUE

40
Q

What hypotheses have been developed to explain why TB populations stay in the host following effective treatment?

A

Bacterial population changes and evolved to counteract the action of the drugs

There are two distinct populations of bacteria, one fast growing that is effectively targeted in the beginning, and a slower growing population that is resistant to the drugs and remains in the host at lower concentrations

41
Q

What hypothesis regarding why TB remains in the body following effective treatment was right?

A

There are two distinct populations of M. tuberculosis

42
Q

How does Rifampicin affect the TB population?

A

Acts on RNA polymerase

43
Q

How does Isoniazid affect the TB population?

A

Acts on the cell wall turnover via fatty acid synthase

44
Q

How does Ethambutol affect the TB population?

A

Acts on cell wall formation

45
Q

How does Pyrazinamie affect the TB population?

A

Prodrug

Uknown population

46
Q

What drugs are used as a first stage treatment of TB?

A

RIfampicin, Isoniazid and Ethambutol

Decrease the concentration of active mycobacteria

47
Q

What was shown about fast and slow-growing mycobacteria in culture?

A

The fast-growing mycobacteria reacted more to Isoniazid than slow-growing

48
Q

What was revealed about the gene expressions of fast and slow growing bacteria in TB?

A

They contained different gene expressions

49
Q

What type of bacteria are Mycobacteria Tuberculosis according to the hypothesis that was proven?

A

M. Tuberculosis are fat and lazy

React indifferently to drugs

Enter a state of quiescence and reactivate when the host becomes immunocompromised

Molecular Basis of Disease (28 decks)

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