Communicable Diseases: Tuberculosis

Tuberculosis is a communicable disease that usually attacks the lungs and some body organs after an extended latent period within the body. The disease is mostly caused by Mycobacterium tuberculosis, which is transmitted to a new host through airborne droplets. The disease is considered a worldwide problem today, and thus, it should be carefully studied and the main aspects of the problem, such as mechanisms of transmission, pathology, complications, epidemiology, and treatment should be addressed. In addition, it is important to identify the methods used by the governments to control the spread of tuberculosis. These aspects will be addressed in the current paper.

Tuberculosis exposure occurs upon sharing of airspace with the patient, who has already been affected by the disease. After the droplet nuclei are inhaled, they are deposited in the terminal airspace of the lung. In the lung terminals, macrophages ingest the droplets and transport the bacteria to the regional lymph nodes (Madkour, 2011). There can be several possible outcomes of the infection: immediate clearance of the bacilli, latent infection, rapidly progressive disease, and activation of dormant state of the disease (Madkour, 2011). Tuberculosis has two clinical forms: pulmonary tuberculosis, which is the disorder of lungs, and extrapulmonary tuberculosis, that mostly occurs outside the lungs, primary within lymph nodes, bones, kidneys, liver, bladder, and eyes.

Tuberculosis is characterized by the following symptoms: shortness of breath due to the clogging of the respiratory system by the excess amounts of mucus, chest pains, night sweats, and weight loss. Tuberculosis can be suspected during physical examination of the patient, who shows pulmonary symptoms, such as cough, which is initially dry but later become productive (NGC, 2016). Other symptoms, which are common in patients with tuberculosis include tracheal shift, tachypnoea, bronchial breath sounds, and dull percussion note. If remains untreated, tuberculosis may result in numerous complications for the patient.

Complications of Tuberculosis

Hemoptysis

Haemoptysis is coughing out blood-stained mucus, mainly from the trachea, larynx, bronchi, and lungs. This complication is usually common for the advanced stage of the disease. It can be either minimum, moderate or massive. Minimum hemoptysis is characterized by inflammation of capillaries and finally, their breakdown (Madkour, 2011). When hemoptysis is extensive, it indicates the flooding of the tracheal tree and is followed by erosion of the lung walls.

Cor-Pulmonale

Cor-pulmonale is alteration in structure of the right ventricle of the heart due to occurrence of pathological processes in the respiratory system. It mainly continues to destruction of the pulmonary vasculature and vasoconstriction (Castelnuovo, 2010). A patient with cor-pulmonale always experiences cyanosis and dyspnoea as the major signs and symptoms of this complication.

Dissemination

Dissemination is most common in infants and in immunosuppressed individuals. It is characterized by lesions appearing in the lungs, spleen, and liver (Schlossberg, 2012). Onset of dissemination is usually indolent and it is associated with fever, malaise, weight loss, and hepatosplenomegally. Due to spread of the bacterium within the human body, extrapulmonary type of tuberculosis develops. When Mycobacterium disseminates in the body by haematogenous pathway, a classical type of tuberculosis, called military tuberculosis, develops in patients.

Pleural Effusion

Pleural effusion is a build-up of fluid between the lungs and the lining of chest cavity within the region, which is referred to as pleural space. The development of this condition is caused by fluid seeping into the pleural space (Madkour, 2011). Patient that has pleural effusion has the following signs and symptoms: pleuritic chest pain, toxaemia, and exertion dyspnoea.

Tuberculosis Emphysema

Tuberculosis emphysema is an outcome of chronic infection in the pleural space due to high number tuberculosis bacilli present in the region. It is mainly characterized by the thickening of pleural fluid. Other complications include abscess, bronchiectasis, and spontaneous pneumothorax.

Treatment of Tuberculosis

The primary goal for treatment of tuberculosis include preventing the development of drug-resistant strains. This will help minimise the development of complications associated with the disease. Prevention of transmission of the infection is also a goal, which is achieved by treatment of the disease. Tuberculosis treatment suggest the complete cure of the disease. Finally, treatment tuberculosis is important, because it prevents from the relapse, which normally occurs, when tuberculosis is incompletely treated and becomes a chronic infection.

Treatment of tuberculosis follows some fundamental principles, such as usage of antibiotic combination rather than single drugs, and ensuring that medication is taken by the patient during the entire six to eight months course of treatment (Denholm, Sreet, Mcbryde, & Eisen, 2012). Patients with tuberculosis are usually prescribed four drugs for the first two months to reduce the bacillary load. This phase of treatment is called the intensive phase. After the intensive period, drugs are further administered for four to six months, which is a continuous phase. The most commonly used antibiotics include rifampicin, isoniazid, pyrazinamide, ethambutol, and streptomycin as first-line treatment (Denholm et al., 2012). Second-line treatment drugs include fluoroquinolones, linezolid, kanamycin, amikacin, and cycloserine.

During the intensive phase, which usually lasts for the first two months, the following drugs are administered: isoniazid, pyrazinamide, rifampicin, and ethambutol. After the intensive phase, the patient is considered to be undergoing the continuous period, which usually takes four to six months (Denholm et al., 2012). The drugs used during this phase include isoniazid, which kills the rifampicin-resistant strain, and rifampicin, which kills the dominant bacteria. Ethambutol is also used during this period of treatment.

For drug-resistant tuberculosis, the duration of treatment is different to the newly diagnosed cases caused by sensitive bacteria. In this case, the intensive course of therapy usually takes eight months, followed by the continuous phase which takes 12 months. It should be mentioned that for the patients, who have received previous treatment against the drug-resistant TB, the duration of treatment should extend to 30 months. The drugs used during the intensive phase of treatment against drug-resistant tuberculosis include kanamycin, prothionamide, levofloxacin, cycloserine, and pyrazinamide. In case of the continuous period, the applied antibiotics include prothionamide, pyrazinamide, cycloserine, and levofloxacin (Denholm et al., 2012). Therefore, tuberculosis is a serious disorder, which requires long-term treatment and should rather be managed at the initial stages for the more effective recovery.

Mortality, Morbidity, Incidence, and Prevalence

Tuberculosis is the most prevalent infectious disease, and it was declared by the World Health Organization as a global health crisis. Humans are considered as reservoir of the infectious agent. World Health Organization estimates that two billion people are supposed to have latent tuberculosis while around three billion die every year from this malady (Madkour, 2011). It is considered that people with tuberculosis can infect approximately 10-15 other people through close contact within a year.

Tuberculosis is a reportable disease. Patients, who experience continuous cough for more than three weeks, should inform the health worker and undergo testing for the disease, if tuberculosis is highly suspected. Such approach is important, because identification of disease at the earlier stages ensures timely start of the effective treatment, which helps avoiding the complications of tuberculosis, as the risks for their development are higher in case of untreated disease.

Risk Factors for Development of Tuberculosis

Immunosuppressive Conditions

It was identified that HIV co-infection is the most common immunosuppressive risk factor for the development of tuberculosis (Schlossberg, 2012). HIV infection increases the chances for reactivation of latent tuberculosis, which also increases the rate of progression following primary infection, or reinfection with tuberculosis. In addition, HIV co-infection exacerbates the severity of tuberculosis progression. Cell-mediated immunity is a crucial component of host defence mechanism against Mycobacterium tuberculosis, which is always weakened by HIV infection, and therefore, this disease results in reactivation of tuberculosis.

Diabetes and Other Risk Factors

Diabetes increases the risks for tuberculosis, because it impairs the innate and adaptive immune response and, therefore, progression of disease accelerates (Madkour, 2011). Other factors that increase the risks for tuberculosis infection include age, alcoholism, tobacco smoking, malnutrition, malignancy, and use of steroids. All these conditions lead to the suppression of immune system and hence, rapid replication of bacteria causing tuberculosis within human organism.

Epidemiologic Triangle

Epidemiologic triangle is a model, which is used by scientists in explanation of spread of infectious diseases, as well as development of measures for its prevention. The triangle contains three vertices: the agent that causes the disease, host, which is susceptible to disease, and environmental factors that contribute to disease transmission. Tuberculosis can be characterized by the triangle with the three named components. The important characteristics of host in case of tuberculosis include age, gender, malnutrition, diabetes mellitus, and immune status. The environmental factors and social factors include occupational risks, alcohol, smoking, crowding, and poor ventilation (Schlossberg, 2012). The agent of disease is Mycobacterium tuberculosis, which has a number of strains characterized by variation in their virulence (Madkour, 2011). Thus, tuberculosis can be described from the perspective of epidemiological triangle, as this infectious disease includes all the basic components.

Public awareness on tuberculosis should be put into consideration to avoid and reduce the number of tuberculosis-related deaths. In schools, for example, the students should always be taught and made aware of how to minimise tuberculosis spread, and they should be advised against smoking and drinking too much alcohol, as these are the risks factors for reduction in the activity of immune system. The students should be educated about the importance of proper ventilation in rooms and classes, where they study (Madkour, 2011). It is also important to deliver the same knowledge to the community, because it is likely to provide higher level of control over spread of disease and reduction in the number of tuberculosis-related deaths.

The community nurse should always adhere to professional ethics, while handling the patients. If tuberculosis is suspected, the nurse should suggest laboratory diagnosis for the patient to confirm the diagnosis. It is also a responsibility of nurse to educate patients about the disease. When the lab report confirms that a patient has tuberculosis, the nurse should design the correct regimen for the patient and ensure that the patient is educated about the importance of drug compliance (Castelnuovo, 2010). During the follow-up, the nurse should monitor for tolerance to the prescribed drugs, as well as report any adverse effects to the physician in charge. The nurse should also document the patient’s response to treatment and record cases of patient noncompliance for special monitoring.

Centers for Disease Control (CDC) and Prevention is one of the national agencies, which contribute to control and prevention of tuberculosis. The organization contributes to treatment of the disease by controlling access to drugs. They have lowered the cost of antibiotics used in the treatment of disease and also control the quality of drugs. CDC has also helped in development of testing techniques that can easily and rapidly detect tuberculosis infection, and hence, allows for timely implementation of treatment (CDC, 2017). CDC also organizes educational program that inform general public about the dangers of tuberculosis and the ways, in which tuberculosis can be controlled and controlled. The organization also helps to control the infection by training of the healthcare workers about recently introduced effective ways of diagnosis and treatment.

Global impact of tuberculosis is that it occurs in every part of the world. It was reported that Asia had the highest rate of disease development, followed by Africa in 2016. It was identified that 87% of new tuberculosis cases occurred in 30 high-burden countries in 2016 (NGC, 2016). Tuberculosis is not an endemic disease, since it affects people across the globe and hence, is termed a global crisis. The control and preventive measures for this disease are the same across every country. At the same time, antibiotics used for the treatment of tuberculosis are also the same. During the management of tuberculosis, it should be ensured that the patients are educated about the ways of prevention of further disease spread.

Conclusion

Tuberculosis is a communicable disease that should be immediately treated upon diagnosis to avoid the spread of the disorder to healthy individuals. The disease is easily transmitted, and therefore, healthcare workers are advised to isolate the affected patients. Persons receiving medication against tuberculosis should also be well-educated on the importance of drug compliance to ensure complete cure from the disease. Countries, where tuberculosis occurs at the highest rate, should adopt policies for disease control and prevention in collaboration with relevant organizations. In this way, tuberculosis and its negative outcomes for the human population can be overcome.

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