Test for tuberculosis
Hi friends ……. आज मैं (MDR TB) how to diagnose MDR TB, Test for tuberculosis अभी हाल मे टीबी के इलाज और निदान और डायग्नोस्टिक्स और दवाओं में काफी प्रगति हुई है जिसके कारण टीबी के इलाज में बदलाव आया है,
तो आइए जानते है Drugs Resistant tuberculosis के बारे मे अगर हम पहले की बात करे Drugs Resistant Tuberculosis को पता लगाने मे काफी मुश्किल था जिससे मरीज का निदान और डायग्नोस्टिक्स करने मे काफी समय खाराब हो जाता था, जिससे मरीज की बिमारी काफी बिगड जाती थी,इस वजह से टीबी से ग्रसित लोग काफी परेशान रहते थे
अब हमारे पास नई तकनिक आ गयी है जिससे Drugs Resistant Tuberculosis डायग्नोस्टिक्स के इलाज मे काफी सहायक हो रही है,
What is U.D.S.T
यू. डी.एस. टी एक टेस्ट है जिसका प्रयोग करके टीबी मरीजो को दी जाने वाली सभी दवाओ केे अवरोधण या प्रतिरोधक क्षमता का पता लगाया जा सकता है,
Drugs Resistant Tuberculosis टीबी को पता लगाने के लिये आज कल UDST [universal drug Susceptibility Test] का प्रयोग किया जा रहा है इससे तकनिक से असानी से पता चल जाता है की मरीज को नोर्मल टीबी है या Drugs Resistant Tuberculosis टीबी है उसके बाद रिपोर्ट के अधार पे रोगी का सही इलाज किया जाता है
cbnaat test
Cartridge Base Nucleic acid amplification test यह एक जीन बेस टेस्ट है,जो आसानी से टीबी मरीजो के इलाज मे उपयोग की जाने वाली मुख्य दवा रिफैम्प्सिन की अवरोधण या प्रतिरोध का पता लगा लेता है इसमे रोगी को अपना बलगम या सैम्पल देना होता है जो CBNAAT की मशीन मे लगाकर drug Susceptibility Test टेस्ट किया जाता है इस टेस्ट का रिजल्ट दो घंटे मे आ जाता है इस टेस्ट मे MTB Detected/MTB not Detected का पता चलता है इसका मतलब मरीज बलगम मे टीबी का किटाणू है या नही है इसके अलावा उसके इलाज मे प्रयोग होने वाली दवा काम कर रही है या नही इस बात का भी पता असानी सेे लग जाता है जैसे Rifampcin sensitive / Rifampcin resistant
Gene xpert/ CBNAAT की मशीने विदेशों में निर्मित होती है, इसलिए यह मेक इन इंडिया के साथ बहुत महंगा है। हमारे पास अन्य न्यूक्लिक एसिड एम्प्लीफिकेशन टेस्ट Truenat आने वाला है जिसे भारत में विकसित किया गया है और यह अभी लंबित है। यह रिफैम्पिसिन प्रतिरोध आणविक परीक्षणों के लाभ के लिए दिखता है, यह बैटरी से संचालित है, ये बिजली के बगैैर भी चलता है इसे दूर दराज के जगहो पे भी इस्तेमाल किया जा सकेगा, ज़हा CBNAAT/GeneXpert दो घंटे मे रिजल्ट देता है वही Truenat सिर्फ 90 min मे रिजल्ट दे देगा ऐसा माना जा रहा है ये स्वादेशी है सस्ता है साइज मे छोटा है इसलिये से Truenat अच्छा माना जा रहा है
What is LPA / Line probe assay
Line probe Assay LPA: – नोर्मल टीबी को ठीक करने के लिये प्रथम लाइन की दवाओ की ड्र्गसेसविटी का पता लगना बहुत जरुरी है इसके लिये सभी मरीजो को UDST करना जरुरी होता है UDST मे सबसे पहले CBNAAT test होता है, लेकिन CBNAAT test मे चार दवावो मे से केवल एक द्वा रिफाम्पसिन का ड्र्गसेसविटी पता चल पाता है आइसोनियाज़ेड और बाकी दवाओ की ड्र्गसेसविटी Line probe Assay LPA/culture करना होता है,
Line probe Assay इस टेस्ट मे रिफम्पसिन और आइसोनियाज़ेड दोनो दवाओ की ड्र्गसेसविटी पता चल जाता है परंतु LPA की रिपोर्ट CBNAAT test से ज्यादा समय लग जाता है इसके टेस्ट प्रोसेस मे पांच से दस दिन लग सकते है इस टेस्ट मे हमे रिफम्पसिन और आइसोनियाज़ेड दोनो दवाओ की ड्र्गसेसविटी पता चल चुका है
अगर रिफम्पसिन और आइसोनियाज़ेड दोनो सेनसटिव है तो मरीज का इलाज नोर्मल टीबी मे ही चलता रहेगा लेकिन अगर रिफम्पसिन और आइसोनियाज़ेड दोनो रजिसटेंट है तो मरीज drug resistant Tuberculosis मे चला जयेगा इस स्थिति मे मरीज का इलाज नोर्मल टीबी से रोककर DR/MDR टीबी मे स्विच कर दिया जयेगा,
अगर टेस्ट मे आइसोनियाज़ेड रजिसटेंट है तो मरीज Mono/Drug resistant Tuberculosis मे चला जयेगा इस स्थिति मे मरीज का इलाज नोर्मल टीबी से रोककर Mono/MDR टीबी मे स्विच कर दिया जयेगा,
अगर मरीज पहले कभी टीबी कि दवा ले चुका है या वो MDR/XDR TB मरीज के समपर्क मे रहता है तो हम मरीज का first line LPA के साथ second line LPA भी लगवा सकते है इससे ये पता चल सके कही मरीज second line से resistant तो नही है अगर है तो हम मरीज को MDR/XDR TB जैसी भी रिपोर्ट होगी वैसा इलाज चलेगा,
culture test
Culture Test:- कल्च्र्र टेस्ट भी एक UDST टेस्ट है इस टेस्ट पे सबसे ज्यादा विश्वास किया जा सकता है ये किसी मशीन पे निर्भय नही होता है ये मेंनुअल लैबटेक्निश्यन के द्वारा किया जाता है इसमे सभी दवाये जो टीबी के इलाज मे प्रयोग की जाती है उन सभी दवावो का ड्र्गसेसविटी का पता लगाया जा सकता है फिर उसी हिसाब से मरीज का इलाज भी किया जा सकता है यह बहुत पुरानी टेकनिक है इस मे रिपोर्ट आने मे काफी लम्बा समय लगता है लगभग 70 to 90 days का समय लगता है इसलिये Culture Test का प्रयोग सबसे बाद मे किया जाता है
कल्च्र्र टेस्ट मे मरीज द्वारा दिये गये सैम्पल/ बलगम को एक सैल्यूश्न मे मिलाकर उसे अलग अलग परखनलियो मे भरकर उन परखनलियो टीबी किटाणू के अनकुल वतावरण मे रक्खा जाता है जिससे टीबी के किटाणू उन परखनलियो मे असानी से ग्रो कर सके फिर उन परखनलियो मे एक एक दवाओ का बरीक पाउडर डालते है जितनी भी मेडिसन की ड्र्गसेसविटी का पता लगाना है हमे उतनी परखनलिया लेनी होगी, अब 70 से 90 दिन के बाद उन सभी परखनलियो का परिक्षण किया जाता है, जो मेडिशन टीबी किटानू पर resistant अवरोध होगी उसमे टीबी का किटाणू तेजी से ग़्रो कर रहा होगा बाकी सभी परखनलियो मे कवक या काइ आ गयी होगी, ये सबसे असान तरीका है टीबी मे प्रयोग की जाने वाली दवाओ resistant अवरोध पता करने पर ये बहुत स्लो प्रोसस है इसिलिये इसका प्रयोग सबसे बाद मे किया जाता है
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