Posted: March 30th, 2022
Why tuberculosis is a complex condition to treat regarding its cellular path physiology and the bacterial cell wall
In the pulmonary alveoli, the mycobacterium invades and replicate in alveolar macrophages, usually in the upper lobe of the lung generating a population of cells that grow at different rates, with different sizes and differ how they are susceptible to antibiotics. Mycobacterium is also transported to lymph nodes and via the bloodstream to other tissues and organs where secondary TB lesions can develop—the infection results in local granulomas and abnormal tissue destruction.
Mycobacterium can survive the host immune system and can cause lung damage and is transmitted through air, hence able to successfully infect a new host. It can take a long time to manifest, therefore making it difficult to treat.
Dormant cells even exist in patients with active disease, and these cells are less susceptible to antibiotics, and these make it difficult to interfere with the cell wall of infected cells
Mycobacterium has a waxy outer layer made of mycolic acids that makes them naturally impenetrable and difficult to penetrate with antibiotics
2 Aims of using combinational therapy
When TB patients do not achieve adequate control of their disease, the best course of action is to use combination therapy with minimum side effects to complete their treatment goals. The Combination therapy should be started as soon as possible to avoid complications and ensure treatment adherence. Combination of Isoniazid, rifampin, pyrazinamide, and ethambutol or streptomycin for two months, pyrazinamide is stopped, and Isoniazid plus rifampin are continued for further four months, in cases of isoniazid résistance, discontinue and continue with rifampin, pyrazinamide and ethambutol for entire six months.
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