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Epidemiology of tuberculosis
Tuberculosis (TB) has returned to become one of the leading causes of preventable deaths in some 200 countries and territories, including South Africa [1]. Paleopathology studies showed that the M.tb complex was detected even in Egyptian mummies by making use of modern day DNA and HPLC analysis [2, 3]. The bacillus causing the actual disease, Mycobacterium tuberculosis (M.tb), was identified and described by the German physician Robert Koch in 1882 [4]. Prior to Robert Koch’s work, the disease “consumption” was believed to have various sources depending on
the affected community’s folklore [5]. Early treatments focused on a healthy diet and the administration of expectorants and purgatives, with the first sanatorium opened in 1854 in Germany where good hygiene and fresh air were thought to stimulate the body’s natural immune system. Consequently the success rate was much higher than any previous treatment and the system was adopted by other countries such as Britain. The further critical improvement of public health reduced the number of tuberculosis cases even before the introduction of antibiotics in the mid 20th century [6].
However, an increase in mortality rates from the 1980s changed this perception dramatically. It could be attributed to the breakdown in health services, the spread of HIV/AIDS and the emergence of multidrug-resistant TB (MDR-TB) [5]. Co-infection with the human immunodeficiency virus (HIV), a phenomenon that started in the 1980s and became eminent in the late 1990s, causes a severe burden on the individual’s immune system making them susceptible to opportunistic infections, of which TB is the most prominent. The mortality rate for individuals which are coinfected with TB is very high [1]. MDR-TB is a dangerous form of drug-resistant TB, that comes about when the infecting bacillus develops resistance to at least INH and RIF, the two most often used first line anti-TB drugs.
As indicated in the global tuberculosis control report of 2009 from the world health organisation [1], South Africa currently has the highest incidence of TB per 100 000 (358 per 100 000) people in the world. In 2007 an estimated 112 000 people died of Chapter 1: General introduction B in South Africa alone, of which 94 000 (72%) were co 2007, the prevalence of TB per 100,000 people was highest in sub and was also relatively high in Asia
Chapter 1: General introduction
1.1 Epidemiology of tuberculosis .
1.2 TB treatment .
1.3 Nanoparticles (NP) as drug delivery vehicles
1.4 Targeting of nanoencapsulated anti-TB drugs to the sites of infection ..
1.5 Aim of the project
Chapter 2: The cholesteroid nature of MA as a tool for targeting
2.1 Introduction
2.2 Hypothesis
2.3 Aims of study
2.4 Materials
2.5 Methods .
2.6 Results
2.7 Discussion
Chapter 3: Synthesis and characterization of mycolic acid containing nanoparticles .
3.1 Introduction
3.2 Hypothesis
3.3 Aims of study .
3.4 Materials .
3.5 Methods
3.6 Results .
3.7 Discussion
Chapter 4: Conclusion
References
Appendix
