Isoniazid is used for treating or preventing tuberculosis.
Isoniazid (Nydrazid) as known as: Akurit, Cemidon, Cemidon b6, Combiblister, Dianicotyl, Hidrazida, Hydra, Hydrazide, Inapas, Inazid, Inh, Inh-ciba, Inha, Inoxin, Iscotin, Iso-eremfat, Isokin, Isonex, Isoniac, Isoniazida, Isoniazide, Isoniazidum, Isonicid, Isonid, Isotamine, Isozid, Kidz, Moxina dos, Nicotibina, Nicotibine, Nicozid, Nidrazid, Nufadoxin forte, Nydrazid, Oboliz, Pehadoxin, Phthizopiram, R-cinex, Rifamate, Rifamazid, Rifater, Rifazid, Rifinah, Rimactazid, Rimcure, Rimicid, Rimifon, Rina, Servizid, Suprazid, Tebesium, Tibinide, Tisobrif, Tubilysin, Valifol
Nydrazid is a prodrug and must be activated by bacterial catalase. Specficially, activation is associated with reduction of the mycobacterial ferric KatG catalase-peroxidase by hydrazine and reaction with oxygen to form an oxyferrous enzyme complex. Once activated, isoniazid inhibits the synthesis of mycoloic acids, an essential component of the bacterial cell wall. At therapeutic levels isoniazid is bacteriocidal against actively growing intracellular and extracellular Mycobacterium tuberculosis organisms. Specifically isoniazid inhibits InhA, the enoyl reductase from Mycobacterium tuberculosis. by forming a covalent adduct with the NAD cofactor. It is the INH-NAD adduct that acts as a slow, tight-binding competitive inhibitor of InhA.Nydrazid for patients
Data is temporarily not availableNydrazid Interactions
Food: Isoniazid should not be administered with food. Studies have shown that the bioavailability of isoniazid is reduced significantly when administered with food.
Acetaminophen: A report of severe acetaminophen toxicity was reported in a patient receiving Isoniazid. It is believed that the toxicity may have resulted from a previously unrecognized interaction between isoniazid and acetaminophen and a molecular basis for this interaction has been proposed. However, current evidence suggests that isoniazid does induce P-450IIE1, a mixed-function oxidase enzyme that appears to generate the toxic metabolites, in the liver. Furthermore it has been proposed that isoniazid resulted In induction of P-450IIE1 in the patients liver which, in turn, resulted in a greater proportion of the ingested acetaminophen being converted to the toxic metabolites. Studies have demonstrated that pretreatment with isoniazid potentiates a cetaminophen hepatoxicity in rats.
Carbamazepine : Isoniazid is known to slow the metabolism of carbamazepine and increase its serum levels Carbamazepine levels should be determined prior to concurrent administration with isoniazid, signs and symptoms of carbamazepine toxicity should be monitored closely, and appropriate dosage adjustment of the anticonvulsant should be made.
Ketoconazole : Potential interaction of Ketoconazole and Isoniazid may exist. When Ketoconazole is given in combination with isoniazid and rifampin the AUC of ketoconazole is decreased by as much as 88% after 5 months of concurrent Isoniazid and Rifampin therapy.
Phenytoin . Isoniazid may increase serum levels of phenytoin. To avoid phenytoin intoxication, appropriate adjustment of the anticonvulsant should be made.
Therophylline . A recent study has shown that concomitan administration of isoniazid and theophylline may cause elevated plasma levels of theophylline, and in some instances a slight decrease in the elimination of isoniazid. Since the therapeutic range of theophylline is narrow theophylline serum levels should be monitored closely, and appropriate dosage adjustments of theophylline should be made.
Valproate . A recent case study has shown a possible increase in the plasma level of valproate when co administered with isoniazid. Plasma valproate concentration should be monitored when isoniazid and valproate are co administered, and appropriate dosage adjustments of valproate should be made.Nydrazid Contraindications
Isoniazi d is contraindicated in patients who develop severe hypersensitivity reactions, including drug -induced hepatitis; previous isoniazid-associated hepatic injury; severe adverse reactions to isoniazid such as drug fever, chills, arthritis; and acute liver disease of any etiology.
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.GENERIC NAME: Isoniazid DISCONTINUED BRANDS: Nydrazid, Laniazid, INH
DRUG CLASS AND MECHANISM: Isoniazid is an anti-bacterial drug that has been used to prevent and to treat tuberculosis since 1952. Tuberculosis is an infectious disease caused by a bacterium. Once the infection is acquired. it usually remains dormant in the lungs for up to many years. Later, the infection may become active in the lungs and sometimes spreads throughout the body. Patients with a tuberculosis skin test that has recently become abnormal (demonstrating recent infection with tuberculosis) but a normal chest X-ray (demonstrating inactive infection) are given Isoniazid alone for 9 months. Patients with active infection on chest X-ray are given Isoniazid combined with other antituberculous drugs. The mechanism of action of Isoniazid is not known, but it is thought to work through its effects on lipids (fats ) and DNA within the tuberculosis bacterium. It is very selective for the tuberculosis bacteria, that is, it has few if any effects on other bacteria.
Medically Reviewed by a Doctor on 2/11/2015
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Suggested Reading on isoniazid (Nydrazid, Laniazid, INH are all discontinued brands) by Our Doctors Related Diseases & Conditions
What is Nydrazid? Nydrazid (Isoniazid) is used to treat tuberculosis (TB) or prevent its return (reactivation). It may be given alone, or in combination with other medicines, to treat TB or to prevent its return (reactivation). A doctor may prescribe Nydrazid (Isoniazid) for additional conditions. Further Nydrazid reference material.Looking To Get Nydrazid Online?
Have a look at the other common names. You can get Nydrazid under several brand and generic names around the world. When you click Order Nydrazid Online . you'll see what other brands Nydrazid is available as from international pharmacies. International pharmacies may not require you to send in a prescription, and if required their doctors will assess your condition and provide you with a prescription for free right online. Please check your local import regulations.How To Order Nydrazid Online Without A Prescription *
* Prescription-Mexico.com list potential pharmacies when you are looking to order Nydrazid online. You may not need to send your prescription when you buy Nydrazid online from an international pharmacy. Get quality prescription medications at a substantial savings through leaders in discount drugs online. Just click Order Nydrazid Online to see the latest pricing and availability. Any US pharmacy listed will require a prescription. Some international pharmacies may also require proof of prescription from US residents. Please verify your local import regulations; the ability for a pharmacy to offer a medication without a prescription does not supersede any local requirement you may have.Get Nydrazid Online at a Discount
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Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
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There are 5 disease interactions with Nydrazid (isoniazid):Inh (Includes Nydrazid) ↔ Hepatotoxicity
Severe Potential Hazard, High plausibility
Applies to: Liver Disease, Alcoholism
The use of isoniazid is contraindicated in patients with acute liver disease or a history of hepatic injury due to isoniazid. Caution is advised when using the drug in patients with chronic liver disease or a history of alcoholism. Isoniazid has been associated with severe and sometimes fatal hepatitis, which may occur even after many months of therapy. In a US Public Health Service Surveillance Study of nearly 14,000 isoniazid patients, the incidence of hepatitis was 1.25%, of which 4.6% was fatal. However, more recent studies have reported considerably lower rates when CDC guidelines for selection and monitoring of patients were followed. Epidemiologic studies indicate an increased incidence with increasing age, alcohol use, and female gender. As a precautionary measure, routine monitoring of serum transaminases (SGOT, SGPT) and bilirubin may be considered, although a transient and harmless increase in serum transaminase reportedly occurs in 10% to 20% of patients, usually in the first 3 months of therapy. Patients should be advised to promptly discontinue isoniazid therapy and seek medical attention if they experience signs or symptoms suggestive of liver damage such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. Reinstitution of the drug should occur only after symptoms and laboratory abnormalities resolve, with low and gradually increasing dosages.References
Severe Potential Hazard, High plausibility
Applies to: Liver Disease
Isoniazid is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from isoniazid due to decreased drug clearance. Dosage reductions are recommended in these patients.References
Severe Potential Hazard, High plausibility
Applies to: Malnourished, Diabetes Mellitus, Alcoholism, Peripheral Neuropathy
Isoniazid commonly causes dose-related peripheral neuropathy, which results from the depletion of pyridoxine in the presence of the drug. The neuropathy is usually preceded by paresthesias of the feet and hands. Therapy with isoniazid should be administered cautiously in patients with preexisting peripheral neuropathy or risk factors for developing the condition, such as malnutrition, diabetes and alcoholism. Pyridoxine (vitamin B6) at a dosage of 10 to 50 mg/day may prevent or attenuate isoniazid-related peripheral neuropathy and is recommended for these patients.References
Moderate Potential Hazard, High plausibility
Applies to: hemodialysis
Isoniazid is substantially removed by hemodialysis and should be administered after dialysis.References
Moderate Potential Hazard, Moderate plausibility
Applies to: Renal Dysfunction
Isoniazid is metabolized primarily by acetylation and dehydrazination in the liver. It is not significantly excreted by the kidney. Dosage adjustments in renal impairment are generally not necessary except in slow acetylators with a creatinine clearance below 10 mL/min. The rate of acetylation is genetically determined. Approximately 50% of blacks and caucasians are slow acetylators, and the majority of Eskimos and Asians are rapid acetylators.References
Nydrazid (isoniazid) drug Interactions
There are 485 drug interactions with Nydrazid (isoniazid)
Nydrazid (isoniazid) alcohol/food Interactions
Severe and sometimes fatal hepatitis associated with isoniazid therapy has been reported and may occur or may develop even after many months of treatment. The risk of developing hepatitis is age related. Approximate case rates by age are: less than 1 per 1,000 for persons under 20 years of age, 3 per 1,000 for persons in the 20-34 year age group, 12 per 1,000 for persons in the 35-49 year age group, 23 per 1,000 for persons in the 50-64 year age group, and 8 per 1,000 for persons over 65 years of age. The risk of hepatitis is increased with daily consumption of alcohol. Precise data to provide a fatality rate for isoniazid-related hepatitis is not available; however, in a U.S. Public Health Service Surveillance Study of 13,838 persons taking isoniazid, there were 8 deaths among 174 cases of hepatitis.
Therefore, patients given isoniazid should be carefully monitored and interviewed at monthly intervals. For persons 35 and older, in addition to monthly symptom reviews, hepatic enzymes (specifically, AST and ALT (formerly SGOT and SGPT, respectively) should be measured prior to starting isoniazid therapy and periodically throughout treatment. Isoniazid-associated hepatitis usually occurs during the first three months of treatment. Usually, enzyme levels return to normal despite continuance of drug, but in some cases progressive liver dysfunction occurs. Other factors associated with an increased risk of hepatitis include daily use of alcohol, chronic liver disease and injection drug use. A recent report suggests an increased risk of fatal hepatitis associated with isoniazid among women, particularly black and Hispanic women. The risk may also be increased during the post partum period. More careful monitoring should be considered in these groups, possibly including more frequent laboratory monitoring. If abnormalities of liver function exceed three to five times the upper limit of normal, discontinuation of isoniazid should be strongly considered. Liver function tests are not a substitute for a clinical evaluation at monthly intervals or for the prompt assessment of signs or symptoms of adverse reactions occurring between regularly scheduled evaluations. Patients should be instructed to immediately report signs or symptoms consistent with liver damage or other adverse effects. These include any of the following: unexplained anorexia, nausea, vomiting, dark urine, icterus, rash, persistent paresthesias of the hands and feet, persistent fatigue, weakness or fever of greater than 3 days duration and/or abdominal tenderness, especially right upper quadrant discomfort. If these symptoms appear or if signs suggestive of hepatic damage are detected, isoniazid should be discontinued promptly, since continued use of the drug in these cases has been reported to cause a more severe form of liver damage.
Patients with tuberculosis who have hepatitis attributed to isoniazid should be given appropriate treatment with alternative drugs. If isoniazid must be reinstituted, it should be reinstituted only after symptoms and laboratory abnormalities have cleared. The drug should be restarted in very small and gradually increasing doses and should be withdrawn immediately if there is any indication of recurrent liver involvement.
Preventive treatment should be deferred in persons with acute hepatic diseases.DRUG DESCRIPTION
Isoniazid is an antibacterial available as 100 mg and 300 mg tablets for oral administration. Each tablet also contains as inactive ingredients: colloidal silicon dioxide, lactose monohydrate, pregelatinized starch, povidone, and stearic acid.
Isoniazid is chemically known as isonicotinyl hydrazine or isonicotinic acid hydrazide. It has an empirical formula of C6 H7 N3 O and a molecular weight of 137.14. It has the following structure:
Isoniazid is odorless, and occurs as a colorless or white crystalline powder or as white crystals. It is freely soluble in water, sparingly soluble in alcohol, and slightly soluble in chloroform and in ether. Isoniazid is slowly affected by exposure to air and light.What are the possible side effects of isoniazid ()?
If you experience any of the following serious side effects, stop taking isoniazid and seek emergency medical attention or contact your doctor immediately:
Last reviewed on RxList: 1/11/2008
This monograph has been modified to include the generic and brand name in many instances.
Autoimmune diseases also referred to as collagen vascular diseases or autoimmunity are disorders where the body's immune system reacts against some of its own cells and produces antibodies to attack it. These disorders are classified into two types, organ-specific (directed mainly at one organ) and non-organ-specific (widely spread throughout the body). Autoimmune diseases keep the healthy body from releasing an immunological army that destroys all healthy cells it encounters.
The human immune system is a protection mechanism which defends the body against millions of bacteria, microbes, viruses, toxins and parasites that try to invade the human body. Our immune system can detect viruses, parasitic worms and differentiate them from healthy cells and tissues, required for the normal functioning of the body. Due to autoimmune disorders, the immune system mistakenly attacks self, targeting the cells, tissues, and organs of a person's own body.
Autoimmune diseases are currently ranked as the third biggest disease category in the US behind heart disease and cancer. According to several studies patients with these disorders are more likely to have a relative with an autoimmune disease, but they do not necessarily have the same type of autoimmune disease. Autoimmune disorders may result in destruction of one or more types of body tissue, abnormal growth of an organ or change in organ function. Organs and tissues such as red blood cells, blood vessels, endocrine glands, connective tissues, joints, skin and muscles are commonly targeted by autoimmune diseases.
There are over 100 different autoimmune diseases and these are mainly caused by the immune system attacking different organs of our body. Their treatment is essentially the same, since all these diseases have similar method of action. The common types of autoimmune diseases that affect most people have been listed and described below.
Autoimmune disorders /Types of autoimmune diseases
Types of autoimmune diseases include:
Excessive red blood cell destruction anemia or Hemolytic anemia causes the red blood cells to die early (generally they live for 110-120 days) which are removed through the spleen. To compensate for this loss, the bone marrow produces more red blood cells than normal, and if the bone marrow cannot keep up with the red blood cell production, it may lead to hemolysis.
Autoimmune hemolytic anemia or Hemolysis can also be caused due to immune reactions, infections as well as some medications and toxins. The severity of this disease depends on the main causes such as cytomegalovirus, hepatitis, HIV and lupus. This disorder may develop gradually or even suddenly causing serious symptoms.
Autoimmune Thyroiditis or Hashimoto’s Thyroiditis is a condition that causes the thyroid gland to become enlarged, due to an attack of antibodies and is the most common type of Thyroiditis. This disease causes the cells of the thyroid gland to become inefficient for converting iodine into thyroid hormone which eventually cause the thyroid gland to grow more than the normal size.
Autoimmune Thyroiditis can lead to goiters which appear on the front neck and are developed due to extremely swollen thyroid gland. It makes the gland incapable to produce adequate thyroid hormone for the body. Goiters are usually caused due to iodine deficiency.
The common symptoms associated with this disorder are weight gain, weakness, abnormal growth, pale skin, heavy menstrual periods, aching muscles, aches in the legs and feet, depression, puffiness in the face, irritation etc. In severe cases it can result in all manner of complications including heart disease, serious depression, lowered interest in sexual activity, higher incidence of birth defects for children of mothers with untreated Hashimoto’s, and development of fatal conditions.
Autoimmune hepatitis is a chronic liver disease where body’s immune system attacks the liver and causes it to become inflamed. This disease is classified into two forms, Type 1 autoimmune hepatitis and Type 2 autoimmune hepatitis .
Type 1 autoimmune hepatitis is common among young women and is often associated with other autoimmune diseases. Type 2 autoimmune hepatitis is less common and generally affects girls between the ages of 2 and 14. Due to this disease, auto antibodies circulating in the bloodstream cause the immune system to attack the liver, as immune cells treats liver’s normal cell as foreign tissue or disease causing agent (pathogen). The disease is usually quite serious and, if not treated, gets worse over time.
Common symptoms associated with this disorder are an enlarged liver, jaundice, itching, skin rashes, joint pain, abdominal discomfort, nausea, vomiting, loss of appetite, dark urine; pale or gray-colored stools etc. In severe cases it can even lead to liver cirrhosis, ascites and in worse condition it can even lead to liver failure. With early diagnosis and proper treatment, autoimmune hepatitis can be controlled.
Autoimmune pancreatitis (AIP), is a rare autoimmune disorder, and was first identified in Japan in 1955, described as a new form of chronic pancreatitis. It is also referred to by a variety of names including sclerosing pancreatitis, tumefactive pancreatitis and nonalcoholic destructive pancreatitis.
This autoimmune disorder develops when the immune system mistakenly attacks healthy tissue, causing ongoing inflammation and potentially serious complications not only to the pancreas but also to the bile ducts, salivary glands, kidneys and lymph nodes.
Type 1 diabetes is a disease, where the pancreas does not produce enough insulin which causes glucose levels in the blood to increase, instead of being used for energy. The immune cells of the immune system attack particular cells in the pancreas which are known as beta cells. Beta cells play a vital role in the production of insulin. which is a hormone that helps the body to control the level of glucose (sugar) in the blood.
Type 1 diabetes can occur at any age, but it is most often diagnosed in children, adolescents, or young adults. This disease cannot be prevented but can be controlled by taking insulin injections on a daily basis so that blood sugar level remains normal. People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This help prevent blood sugar from becoming extremely high or low.
Some of the common symptoms for type 1 diabetes include weight loss, excessive thirst, feeling hungry, fatigue, losing the feeling or feeling tingling in the feet. It may also lead to hypoglycemia (low blood sugar) due to insulin intake by a diabetic person.
Rheumatoid Arthritis (RA) causes the synovial joints to become thickened and inflamed and may also affect other organs of the body. If the synovial fluid sticks around too long after working out, it can cause cracks in the cartilage, ice helps get the fluid out of the joint and into the lymphatic system, which is the garbage disposal of the body. Generally, women are more at risk of being affected by rheumatoid arthritis than men.
It is a chronic illness in which patients may experience long periods without any symptoms and has the potential to cause joint destruction and functional disability. Joints play a vital role in fluid movement of human body and hence require careful attention. But when they get diseased or injured, the resulting pain can severely limit a person’s ability to work and move.
Obese, overweight people are more at risk of having joint related problems, as bones and joints are under heavy stress and tension due to the extra weight of the body.
Drinking ginger tea at bed time is particularly recommended for Rheumatoid Arthritis. Application of ice to the joints can help in reducing pain and swelling.
Multiple sclerosis is a chronic nervous system disorder which is the cause of nontraumatic disability among young and middle aged people. It is generally caused by destruction of the myelin insulation covering nerve fibers in the central nervous system and affects movement, sensations and vital body functions.
Some patients experience such mild symptoms that they do not notice anything until much later in the course of the disease. Weakness, numbness, pain, disturbances of speech or vision, parasthesias, ataxia, tremor, dizziness, bladder or bowel dysfunction, fatigue, cognitive problems and depression are some of the common symptoms associated with this disorder.
Psoriatic arthritis is a joint condition that occurs mainly due to the complications of psoriasis (a chronic skin disorder with the appearance of raised, red, roughened patches covered by silvery shiny scales). Up to 30 percent of people with psoriasis also get psoriatic arthritis, a chronic inflammatory joint disease that causes pain, stiffness, swelling and restrictive mobility.
This type of joint condition usually affects people, both men and women, in the ages of 30-50. It has been noticed that white colored people are more likely to get Psoriatic arthritis than black colored people. It usually affects joints in an asymmetric manner but may sometimes also affect joints in a symmetric fashion, similar to rheumatoid arthritis.
Psoriatic arthritis can be divided into 5 types mainly Asymmetric arthritis (it is the most common form of psoriatic arthritis where the joint inflammation in joints does not follow a typical pattern), Spondylitis (also called spondyloarthropathy and involves inflammation in the joints between the spinal vertebrae), Symmetric arthritis (also called symmetric polyarthritis and involves inflammation in the same joints on both sides of the body), Distal interphalangeal predominant (DIP) arthritis (also called distal arthritis which occurs in the fingers and/or toes, usually affecting the joints closest to the fingernails and toenails) and Arthritis mutilans (a very rare type but devastating form of psoriatic arthritis that can destroy joints, especially of the hands, feet, back or neck ,resulting in deformity).
Lupus is a chronic disorder which causes the immune system of the human body to attack normal tissues, especially the skin, joints blood and kidneys. This disorder cannot differentiate between the foreign bodies and body’s own healthy organ and tissues and thus starts making harmful antibodies that attack its own organs and tissues.
This is a disease that is usually hereditary, but in some cases there is no family history of Lupus. Lupus normally develops between 15 and 40 years of age. Common symptoms include painful or swollen joints and muscle pain, unexplained fever, "Butterfly" rashes most commonly across the bridge of nose and cheeks, chest pain, unusual hair loss, swelling, or edema, in the legs or around the eyes, swollen glands and extreme fatigue.
Systemic lupus erythematosus (SLE) is a type of lupus which causes flares and followed by periods of wellness, called remission. It generally affects different organs and tissues and causes fluctuating pain; hence a person suffering from this disease at times feels better and other time feel terrible pain.
Discoid lupus is chronic disease which affects the skin with red scaling rash that leads to scarring. This disorder can lead to SLE. It causes ugly rashes on the face, and may also result in severe hair loss and scarring of the scalp. Discoid lupus is not completely curable as it may reoccur at some point of time.
This disease is common seen among new born babies as mother affected by lupus passes harmful antibodies (SSA/Ro and SSA/La) to the fetus through placenta. This disorder leads to anemia and decrease in platelet count due to the destruction of red blood cells and platelets by these harmful antibodies.
This disorder is caused due to the use of certain drugs and affects central nervous system and kidneys. Drug induced lupus have symptoms similar to SEL. Use of drugs such as minocycline, laniazid, nydrazid, aldomet and promine usually cause this disorder. In some cases this disorder can be completely resolved by avoiding the use of drugs that cause this disorder.
Addison’s disease is an autoimmune disease which affects adrenal glands which are located above each kidney. These two glands produce essential hormones known as cortisol and aldosterone. In this disorder the body’s immune system attacks healthy tissues which hampers the production of these essential hormones and thus cause harmful effects on the body.
Chronic infection, tuberculosis, amyloidosis are some of the causes that lead to destruction of adrenal glands. Common symptoms associated with this disorder are nausea, depression, irritability, darkening of skin, dizziness, vomiting, weight loss and loss of appetite etc.
Pernicious anemia also known as Biermer's anemia is a form of megablastic anemia which is caused by impaired uptake of vitamin B 12 due to the lack of intrinsic factor (IF) in the gastrointestinal tract. In this case large, immature, nucleated cells known as mega oblasts circulate in the blood, and do not function as blood cells. Vitamin B12 is necessary for the proper development of red blood cells.
Pernicious anemia that occurs at birth is inherited and the person having this disease tends to inherit two copies of defective genes; one from each parent. This disease begins slowly and mainly occurs in children. This type of anemia usually does not appear before age 30 in adults. The disease was named pernicious anemia because it was fatal before treatment became available. It was first available as a, liver therapy and then as purified vitamin B12 therapy.
Cobalamin deficiency, macrocytic anemia and other neurological complications are some of the disorders that are associated with insufficient absorption and metabolism of vitamin B12, which is mainly cause due to pernicious anemia. The common symptoms of pernicious anemia include bleeding gums, diarrhea, fatigue, sore mouth, and impaired sense of smell, loss of appetite, rapid heart rate, and shortness of breath. Other symptoms of pernicious anemia may include pale or yellowish skin, a low-grade fever, and dizziness when standing up. In severe cases pernicious anemia can also lead to heart failure and cancer.
Autoimmune disease symptoms
Autoimmune disease is classified into two types, organ-specific (directed mainly at one organ) and non-organ-specific (widely spread throughout the body). Autoimmune disease keeps the healthy body from releasing an immunological army that destroys all healthy cells it encounters.
The most common symptoms include:
Pregnant women have an increased risk of fetal growth retardation. People suffering from this disease may also have an uncomfortable tingling or crawling feeling in legs or unusual cravings for non-nutritive substances.
The symptoms of an autoimmune disease depend on what part or parts of the body are mistakenly attacked by the immune system. For some people the condition of disease could be mild and may not show any signs or symptoms of the disease but in case of severe condition it can lead to rheumatoid arthritis, pernicious anemia, multiple sclerosis, Type 1 diabetes, autoimmune Thyroiditis. In severe cases it can also lead to cancer, as healthy tissues and cells are destroyed by body’s immune system.
Autoimmune disease prevention
Well-balanced dietary intake is necessary to maintain the general well-being of patients suffering from any type of autoimmune diseases. It is also important that the patient receive all available immunizing agents and nutritional deficiencies should be corrected when present.
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. It usually infects the lungs, but it can also enter the blood and infect almost any part of the body. This includes the liver, kidneys, stomach and gut, bones, skin, breasts, brain and spinal cord. TB in these places is more common in children and people with weak immune systems, including people living with HIV.
TB is spread when a person with active TB disease coughs, sneezes or spits. Tiny droplets of fluid from the lungs are carried in the air and if other people breathe in these droplets they can get infected. TB can also pass from a mother to her unborn child before and after birth. However, it's more common for a baby to catch it after birth, due to close contact with its mother. If you or someone you live with has TB, you are all at risk for TB infection and TB screening is recommended for the whole family. Depending on your health and the health of people you live with, TB preventive therapy might be recommended for others in your household.
You are not likely to catch TB from a stranger coughing on a bus. Even if a healthy person spends 24 hours a day for two months with someone with active disease, there's still only a 50% chance that he or she will catch TB, though certainly people with weakened immune systems are more at risk.TB Infection and Disease
TB infection is not the same as having TB disease. For most people who are exposed to TB bacteria and become infected the immune system can stop the bacteria from growing. Nine out of ten people with healthy immune systems who are infected with TB do not get active disease. They feel well and cannot spread TB to others. This is also true for people who have active TB disease but not in their lungs. Most people with active disease can no longer pass on TB after about three weeks of treatment. TB disease develops when the immune system cannot fight off the infection. People with HIV are ten times more likely to develop active TB than HIV-negative people. For this reason, routine TB screening and appropriate preventive therapy and treatment, when needed, is critical for people living with HIV.
TB is an ever-increasing concern for people living with HIV. In some parts of the world, TB is the leading cause of death of people with HIV. In the U.S. TB prevention and control efforts have been strengthened. However, in environments with crowded living conditions and poor ventilation, such as homeless shelters nursing homes, and prisons, TB is more common. Young children, seniors and people of color are at an increased risk of developing active TB disease. In addition the following factors put a person at an increased risk for developing active TB disease: pregnancy. HIV, Diabetes, Long-term kidney failure, poor nutrition. alcohol and/or injection drug use.What Are the Symptoms?
Not all people with TB have symptoms unless they have active disease. The most common place for active TB is in the lungs and symptoms include a prolonged cough (lasting over 2 weeks), pain in the chest and coughing up fluid (sometimes with blood). A chart of symptoms is shown in the box below. Children infected with TB near their time of birth may have TB in many organs. They may have difficulty breathing or feeding and fail to grow at the normal rate.
Some symptoms of TB disease are similar to symptoms of other common HIV-related infections like toxoplasmosis. Pneumocystis carinii pneumonia (PCP) and Mycobacterium avium complex (MAC). Therefore, it's important to make sure that when symptoms appear they are appropriately diagnosed and treated the right way.Symptoms of Active TB Disease TB and HIV Disease
For many people, TB is the first sign of immune dysfunction associated with HIV infection, and active TB is an AIDS-defining illness. One in ten people living with HIV will get active TB within a year of being diagnosed with HIV. It can occur early in HIV disease when CD4+ cell counts are relatively high, in the 300-400 range. In early HIV infection, TB usually infects and affects just the lungs. As CD4+ cell counts drop, however, TB is more likely to appear in other organs too.
When the immune system responds to TB it can cause HIV levels to increase, and HIV disease may then progress more quickly. This, in turn, increases the risk of other opportunistic infections. The good news is that TB treatment leads to lower HIV levels in people with both infections.
It's very important for people with HIV to be screened regularly for TB. TB testing is recommended to begin when a person is first diagnosed with HIV, then yearly after that. Also, when starting anti-HIV therapy, a TB test is also recommended. Finally, for people living with HIV who come into contact with someone with active TB, a TB test is recommended.
Whether you have TB infection or active TB disease, it's extremely important to get treated right away. If you are diagnosed with TB and HIV at the same time, you may not want to start treating both at the same time. It might be easier to stick to your regimens if you start the anti-TB treatment first and wait awhile before starting anti-HIV therapy. This might not always be possible, but it's something to discuss with your doctor.How Does a Doctor Diagnose TB Infection?
A PPD skin test is used to detect TB infection. A small amount of liquid (called PPD Tuberculin) is injected under the skin of the arm. After 48-72 hours, a nurse or doctor reads the test. A hard swelling at the site larger than 10mm means that the person is infected with TB. A smaller swelling of 5mm is used to detect TB infection in people with HIV. This is because people with HIV might not have a strong immune response resulting in the more pronounced swelling seen 7in people who are HIV-negative and otherwise healthy.
Unfortunately, the PPD test is not 100% accurate for three main reasons. First, the reaction is caused by an immune response, and this may take awhile to develop. There actually may be no reaction within the first 10-12 weeks after infection. Second, a person may react to the test if they're infected with a related bacteria like MAC. Third, some people with weak immune systems do not react even if they're infected with TB.
When a person is infected with TB but does not react to the PPD, he or she is said to be anergic. This is more common when CD4+ cell counts are below 200. A different test can be used to check for anergy, but the results are not very reliable in people living with HIV. Anergy testing is not routinely used, but it may be helpful in certain cases. So, a negative PPD test result does not always mean that a person is free of TB. For this reason, routine testing is very important.How Does a Doctor Diagnose TB Disease?
Chest x-rays are used to detect active TB disease and to check for damage in the lungs. During or after active TB, x-rays will show lumps, holes or scars in the lungs. Chest x-rays may provide misleading or confusing results, however, because a chest x-ray may look unusual due to HIV or other HIV-related complications, including PCP and MAC. This is especially true for people with CD4+ cell counts below 200. This can make TB more difficult to diagnose in people living with HIV.
The best proof that a person has TB is to find the actual bacteria. In a TB smear test, a sample of sputum is studied under a microscope to see if it contains the bacteria. Unfortunately, it cannot tell the difference between TB and related bugs like MAC. If the smear test is positive, then the sputum can be grown in a lab to see if it contains active genetic TB material (called TB DNA). Tests that detect this genetic material have been developed, but are not routinely useful in all situations, such as diagnosing TB in places outside the lungs or definitely telling if someone is TB-negative. Also, growing bacteria from a sputum sample, in the lab, is needed to test for drug resistance .
Tests that are normally used to look for active TB in other organs include scans of the head, chest or abdomen; spinal tap; biopsy of lymph nodes or bone marrow; and urine culture.Treating Active TB
The effectiveness of anti-TB treatment is quite good, regardless of HIV infection. However, it is vital that people take the full course of drugs in order to kill all the TB and to prevent the development of anti-TB drug resistance or recurrence of active TB disease. People on anti-TB drugs are generally encouraged to see their doctors at least once a month and maybe more often at the start of treatment. This is to check whether the drugs are working, to identify adherence problems (problems with taking the drugs as prescribed), and to monitor for side effects or reactions.
The treatment for TB in the lungs and other organs is the same and usually lasts for six months, although widespread TB may require taking anti-TB therapies for a longer period of time. Treating TB in the brain (meninges), bones or joints might require at least nine months of therapy. If anti-TB treatment doses are missed for any reason, longer courses of treatment are likely necessary. Also, people who don't respond quickly to the normal course of therapy might need to continue on anti-TB for nine months or longer.
Symptoms of active TB disease usually ease off 3-4 weeks after starting anti-TB treatment. When a person has had three negative smear tests, he or she is considered to be non-infectious, or not likely to be able to infect others with TB. This usually occurs 2-3 months after starting anti-TB treatment.
The first line treatment for TB disease is a combination of four drugs that includes isoniazid (Nydrazid) (300mg/day), rifampin (Rifadin, Rimactane) (450-600mg/day), pyrazinamide (Tebrazid) (20-30mg/kg/day), and ethambutol (Myambutol) (15-25mg/kg/day) or streptomycin sulfate (15mg/kg/day). These five drugs are given and resistance testing is performed. If the resistance test shows that the TB can be killed by isoniazid and rifampin, then the ethambutol or streptomycin can be stopped. The U.S. Public Health guidelines recommend that people with HIV taking isoniazid also take pyridoxine (Vitamin B6) because they are at higher risk for developing peripheral neuropathy .Six-Month Treatment Plans for TB