Category: Tuberculosis

Introduction

It is eminently considered that many of us carry around multiple conceptions of identity. Identity is perceived as “multifaceted and fluid,” (Davis, 2012, p. 636) due to digitalization and globalization in this postmodern era. YouTube is a cultural form that highlights this concept of identity as multiple. YouTube is a global online platform, accumulating millions of users in one space who upload and view videos of all kinds. Instantaneously, YouTube connotes the existence of multiple identities such as vloggers, artists, comedians, gamers, educators, and many more. However, multiplicity is also demonstrated in-depth, through individuals within the YouTube space. This essay solely focuses on a YouTube creator, Lilly Singh, who is associated with the username ‘Superwoman’ [she will be referred to as ‘Singh’].

Singh is widely known for her comedic skits, though her fan-base has grown immensely and she has since accumulated various roles on social media. At a first glance, Singh exhibits a performative identity on her primary channel through comedic skits of her dressed up as her parents. However, she has an underlying identity in her secondary vlog channel that invites audiences to her work ethic and gender activist passion. From this, Singh implies identity as multiple, because she simultaneously showcases her performative, productive, and activist sides. Therefore, this essay provides a background to Singh’s career, a discussion of social media and identity, following an investigation of Singh’s performative, productive and activist identities, overall accentuating how Singh illustrates the perspective of identity as multiple.

Background to Lilly Singh

To conduct an analysis of Singh’s identities, we must understand her popularity within and beyond the YouTube space. Since joining the platform in 2010, Singh has accumulated over fourteen million subscribers and three billion views on her primary channel. She initiated her channel with comedic skits about lifestyle, her Canadian-Indian heritage, and gender.

As her fan-base grew, she professionalized the production of her videos and diversified her content with raps, challenges, speeches, and collaborations with celebrities. Singh has expanded her brand exponentially. Alongside her primary channel, she posts vlogs on her secondary channel that has over two and a half million subscribers. She has released a New York Times best-selling autobiography, How to be a Bawse. She has performed a world tour around 27 cities, and from this, produced a documentary film, A Trip to Unicorn Island. She is also a Global Goodwill Ambassador for UNICEF, constantly raising awareness on education equality. Additionally, Singh has announced A Little Late With Lilly Singh, becoming the first woman of color to host a late-night talk show (Squires, 2019).

Her work ethic has not been unnoticed, as she has appeared on Forbes’ list of the World’s Highest Paid YouTube Stars in 2015 and Top Influencers for Entertainment in 2017 (Forbes, 2018). Singh is a relevant example for examining identity because she encapsulates how one can create an identity on the platform, and use it to evolve and widen it further.

Role of Social Media

Singh is regarded as a celebrity, and it is noticeable that social media plays a large role in the formation of identity, which can perhaps attest to the idea of Singh’s identity as multiple. It is evident that due to “fast-paced technological advances and rising globalization,” (Davis, 2012, p. 636) people’s identities are heavily affected by the complexity of society.

Burke and Stets (2009) argue that the greater the number of people exposed to one’s activated identities, “the greater is the level of common commitment to the identities,” (p. 141) and this applies to Singh’s identities when considering the case of social media and fans. As her fan-base grew larger, more people were exposed to her performative identity, prompting her to prioritize her social media presence. However, when celebrities become accustomed to validating their popularity through the number of fans and likes that they accumulate, they “may become overwhelmed by events with respect to one identity and suffer performance degradations” (Burke and Stets, 2009, p. 144). This might explain the reduction in the frequency of comedic skits over the past year, as she may have become overwhelmed with the high demand, and rather became consistent with her secondary channel, which portrays a raw and unscripted identity. Regardless, there is a relationship between social media and identity, because celebrities like Singh continue to align what that they portray in the media according to what they assume their fans prefer.

Multiple Identities

Our identity as a whole is put together in pieces, and each piece relates to different experiences. The academia of Cultural Studies works with an anti-essentialist conception of identity, most notably because in this era, identity has become “mobile, multiple, personal, self-reflexive, and subject to change” (Kellner, 1995, p. 231). Some individuals have little control over choosing what features make them identifiable as these are rather determined socially (During, 2005), and for Singh’s case, she gained her initial recognition as ‘Superwoman’ socially through the identity that she projected in the media. Everyone has a private identity that belongs to them personally, yet viewers gain a glimpse of Singh’s personal identity in the media because of how intensely involved she is in this sector.

Likewise, some perceive identity formation as a linear process that is developed in stages as life progresses, “each time incorporating relevant social stimulus from the individuals’ environment,” viewing identity as a “multi-faceted phenomenon” (Koles and Nagy, 2012, p. 3). Joining this perspective are Alvesson et al. (2008), who acknowledge that identity is constantly evolving and is not a fixed essence, considering “the presence of multiple, shifting, and competing identities” (p. 6). Multiple identities do not always operate in isolation; we activate the different selves present within us according to the situations that we place ourselves in. Singh stated in one interview, “I love YouTube and I believe in the power of the digital space, but I want to have my feet in both of those areas,” (O’Connor, 2017) suggesting that Singh’s identity has multiplied when there were more roles available for her. This view suggests that the complexity of the self is correlated with the complexity of society, due to the diversification of groups and roles (Burke and Stets, 2009, p. 132; Koles and Nagy, 2012).

Additionally, if there are identities that share common meanings, such as Singh’s representation of her productivity and activism, they are likely to be expressed together. Burke and Stets (2009) however suggest that common meanings across identities are problematic because if there is a problem experienced in one identity, it will produce a domino-effect among the others. This suggests that Singh consistently advocates her productivity on the media, because any problem could affect the frequency of her performative or activist identities. As discussed, social media and changing contexts generate the development of multiple identities, making identity a fluid concept.

Performative Identity

Performative identity can be seen as a constructed identity that aims to entertain audiences, involving an amplification of certain parts of one’s identity in an artistic manner. Singh’s most-viewed videos are those of a one-woman skit with her dressed up as her mother and father, commenting on typical behaviors that Indian parents display. She comically exaggerates these behaviors as a method to break any taboos and present them as stereotypes. In one video, “Back to School Shopping With Cheap Parents,” Singh uses satire and humor to explore the stereotype of Indian parents being cheap shoppers. In the video, Singh dresses up as her mother, who asks Lilly to buy items that are on sale, providing unrealistic reasons to her about items that are not on sale. Singh here is not depicting her authentic identity through the characters she plays, but gains recognition for her entertainment and performative abilities.

Singh is aware that her performative side is the catalyst to her fame status. She claims that her “relatability” makes her videos globally attractive, because the audience is “watching somebody who is exactly like them and talking about things that they experience as well” (Srinivasan, 2015). Likewise, in an interview on Jimmy Kimmel Live!, Singh (2018) stated, “I was not in a good place and I think I was really authentic on screen and I was relatable to an audience,” suggesting that her performative identity unveils areas of her personal identity. Public self-consciousness must be considered when looking into which parts of one’s identity is displayed at a given time. Public self-consciousness focuses on social qualities involving “an individual’s appearance, mannerisms, style, and other externally decipherable characteristics,” and this is elicited when other individuals or objects such as a camera are present (Koles and Nagy, 2012, p. 4). Self-consciousness plays a role in “maintaining the integrity of an individual’s identity,” (Koles and Nagy, 2012, p. 5) and Singh may engage in self-consciousness to ensure consistency of her performative identity with regards to entertaining and exhibiting parts of her personal identity. Her performativity is a part of her identity, regardless of whether she is another character, because this is the fundamental basis towards her popularity and identity formation.

Productive and Activist Identity

Alongside her performative identity, Singh projects contrasting identities on YouTube that characterize her productive and activist sides. As summarized by Squires (2019), “Singh has an auxiliary YouTube channel with her unscripted content,” merging her personal identity with her professional identity. These videos revolve around her work ethic, encouraging productivity and hustling harder. The vlogs are formatted in the style of a video game, as Singh begins each video with a mission, marking every task as a target to be conquered, and accumulating points whenever she accomplishes them. These vlogs uncover a glimpse of a raw identity, given that she showcases the behind-the-scenes of her career, contradicting the high production quality of her primary channel videos. Singh displays new representations of herself to simultaneously build her overall identity, strengthen her relationship with her viewers, and cater to a broader range of audiences.

Connecting celebrity with identity, the celebrity has the power to “construct a relationship with their audience that is independent of the vehicles in which they appear,” allowing the celebrity to have a personal and professional motivation to construct an identity (Turner, 2014, p. 15). Additionally, “the differences between the different locations of celebrity do not matter,” (Turner, 2014, p. 22) given that fans still follow Singh regardless of whether she is representing her performative or unscripted identity. It is also argued that “people have different levels of commitment and salience for each of the identities,” (Burke and Stets, 2009, p. 142) which could explain why Singh posts more frequently on her secondary channel, because unlike her production videos, she is in control of the camera and her words, allowing her to be more vulnerable to her audience. In an interview, when asked about her relationship with her audience, Singh replied:

Transparency is everything in this business. My fans feel like they know me, feel like I’m accessible to them … so my relationship with them is all about authenticity … It’s a new culture of doing business as a human, not as a corporation. (Schomer, 2019)

Singh expresses that the purpose of her unscripted identity is to present her authentic self in order to strengthen the bond with her audience. Conversely, she voiced in an interview on The Tonight Show Starring Jimmy Fallon, “my journey on YouTube has very much taught me to be comfortable with who I am,” (Singh, 2017) demonstrating the idea of identity as multiple, because Singh has found a way to maneuver her social media presence and identities to develop her individuality.

Moreover, we must not overlook the importance of Singh’s activism, as this interacts with her productive identity. Singh is a passionate activist for education and gender equality, and is recognized for being a UNICEF [United Nations International Children’s Emergency Fund] Goodwill Ambassador, in which she utilizes her YouTube platform to advocate about these issues. Many consider that “the weight of identities changes across time and space,” (During, 2005, p. 146) which applies to Singh’s identities because her emphasis on education and feminism amplified as these issues were increasingly circulating in the media. Singh applies her “UNICEF title to create videos that raise awareness for children’s education” and weaves this “into her own brand of comedic, visual storytelling” (Sinnenberg, 2017). It is explicit that her activism is another identity and is an example of how Singh has developed identities beyond the YouTube space. To aid her activism, Singh has created GirlLove, a campaign that fights girl-on-girl conflicts, and Singh has created videos on both her primary and secondary channel promoting the importance of females supporting each other. As indicated, Singh’s videos not only fulfill the purpose of entertaining, but also informing and educating, forming multiple identities based on her different contexts.

Conclusion

This essay explored the multiple identities within Lilly Singh, discussing her performative identity as ‘Superwoman,’ and her productive and activist identities. Her performative identity is constructed for entertainment and is the basis that gave rise to her popularity. It made her aware of her relatability, stimulating the creation of her productive and activist identities on her secondary channel, enabling her to further her relatability in an unscripted, personal, and vulnerable format. These various identities are not pure contradictions, as she is not closing out a part of her identity to showcase another part. Instead, her performative, productive, and activist sides intertwine and combine to holistically define her as an individual.

Ultimately, identity is a fluid and multidimensional concept that we all carry around multiple versions of. In this postmodern era, especially with the prominence of social media, there exist various expressions of identity for different purposes such as entertainment, vulnerability, and awareness. We activate particular identities depending on situations that we place ourselves in, and the concept of identity has become more intricate to align with the complexity of society.

The definition of evolution according to the oxford dictionary is ,” The process by which different kinds of living organism are believed to have developed from earlier forms during the history of the earth.” Mycobacterium tuberculosis is a pathogen which belongs to the ‘Mycobacteriaceae‘ family it is commonly known to cause tuberculosis. The question is how exactly did Mycobacterium manifest into the bacterium it is today? Did it evolve in humans and only humans or did it first emerge from another biological organism? Hence did factors of the environment such as climate/temperature change engage in the evolution of Mycobacterium Tuberculosis?

The following will be evaluated and investigated through: the history of the development of mycobacterium tuberculosis throughout the world, the relationships between Mycobacterium tuberculosis and humankind (also other organisms such as animals), how technology has provided perspicacity towards the evolution of Mycobacterium tuberculosis and the state of the bacterium from the present proceeding towards the future. The following facets will provide necessary knowledge required to devise a response for the constructed question related to origin and climate change in relation to Mycobacterium tuberculosis.

The origin and analogy between humans and other biological organisms in relation to Mycobacterium tuberculosis plays a cardinal role in the understanding of how to potentially “ control and eliminate the lethal disease”. As a result to Dr Robert Koch’s1 (1882) discovery of Mycobacterium tuberculosis many thereafter have evaluated ways on eliminating the Mycobacterium tuberculosis. In order to record and devise information on a topic one needs to deduce its relationships (past and present) and origin in order to evaluate its development and reduce its effects.

History of disease Tuberculosis and spread of Mycobacterium tuberculosis throughout the world

Approximately 70 000 years ago it is presumed that the tuberculosis bacteria originated through early humans of that period in the African region. Sarah Pruitt 2 (2018, p3)provides information in a History article of how scientist have accumulated research that stipulates how Mycobacterium Tuberculosis originated during the Neolithic Revolution 3. The article further explains that the findings led these scientists to believe that due to the Neolithic revolution Mycobacterium Tuberculosis ‘originated in animals and was then passed down to humans’(Pruitt,2018,p3). They deduced this due to the increasing phase of domestication of animals during the specific Neolithic period. Although Sebastien Gagneux 4 and the Swiss Tropical and Public Health Institute (2018)and other international researchers stated a more alternate conclusion with the research they obtained.

They collected 259 tuberculosis bacteria in different parts of the world and formulated an evolutionary genetic link which enabled them to study human history with the bacteria. This helped them deduce that the bacteria originated approximately 70 000 years ago in early humans in the African region and not in animals. The bacteria then spread due to the observed migration of the early human and increased due to the increase of the population. In order for the bacteria to survive this long Sebastien Gagneux (2018, p5)and many other researchers have deduced that the bacterium stayed dorment in its hosts for approximately 20 000 – 30 000 (years ago) and re-emerged later as means of survival.

The proof of migration and re-emerging is evident in some of the suggested later findings in Ancient Egypt. Elizabeth A. Talbot and Brittany J. Raffa 5 (2015, p1) (in an article 6 stated that it was discovered that in Ancient Egypt numerous mummies were found to have Tuberculosis approximately 5000 BCE. This shows the possible evidence to how the spread of tuberculosis occurred due to migration.

The internal and external spread of tuberculosis7 can occur through the air. An infected host can spread the bacterium through coughs or sneezes. This is because the particles emitted contain infectious bacterium resulting in another host who inhales those particles to become infected.

Relationship between Mycobacterium tuberculosis and humankind

Mycobacterium Tuberculosis is the cause of Tuberculosis in humans which occurs/develops in the lungs of a living host. The bacterium needs a living host because it is a pathogen8.

Tuberculosis occurs in the human body in two ways such as: Latent TB or Active TB. Latent TB is when the host contracts Mycobacterium Tuberculosis although the bacteria remains alive while being dormant. This type of TB cannot be spread to other individuals (a result of a stronger immune system). Active TB occurs when the host is infected with Mycobacterium Tuberculosis and the bacteria settles in their lungs and starts to multiply and spread (a result of a weaker immune system). Therefore the bacterium is able to spread to other individuals.

Zoonotic tuberculosis occurs in animals and according to the International Union Against Tuberculosis and Lung Disease (2018,p10)research has been formulated which stipulates that the bacteria can be spread into food supplies (such as cheese, milk etc.). The bacteria can also be spread through direct contact between animals and humans ( such as domestic livestock).

An additional fact relating to the relationship between mycobacterium tuberculosis and humans according to the World Youth Organization (2018, p8)is that statics show that people with HIV/AIDS are 20 – 30 times more able to contract the bacterium more easily, children are also more likely to contract the bacterium (as in 2017, 1 million children contracted tuberculosis and 230 000 children died). This leads to the deduction that those with weaker immune systems are more likely to be infected by Mycobacterium Tuberculosis, which results in tuberculosis one of the top 10 causes of human deaths in the world.

How improved technology has provided insight to the evolution of Mycobacterium tuberculosis

The rate of the spread of tuberculosis according to the World Health Organization(2018, p1)has said to be decreasing worldwide by 2% each year. This decrease is due to better understanding of the bacterium, more resources and improved technology.

Improved technology and better understanding can be shown through the development of genotyping9 (genotyping term was coined by Wilhelm Johannsen10). Genotyping according the National Center for Biotechnology Information (2018)has now developed more ways for researchers to identify strains that occur in the bacterium such as drug resistance. The genotype of Mycobacterium Tuberculosis is named ‘Beijing’ it is the group/family name for the genotype containing multiple strains.

According to Centers for Disease Control and Prevention (National Center for Health statistics,2018) genotyping is essential to the in-depth detail of the evolution of Mycobacterium Tuberculosis. This information is fundamental as it provides more insight of the relationship between Mycobacterium tuberculosis and humans and their genetic similarity which enabled that bacterium to survive for generations thereafter its origination and dormant phase. Genotyping is important as it enables doctors to diagnose the host through their genotypes and find/create ways to alter the effects of the bacterium.

Another relation to technology and Mycobacterium Tuberculosis is CRISPR11 (Clusters of Regularly Interspaced Short Palindromic Repeats). CRISPR is technology used as a genome silencer or alternator. According to an article by Biomed Research International (Wolf.J,2019.) CRISPR in relation to Mycobacterium Tuberculosis is used to explore the adaption of drug resistance within the bacterium, many researches were accumulated which helped researchers understand the adaption of Mycobacterium Tuberculosis. Further studies are ongoing which is fundamental for the future of the bacterium.

The present and the future

Present

According to medicinenet.com in simplified terms drug resistance is defined as “the ability of bacteria and other microorganisms to withstand a drug that once stalled them or killed them”. The present problem of Tuberculosis is that Mycobacterium tuberculosis has started to adapt and evolve which has resulted into drug-resistant TB. According a report by the UN Interagency Coordination Group (IACG) on Antimicrobial Resistance (Pai.M, 2019) globally drug-resistant tuberculosis contributes to 230,000 deaths per year. The current prevention strategies and treatments include the decrease of spreading the disease through respirators and masks, the BCG vaccine12 ,increase in education about tuberculosis, chemoprophylaxis13, isoniazid14. With more knowledge about prevention to tuberculosis more research is being used to eliminate the current problem of drug-resistant tuberculosis. This involves the improvement of technology through genotyping and CRISPR which can help explain and remove the genome which enables the bacterium to become drug resistant.

Climates change

according to an article by the national center for biotechnology information (2018)mycobacterium tuberculosis does not die at temperatures below 100 degrees Celsius. According to the national Centers for environmental information (2019)global warming is indicated at an average temperature of 70 degrees Celsius which means there is no effect upon the bacterium. According to The Brazilian Journal of Infectious Diseases (2015)a research study showed that the bacterium was widely more spread during winter and people were more likely to contract tuberculosis during colder periods15.

Future

The future goal for scientists when dealing with the bacterium and tuberculosis is to eliminate it. According to the national center for biotechnology information (2019)it is stated that current research was done to show a genome connection between mycobacterium tuberculosis and humans , this resulted in the development to study gene silencing16 the connective genome for the elimination of mycobacterium tuberculosis. The complete extinction of the Bacterium is not fully researched as the according to many sources it had largely spread and the extraction of it through the world according to an article by sahivsoc.org Richard E. Chaisson, MD

Center for AIDS Research Center for TB Research Johns Hopkins University states that the eradication of tuberculosis by 2050 is probably not possible.

Conclusion/Discussion

In summary and in relation to the question of environmental factors and bacterium relation to animals and humans ; the bacterium occurred through the development of early humans and later pasted on to animals through domestication. Although the able transfer between bacteria, animals and humans indicate a possible related

genome which is currently being researched through genotyping, CRISPR and further technology. The external factors such as temperature/climate play a minimal role in the contraction of tuberculosis. As in colder climate /temperatures the contraction of the bacterium can occur more likely and the bacterium in warm heat still survives over temperatures of 50 degrees Celsius therefore global warming won’t necessarily have a drastic change in the bacterium. The elimination of the bacterium is not completely attainable but the development of more attainable treatments and silencing of resistance genes create a solution for the decrease of tuberculosis spread and better evolutionary success of the human population.

ABSTRACT

This audit on aspiratory tuberculosis incorporates an presentation that depicts how the lung is the entrance of section for the tuberculosis bacilli to enter the body and after that spread to the rest of the body. It depicted the mode of transmission and the pathogenesis of pneumonic tuberculosis. The safe reaction to the infection moreover with the signs and indications for both sorts of the aspiratory tuberculosis. In this paper carried by the understudies, its incorporate the complications for essential and auxiliary aspiratory tuberculosis the final but not the list it keep few words almost the avoidance and medications for the disease.

INTRODUCTION

It is characterized as an dynamic contamination of the lungs (Latin pulmo = lung). It is the foremost imperative TB contamination, since an contamination of the lungs is profoundly infectious due to the mode of bead transmission. The malady can moreover influence the other parts of the organs in spite of of the truths that it’s the respiratory infection.

Transmission mode is when the Irresistible bead cores are created when people who have aspiratory or laryngeal TB illness hack, wheezes, yell, or sing additionally has hereditary history.

The foremost abundant antimicrobial variables within the lungs are lysozyme, lactoferrin, and secretory leukocyte proteinase inhibitor. Lactoferrin, a glycoprotein discharged by mucosal epithelium, can anticipate both DNA and RNA infections from contaminating cells by specifically official infection and blocking have receptors utilized by infections to pick up passage into cells.

Mycobacterium tuberculosis is the life form that’s the causative specialist for tuberculosis (TB). Minutely, the aggravation delivered with TB contamination is granulomatous, with epithelioid macrophages and Langhans giant cells beside lymphocytes, plasma cells, maybe a couple of PMN’s, fibroblasts with collagen, and characteristic caseous corruption within the center.

Pneumonic complications of TB can incorporate hemoptysis, pneumothorax, bronchiectasis, broad pneumonic devastation, harm, and inveterate pneumonic aspergillosis.And too spinal torment, joint harm, heart clutter, meningitis and liver or kidney issues.

RESEARCH GOALS OR OBJECTIVES

• Describe the mode of transmission of pulmonary tuberculosis.
• Explain the immune response against tuberculosis infection.
• Describe the pathological features of pulmonary tuberculosis including the gross and microscopic features.
• Describe the complications of primary and secondary pulmonary tuberculosis.

TRANSMISSION OF PULMONARY TUBERCULOSIS

Tuberculosis (TB) is transmitted from an tainted individual to a vulnerable individual in airborne particles, called bead cores. These are 1–5 microns in breadth. These irresistible bead cores are minor water beads with the microscopic organisms that are discharged when people who have aspiratory or laryngeal tuberculosis hack, sniffle, snicker, yell etc. These modest bead cores stay suspended within the discuss for up to a few hours. Tuberculosis microbes, (Mycobacterium tuberculosis) be that as it may are transmitted through the discuss, not by surface contact. This implies touching cannot spread the contamination unless it is.

THE IMMUNE RESPONSE AGAINST PULMONARY TUBERCULOUS EXPLAIN INFECTIO

Aspiratory tuberculosis is characterized by granulomatous aggravation, which may result in broad fibrosis and tissue damage.monocytes (mn)/macrophages particularly alveolar macrophage are the common have for M.tuberculosis. They can decrease the development of mycobacteria and obtain resistant actuation by CD4+ and CD8+ T-cell is fundamental for controlling the disease.

Natural reaction against mycobacterium tuberculosis, The centrality of natural insusceptibility within the defense against Mtb stands out clearly as we consider the MSMD where a disturbance of the intrinsic pivot leads to sensational, life-threatening clinical introduction of TB . In addition, PRRs actuation leads to the generation of incendiary cytokines and to the actuation of mucosal-associated invariant T cells fortifying IFN-γ and tumor rot figure (TNF)-α generation. Macrophage is Whilst IFN-γ may be a key component within the control of Mtb inside the MΦ, it is presently broadly recognized that performing this work requires the nearness of vitamin D.However it increments phagosome development and the generation of antimicrobial peptides through the maximal direction of the hCAP-18 quality encoding for cathelicidin antimicrobial peptide which actuates, in turn, the translation of autophagy-related qualities so it endeavors to square the entry of supplements to the Mtb such as press and manganese. Neutrophils are intrinsic resistant cells involved within the prepare of slaughtering Mycobacterium tuberculosis early amid contamination, Once the mycobacteria enter the human system, neutrophils sense and immerse them. By releasing bactericidal proteins and α-defensins like human neutrophil peptides stacked in their granule armory, neutrophils kill the pathogen. Periphery blood neutrophils transmit a wide run of cytokines like IL-8, IL-1-β and IFN-γ in response to mycobacterium co. so there are numerous other sorts of natural safe reaction e.g. like common executioner, dentric cell so they can play a extraordinary part in protecting the body against mycobacterium tuberculosis disease.

The pathological features of pulmonary tuberculosis including gross and microscopic features.

Most pathologists are commonplace with the little highlights of tuberculosis and they have to be seen at unprecedented stains for acid-fast microbes (AFB) in cases of a granulomatous lung ailment. Be that because it may, misinformed judgments do exist, checking the concept that finding AFB in ‘caseating granulomas’ confirms the assurance of tuberculosis

Cavitating aspiratory TB: Wide spoil with cavitation, commonly happening inside the upper lung or apex, maybe a characteristic highlight of ‘assistant’ or ‘grown-up sort’ tuberculosis. Ordinarily likely related to assurance of M. tuberculosis from a prior fundamental illness. Cavities shape when spoil incorporates the divider of a flying course and the semi-liquid necrotic texture is discharged into the bronchial tree from where it is more frequently than not hacked up and may corrupt others. This polluted texture may seed other parts of the lung through the flying courses to convey tuberculous bronchopneumonia. In case swallowed, illness of the G.I. tract may result. Usually he nets of pneumonic tuberculosis.

The complication of primary and secondary pulmonary tuberculosis

Aspiratory tuberculosis is caused by Mycobacterium tuberculosis when globule centers stacked with bacilli are breathed in. In understanding with the damaging tendency of the living being and the resistances of the have, tuberculosis can happen inside the lungs and in extrapulmonary organs. A collection of sequelae and complications can happen inside the pneumonic and extrapulmonary packages of the thorax in treated or untreated patients. These can be categorized as takes after (a) parenchyma wounds, which consolidate tuberculoma, thin-walled profundity, cicatrization, end-stage lung obliteration, aspergilloma, and bronchogenic carcinoma; (b) flying course wounds, which consolidate bronchiectasis, tracheobronchial stenosis, and broncholithiasis; (c) vascular wounds, which consolidate pneumonic or bronchial arteritis and thrombosis, bronchial supply course dilatation, and Rasmussen aneurysm; (d) mediastinal wounds, which join lymph center calcification and extranodal development, esophagomediastinal or esophagobronchial fistula, constrictive pericarditis.so the taking after said complications will be clarified into detail concurring to the two injuries that’s parenchymal injury and the other one with is non instead of aviation routes injury.

Bronchogenic carcinoma and aspiratory tuberculosis regularly coexist, making a troublesome symptomatic issue. Signs of carcinoma may be clouded or confused as the movement of tuberculosis. Tuberculosis may favor the advancement of bronchogenic carcinoma by neighborhood components (scar cancer), or tuberculosis and carcinoma may be coincidentally related. In expansion, carcinoma may lead to the reactivation of tuberculosis, both by disintegrating into a typified center and by diminishing the patient’s resistance (,22–,25). Subsequently, any transcendent or developing nodule should be suspicious for coexisting lung cancer in patients with tuberculosis.

Aspergilloma has a history of tireless cavitary tuberculosis. The prevalence of aspergilloma related to ingrained tuberculosis has been point by point to be 11% (,8). In show disdain toward the reality that aspergilloma may exist for a long time without side impacts, hemoptysis is the first common clinical complication, with a prevalence of 50%–90% (,18). Aspergilloma is customarily found the interior a profundity or ectatic bronchus and comprises of masses of infectious hyphae admixed with substantial liquid and cellular junk and jetsam.

Bronchiectasis may make as a result of tuberculous consideration of the bronchial divider and ensuing fibrosis. Bronchiectasis is seen in 30%–60% of patients with energetic postprimary tuberculosis and 71%–86% of patients with torpid illness at high-resolution CT. In show disdain toward the reality that bronchiectasis in postprimary tuberculosis can be a result of cicatricial branch stenosis after neighborhood illness more commonly it happens by demolition and fibrosis of the lung parenchyma with assistant bronchial dilatation (balance bronchiectasis). Bronchiectasis found inside the apical and back segments of the upper projection is exceedingly suggestive of a tuberculous root. When various apical cavities are experienced, the credibility that cystic bronchiectasis is shown in development to necrotic cavities must be considered.

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Introduction

Tuberculosis as we know it is a chronic, contagious, infectious disease that attacks our lungs. Apart from pulmonary tuberculosis there are also spinal tuberculosis, meningeal tuberculosis as well as the main focus of this assignment, renal tuberculosis. According to MacKenzie (2018:620) renal tuberculosis usually begins in one kidney and then it progresses towards the other kidney. Renal tuberculosis makes itself known through the bladder irritation that is caused and are at first always mistaken for cystitis.

Aetiology

According to Eastwood (2001:1307) renal tuberculosis, like other forms of tuberculosis, are caused by members of the Mycobacterium tuberculosis group. M. tuberculosis, the human tubercle bacillus, is the most common organism that causes renal tuberculosis but M. bovis, the bovine tubercle bacillus is also a major factor in causing tuberculosis (Eastwood, 2001:1307).

Pathophysiology

According to Chijioke (2001:107) the pathophysiology of tuberculosis of the kidneys starts with the first localization of tubercle bacilli in the cortex of the glomerus and this causes stress that ultemately leads to a change in the cell morphology. Krishnamoorthy et al,. (2008:371) is of opinion that the change in cell morphology are called granulomas and they can remain static for a 10-15 years. The presence of tubercle bacilli also causes faster protein synthesis and increased growth of normal glomerular cells as well as the penetrating blood borne cells (Chijioke, 2001:107). This infection can remain in the renal parenchyma without spreading and can result in many forms of glomerulonephritis (Chijioke, 2001:107). According to Sankhe (2014:67) this is the stage where renal tuberculosis occurs as a result of regrowth after dormancy. Sankhe (2014:67) is of opinion that if, at this stage, the infection is not under control or not managed correctly yet, and the hosts’ immune system is diminished, the organism will enter the fluid in the tubular cavity. Further distribution of the bacilli to the medulla and tissues of the pyramid takes place. This causes papillitis that expand into the proximal loop of Henle and this leads to papillary necrosis (Shankhe, 2014:68). It can also lead to the existance of frank cavities that forms abscesses and this leads to the overall scarring of the renal parenchyma (Krishnamoorthy et al,. 2008:372). Krishnamoorthy et al,. (2008:372) also states that together with progression comes formation of lesions in the renal cortex and this results in strictures at the infundibular and pelvi-ureteric junction. This disease can lastly also expand into the collecting system and this results in bacilluria. Renal tuberculosis result in a kidney that does not function as it should, with a large percentage of calcification over the entire area of the kidney and this ultimately leads to renal failure (Krishnamoorthy et al,. 2008:373).

Clinical manifestations

The greater part of symptoms of renal tuberculosis present in the urine, thus the fact that renal tuberculosis is mostly mistaken for cystitis (Sankhe et el., 2014:68). According to Macalpine, (1935:406), the kidneys will appear damaged in approximately 15% of cases of renal tuberculosis, in all the other cases, this only looks like the bladder that is problematic. Presenting symptoms if renal TB is haematuria, dysuria, nocturia, pyuria and frequency (Malcalpine, 1935:406). Other symptoms that occasionally occur is flank, back and suprapubic pain. It can also be associated with lower back pain and suprapubic pain (Eastwood, 2001:1307). These symptoms usually refer to bacterial cystitis and are thus treated with antibacterial treatment (Macalpine, 1935:406). Only when these antibacterial treatments are not successful, further investigations are done and this only when renal TB is found. Usual symptoms of pulmonary TB like malaise, weight loss and low grade fever are not seen with renal TB (Macalpine, 1935:406). When there is pain present in a kidney, it will not necessarily be the affected kidney. The double responsibility that the healthy kidney has now, can also cause pain (Macalpine, 1935:406).

Management

According to John (1956:102) the triple-drug therapy for renal tuberculosis is made up of 1 g Streptomycin twice a week, 100 mg. Isoniazid eight hourly, and 5g. Sodium Aminosalicylic Acid eight hourly. This need to be given simultaneously and without any interruption for one year. It is of utmost importance that there is no relapse and that this medication is finished. Furthermore, Eastwood (2001:1313) added that a short-course drug regimens are effective when it comes to all kinds of tuberculosis. Usually the following four drugs that shown to be very effective in destroying all the tubercle bacilli: Rifampicin, Isoniazid, Pyrazinamide, and Streptomycin. This treatment is only given for 2 months. After this there will be 4 months were only Rifampicin and Isoniazid are given, and this is to demolish the remaining bacilli that might show any signs of resistance. Direct supervision of this therapy should be ensured because of the fact that failure to comply can cause resistant bacilli (Eastwood, 2001:1313). It is of utmost importance that the course must be finished, otherwise resistant bacilli will be the result.

Summary

According to Eastwood (2001:1313) the clinical manifestations of renal tuberculosis imitate the symptoms of other kidney infections. This means that diagnostic awareness can prevent unnecessary death. Diagnosis is extremely difficult, but development in nucleic acid-based bacteriological tests are improving at a very fast rate (Eastwood, 2001:1313). Krishnamoorthy (2008:270) is of opinion that renal tuberculosis is a very common condition but also very difficult to manage due to its various ways of presentation. It is thus of utmost importance that a high grade of suspicion would lead to faster diagnosis and this will lead to a decrease in number of deaths (Krishnamoorthy et al,. 2008:369).

INTRODUCTION

Tuberculosis, is a pathology that caused by bacterial infection that spread by air between people. When it comes to lung, the medical term for this pathology are pulmonary tuberculosis. It may cause chest pain, severe coughing, weight loss and many more.

Pulmonary tuberculosis is a worldwide problem which is can affected to all age, either young or old age. Tuberculosis can divide to two groups which are active and latent forms. For the active disease, it can occur as primary tuberculosis, post primary tuberculosis, developing of latent tuberculosis. Primary tuberculosis usually infect the children.

Normal chest radiography are used to diagnose for the risk and to assess the asymptomatic tuberculosis disease. It is needed because sometimes nontuberculosis mycobacterial disease can mimic of the findings of active tuberculosis which laboratory confirmation is required to make distinction. Conventional imaging is important for the diagnosis and management of the tuberculosis patient. There are three projection that usually used to evaluate pulmonary tuberculosis which are PA erect, AP erect and AP lordotic view.

PA ERECT CHEST

PA erect chest is a very common projection in evaluating thorax cavity. The posteroanterior (PA) chest view examines lungs, bony thorax cavity, mediastinum and vessels and usually used in diagnosing acute and chronic conditions including organs of the thorax cavity. In addition, pulmonary tuberculosis (PTB) is affecting lungs.

To get a good image, the patient is in erect position facing the image receptor with the border of the image receptor is about 5cm above the shoulder and chin is raised up. Rotate the shoulder anteriorly to allow the scapula move laterally off the lung field and shoulder also are depressed to make sure lung apices in profile.

In evaluating PTB in normal chest x-ray, PTB can be found in some condition such as air space nodules in the upper or midzone of the lungs. In addition, thick walled cavity, unilateral hilar and plural effusion or empyema can be indicators to detect PTB.

In the diagram above are images of active TB. In radiograph A, its right upper zone shows consolidation with prominent right hilum. In radiograph B, the images shows multiple coalescent air-space nodules in right lung upper zone. Meanwhile in radiograph C, reticulo-nodular lesions in both lungs with basal predominance can be seen. Scattered air space nodules are seen in both lungs with left hilar adenopathy can be seen on radiograph D. Lastly, the right sided pleural effusion with multiple air-space nodules scattered in both lungs can be found on E image.

AP ERECT CHEST

The erect anteroposterior chest view is performed with the x-ray tube is anteriorly through the patient to form image on the image receptor which is placed behind the patient. The image receptor can be positioned behind a immobile patient. This projection is an alternative to the PA view when the patient is too unwell to standing or leaving the bed. AP projection also examines lungs, bony thorax cavity, mediastinum and great vessel. AP view usually to aid of diagnosis of acute and chronic conditions in intensive care units and wards. This view has lesser quality than the PA view for some reasons but sometimes it is the only projection that available for the patient.

For the positioning, the patient is upright as possible with their back against the image receptor and the chin is raised to avoid included in the image. If possible, placed patient’s hand at side and shoulders are depressed to move the clavicles below the lung apices for better image.

In detecting PTB using this projection, the image evaluation is more like PA projection which are air space nodules and many more. AP erect chest usually done for PTB patient that was immobilized and very unwell to do PA chest.

AP LORDOTIC PROJECTION

Beside PA and AP normal chest projection, there is one special projection that can be used as examination to detect pulmonary tuberculosis. AP lordotic chest radiograph or AP axial chest radiograph demonstrates areas of the lung apices that may be not seen in AP and PA projection. It is used to evaluate suspicious areas within the lung apices that appeared obscured by overlying soft tissue, upper ribs or the clavicles on previous projection.

For the positioning, the patient is standing around 30cm away from the image receptor with back arched until upper back. Shoulders and head are against the IR. The shoulder and elbows are rolled anteriorly with the angle of the tube 45 degrees cephalic to the midcoronal body plane and image receptor. Breathing technique is applied.

CONCLUSION

In this article, I have mentioned the approaching technique that can be used to evaluate pulmonary tuberculosis. There are 3 projection that normally used to diagnose pulmonary tuberculosis. PTB can be found in any age either in children or adults. Thus, selecting the suitable projection are important to evaluate the disease because it is easier to diagnose and set disease management for the patient.

In my opinion, PA chest are the best projection to evaluate PTB. This is proven by using PA projection, all the lung field can be seen in the radiograph. All the requirement that need to fulfil in evaluating this disease can be achieved. Furthermore, PA projection also have better image quality than AP erect chest. Moreover, this projection also is a gold standard for pulmonary tuberculosis and other thorax cavity disease and abnormality. However, if the disease are hidden in the area of the lung apices, AP lordotic can be as a alternative projection to evaluate pulmonary tuberculosis. Besides, using other modalities such as CT scan can be helpful to confirm the disease or act as a supplement for the treatment for pulmonary tuberculosis.

Abstract

Tuberculosis is a disease once incurable but now it can be cured. It basically affects the lungs but other parts maybe effected. It can be treated now. Its symptoms include cough, fever, chills and mucus with blood. Vaccines are available to treat Tuberculosis which decreases the risk by 20% and 60% in children and woman respectively.

Introduction

Tuberculosis (TB) is a communicable disease usually caused by tubercle bacillus (MTB) bacteria. Tuberculosis generally affects the lungs, but also can affect other parts of the body. Most infections don’t have symptoms, during which case it’s referred to as latent tuberculosis. About 10% of latent infections reach active disease which, if left untreated, kills about half those affected. The classic symptoms of active TB are a chronic cough with blood-containing mucus, fever, night sweats, and weight loss. it had been historically called ‘consumption’ thanks to the load loss. Infection of other organs can cause a good range of symptoms.. Tuberculosis is spread through the air when people that have active TB in their lungs cough, spit, speak, or sneeze. Active infection occurs more often in people with HIV/AIDS and in those that smoke. Tuberculosis may infect any a neighborhood of the body, but most commonly occurs within the lungs (known as pulmonary tuberculosis). Extrapulmonary TB occurs when tuberculosis develops outside of the lungs, although extrapulmonary TB may coexist with pulmonary TB.

Observations

The main explanation for TB is Mycobacterium tuberculosis (MTB), a small, aerobic, nonmotile bacillus. The high lipid content of this pathogen accounts for several of its unique clinical characteristics. It divides every 16 to twenty hours, which may be a particularly slow rate compared with other bacteria, which usually divide in but an hour. Mycobacteria have an outer membrane lipid bilayer.If a Gram’s Method is performed, MTB either stains very weakly ‘Gram-positive’ or doesn’t retain dye as a results of the high lipid and mycolic acid content of its cell membrane. MTB can withstand weak disinfectants and survive during a dry state for weeks. In nature, the bacterium can grow only within the cells of variety organism, but M. tuberculosis is often cultured within the laboratory. variety of things makes people more susceptible to TB infections. the foremost important risk factor globally is HIV; 13% of all people with TB are infected by the virus. this is often often a selected problem in Sub-Saharan Africa, where rates of HIV are high of people without HIV who are infected with tuberculosis, about 5–10% develops active disease during their lifetimes; in contrast, 30% of these co infected with HIV develop the active disease. Tuberculosis is closely linked to both overcrowding and malnutrition, making it one among the principal diseases of poverty. Those at high risk thus include: folks that inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g. prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients. Chronic lung disease is another significant risk factor. Silicosis increases the danger about 30-fold. people who smoke cigarettes have nearly twice the danger of TB compared to nonsmokers. Other disease states can also increase the danger of developing tuberculosis. These include alcoholism[14] and DM (three-fold increase). Certain medications, like corticosteroids and infliximab (an anti-αTNF monoclonal antibody), are other important risk factors, especially within the developed world. Genetic susceptibility also exists that the overall importance remains undefined. About 90% of these infected with M. tuberculosis have asymptomatic, latent TB infections (sometimes called LTBI), with only a tenth lifetime chance that the latent infection will reach overt, active tuberculosis disease. In those with HIV, the danger of developing active TB increases to just about 10% a year. If effective treatment isn’t given, the death rate for active TB cases is up to 66%. Diagnosing active tuberculosis based only on signs and symptoms is difficult, as is diagnosing the disease in people who have a weakened system. A diagnosis of TB should, however, be considered in those with signs of lung disease or constitutional symptoms lasting longer than fortnight. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically a neighborhood of the initial evaluation. Interferon-γ release assays and tuberculin skin tests are of little use within the developing world. Interferon gamma release assays (IGRA) have similar limitations in those with HIV. The Mantoux tuberculin diagnostic test is usually wont to screen people at high risk for TB. those that are previously immunized with the Bacille Calmette-Guerin vaccine may have a false-positive test result. The test could also be falsely negative in those with sarcoidosis, Hodgkin’s lymphoma, malnutrition, and most notably, active tuberculosis. Interferon gamma release assays, on a blood sample, are recommended in those that are positive to the Mantoux test. These aren’t suffering from immunization or most environmental mycobacteria, in order that they generate fewer false-positive results. However, they’re suffering from M. Szulgai, M. Marinum, and M. Kansasii. Igras may increase sensitivity when utilized in addition to the diagnostic test, but could also be less sensitive than the diagnostic test when used alone.

Conclusions

Tuberculosis prevention and control efforts rely totally on the vaccination of infants and therefore the detection and appropriate treatment of active cases. the planet Health Organization (WHO) has achieved some success with improved treatment regimens, and alittle decrease just in case numbers. The only available vaccine as of 2011 is Bacillus Calmette-Guérin (BCG). In children it decreases the danger of getting the infection by 20% and therefore the risk of infection turning into active disease by nearly 60%. the planet Health Organization (WHO) declared TB a ‘global health emergency’ in 1993, and in 2006, the Stop TB Partnership developed a worldwide decide to Stop Tuberculosis that aimed to save lots of 14 million lives between its launch and 2015. variety of targets they set weren’t achieved by 2015, mostly thanks to the rise in HIV-associated tuberculosis and therefore the emergence of multiple drug-resistant tuberculosis. A tuberculosis arrangement developed by the American Thoracic Society is employed primarily publicly for health programs.

References

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Abstract:

Tuberculosis (TB) is a bacterial infection that usually infects the lungs, but it can also affect the kidneys, brain, and other organs. The main TB bacterium is Mycobacterium tuberculosis (M. tuberculosis). This bacterium is spread by those who are infected in an airborne manner through droplets. The two main types of TB are latent and active and at present, the successful transmission of drug-resistant M. tuberculosis, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains in human populations, threatens tuberculosis worldwide. Different from many other bacteria, M. tuberculosis drug resistance is acquired mainly through mutations in specific drug resistance-associated genes. Human societal failures have potentiated the evolution of drug-resistant strains of the tubercle bacillus in the United States and around the world. This evolutionary change has been largely posed a threat to the health and survival of the individual whom inadequate therapy promoted the drug resistance.

Tuberculosis (TB) is an infectious bacterial disease that primarily affects the lungs through the respiratory route, but it also can infect other part of organs (Bloom et al., 2017). The main bacterium that causes TB is Mycobacterium tuberculosis (M. tuberculosis) and is belong to the member of Mycobacterium tuberculosis complex (MTBC) which is a group of closely related species that are adapted to human and animals (Echeverria-Valencia, Flores-Villalva & Espittia, 2017). The bacterium also belongs to the family of Mycobacteriaceae, which is characterized by their unique cell wall that made up of mycolic acid and is considered as a slow growing bacterium.

TB has always been the leading cause from a single infectious disease agent, and it accounts for approximately 40% of death in human immunodeficiency virus (HIV) infected patients. (MacNeil, Glaziou, Sismanidis, Maloney & Floyd, 2019). On a global level, one-third of the world population is infected with M. tuberculosis and there are 30 countries that are referred as “high burden” countries, because they account for 87% of all incident cases of TB in 2018 (“Tuberculosis,” 2019). High burden countries are mostly South-East Asia and African countries. There were an estimated 10 million incident cases of TB occurred, and approximately 1.6 million TB related death in the year of 2017 (MacNeil et al., 2019).

The genus, Mycobacterium, originated more than 150 million years ago (Dutta, 2019) and had killed millions of people since then because the disease cannot be identified, and treatments cannot be made due to the lack of diagnosis. On March 24, Dr. Robert Koch discovered M. tuberculosis, which was the first and most important step taken towards the control and elimination of this deadly disease (“Tuberculosis,” 2019).

Vaccination and antibiotics were invented in the year of 1906 and 1944 respectively, and TB incidence progressively declined (Dutta, 2019). Unfortunately, TB showed an increase during the 1990s due to the increase of acquired immunodeficiency syndrome (AIDS) epidemic. AIDS weakens one’s immune system allowing M. tuberculosis to have this opportunity to progress into active TB. Besides that, cases of drug-resistant TB also contributed to the increase of TB incidence because drug-resistant TB shows a significant challenge in TB treatment.

M. tuberculosis is a highly clonal bacteria in the absence of recombination with an extremely conserved genome and a long history of co-evolution with human (Nguyen, Contamin & Bañuls, 2018). M. tuberculosis also has a remarkable capacity of adaptation and the variety of extrinsic and intrinsic processes contribute specifically to the emergence and spread of highly drug-resistant strains (Nguyen et al., 2018). Epistasis is an example of intrinsic mechanism that drive the evolution of antibiotic resistant and it can generate the combination of a set of alleles from different loci (Nguyen et al., 2018). These sets of co-adapted alleles are then favored by the clonal reproductive mode of M. tuberculosis, leads to the spreading within the population (Nguyen et al., 2018).

Drug-resistant TB can be further divided into three categories, which are the multi-drug resistance tuberculosis (MDR-TB) which resistant to first-line antibiotics, extensively-drug resistant (XDR-TB) which resistant to second-line antibiotics and totally drug-resistant (TDR-TB) which resistant to all kinds of antibiotics. Due to the acquisition of mutations, the number of drug-resistant TB, especially MDR and XDR TB cases is progressively increasingly worldwide (Nguyen et al., 2018).

According to a case study conducted from Meacci et al., a male patient from Italy was diagnosed with active TB at the age of 29 and had a history of intravenous drug abuse. He went to Umberto I Hospital in Ancona, Italy with symptoms of TB disease and his chest radiograph showed pulmonary infiltrates in both upper lobes with extensive cavities and his sputum smear shows the presence of acid-fast bacilli. Further blood tests discovered seropositivity to HIV. After the drug susceptibility testing (DST), this patient showed susceptibility to all first-line anti-TB drugs. His treatment including TB chemotherapy and zidovudine (drug for HIV/AIDS treatment) was begun. The patient became poorly compliant with the therapy even though he showed an initial improvement. A 3-year follow-up control has revealed many acid-fast bacilli in smears of gastric aspirate and sputum samples; the strain showed resistant to multiple first-line anti-TB drugs and was identified as MDR-TB. The patient behaved in an aggressive manner towards health care providers and continuing to refuse further follow-up procedures. The patient was again admitted to the hospital with cytomegalovirus retinitis after 7 years of the onset of clinical symptoms. Chemotherapy and more antibiotics were prescribed but the patient once again poorly compliant with the anti-TB treatment and sputum test was performed again in the following year but his TB progress to XDR-TB. 12 years after his initial TB diagnosis, he died from a progressive wasting syndrome.

This case study has clearly showed that M. tuberculosis has the ability in acquisition of mutations in genes that code for drug targets or drug-activating enzymes (Dookie, Navisha, Mahomed, Naidoo, & Kogieleum, 2018). Unlike other bacteria, resistance is not acquired via horizontal gene transfer by mobile genetic elements but mainly in the forms of single nucleotide polymorphisms (SNPs), insertions or deletions and to a lesser extent, large deletions (Dookie et al., 2018). However, mutations causing drug resistance varies depending on the lineage to which the strain belongs according to recent studies (Dookie et al., 2018).

According to Iseman, the environmental factor that is responsible for the rising prevalence of drug-resistant tuberculosis around the globe is humankind (1994). Modern genetic analysis has indicated an extremely high degree of DNA homology between M. bovis and M. tuberculosis, which means that they are virtually the same species (Iseman, 1994). This has brought to a hypothesis that the parent strain of M. bovis, is not very invasive and have posed little disease-producing capacity within human has undergone subtle host adaptation within the human body to become tubercle bacillus (Iseman, 1994). Through this evolution process, the microbe has developed some unique traits: (I) it’s only significant natural reservoir is humans, (II) it has substantially diminished virulence for most animal species other than human, and (III) it has developed a survival-transmission strategy that is unparalleled among the mycobacteria.

Although tuberculosis is a form of bacterium, it is highly resistant to conventional antibiotics, such as penicillin or sulfa. Fortunately, a soil biologist Selman Waksman discovered streptomycin which is one of the substances that has substantial activity against the tubercle bacillus in 1943-1944 and was rapidly pressed into clinical use (Iseman, 1994). Although streptomycin showed an increase in ameliorating disease manifestations, but it was not able to cure the infection because a population of M. tuberculosis has mutant offspring that was resistant to the effects of streptomycin (Iseman, 1994).

Two other medications which are the p-aminosalicylic acid and isoniazid were discovered not too long after, and clinicians found out that drug resistant did not emerge and lifetime cures of tuberculosis finally were achievable when all these drugs were given simultaneously and the reasons behind this are (I) random bacteria mutations occurred in a slow rate during microbial replication, (II) these mutations were unlinked; therefore, the probability of a microbe spontaneously developing resistance to two drugs was the product of the individual risks (Iseman, 1994).

The prevalence of drug-resistant strains of M.tuberculosishas risen dramatically in certain regions or populations as a consequence when irregular or incomplete adherence rose steadily over the past two decades (Iseman, 1994). Unfortunately, inadequate treatment programs have resulted in drug-resistant rates in excess of 30% in some developing nations where resources are limited. The most common way the M. tuberculosis resistance has evolved from patients either cryptically discontinue one or more of their multiple drugs or take less than the prescribed dosage (Iseman, 1994). An environment that selects for survival of the drug-resistant mutants was created when insufficient numbers or dosages of drugs. The drugs only tip the balance in favor of the naturally derived variants but not inducing the mutations (Iseman, 1994).

World’s tuberculosis cases involved drug-resistant organisms has been gradually increasing in this manner. Most of the drug-resistant cases have historically involved failed treatment in an individual. However, in some cases, these drug-resistant strains can be transmitted to a new patients, who then develops tuberculosis with pre-formed drug resistance but this has occurred with small amount of cases because the metabolic comprises made by the microbes to enable drug resistance have made them modestly less virulent (Iseman, 1994).

The outcome of TB infection is determined by the immune response of an individual, environmental and bacterial factors (Echeverria-Valencia et al., 2017). There are two types of TB, which are the latent TB and active TB. Individual with latent Tb is infected with M. tuberculosis but does not show any clinical symptoms, radiological abnormality or microbiological evidence while individual with active TB will show all symptoms (Lee, 2016). Most individual who are infected with TB and remained in latent stage because our body is able to fight off the infection. However, approximately 10% of the infected population will progress to active TB disease (Bloom et al., 2017).

Diagnosis of TB may include performing a Mantoux tuberculin skin test, which is given by injecting a standard does of tuberculin fluid into the skin of lower portion of the arm (Agyeman & Ofori-Asenso, 2017). Blood test will be definite test of determining if an individual has TB, but this test will not be able to distinguish between latent and active TB (Agyeman & Ofori-Asenso, 2017). Therefore, chest x-rays and sputum test will be carried out to reconfirm the diagnosis of latent or active TB. Chest x-rays are performed to detect chest abnormalities and sputum culture test is considered as diagnostic gold standard for active TB (Agyeman & Ofori-Asenso, 2017). Furthermore, drug susceptibility testing (DST) is performed on the isolated tubercle bacilli specimen that was isolated from the sputum culture to test for any drug-resistant TB (Agyeman & Ofori-Asenso, 2017).

The treatment for latent TB needs to be treated and not ignored because it has a possibility of progressing into active TB. Treatment varies between patients and typically antibiotics will be given accordingly. For active TB treatment, a cocktail of antibiotics for an average of 6 to 9 months. The four drugs in the cocktail termed RIPE, which are Rifampin, Isoniazid, Pyrazinamide and Ethambutol (Mitnick, McGee & Peloquin, 2010). This effective treatment was developed in the early 1970s and it has showed a cure rate as high as 98% (Nguyen et al., 2018).

In conclusion, tuberculosis remains to be an ancient disease that is a global health issue and has costed many deaths in human population. Human societal failures have potentiated the evolution of drug-resistant strains of the tubercle bacillus in the United States and around the world. This has largely posed a threat to the health and survival of the individual in whom inadequate therapy has promoted the drug resistance until recently.

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7. Lee, S. H. (2016, October 5). Tuberculosis Infection and Latent Tuberculosis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5077723/.
8. MacNeil, A., Glaziou, P., Sismanidis, C., Maloney, S., & Floyd, K. (2019, March 21). Global epidemiology of Tuberculosis and progress toward achieving global targets – 2017. Retrieved from https://www.cdc.gov/mmwr/volumes/68/wr/mm6811a3.htm.
9. Matteelli, A., Roggi, A., & Carvalho, A. C. (2014, April 1). Extensively drug-resistant tuberculosis: epidemiology and management. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979688/.
10. Meacci, F., Orrù, G., Iona, E., Giannoni, F., Piersimoni, C., Pozzi, G., … Oggioni, M. R. (2005, July). Drug resistance evolution of a Mycobacterium tuberculosis strain from a noncompliant patient. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1169130/.
11. Mitnick, C. D., McGee, B., & Peloquin, C. A. (2010, February). Tuberculosis pharmacotherapy: strategies to optimize patient care. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2674232/.
12. Nguyen, Q. H., Contamin, L., Nguyen, T. V. A., & Bañuls, A.-L. (2018, June 21). Insights into the processes that drive the evolution of drug resistance in Mycobacterium tuberculosis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6183457/.
13. Tuberculosis (TB). (2016, December 12). Retrieved from https://www.cdc.gov/tb/worldtbday/history.htm.
14. Vynnycky, & Fine, P. E. (1999, April 1). Interpreting the decline in tuberculosis: the role of secular trends in effective contact. Retrieved from https://academic.oup.com/ije/article/28/2/327/655249.

Overview

The local community has always suffered from lack of critical information as regards to the prevention of tuberculosis. Many people in the community have little knowledge concerning the management and prevention of tuberculosis. This project will aim at coming up with mechanisms through which the community will prevent and manage the disease since it is considered one of the killer diseases among the locals.

The project will aim at empowering the community to take precautionary measures in addressing the challenges that the disease poses. In many hospitals, people are diagnosed with the disease yet preventive treatment is not given. Others contract the disease while in the hospital because of poor hygienic conditions and sanitation.

Tuberculosis is a communicable disease that affects each person in society if preventive measures are not adopted. The project will aim at changing the people’s perceptions towards the disease because people think that those close to them cannot infect them with the disease. The issue came into my attention after a reported case whereby a close relative could not take preventive measures when caring for the sick suffering from TB.

The healthy caregiver ended up contracting the disease simply because of ignorance. Indeed, research shows that many people contract tuberculosis out of ignorance. The project will mobilize the locals to utilize the available preventive strategies in keeping away from the dangers that the disease poses (Anderson, 1988).

The community deals with the issue in a very casual manner because it does not accept the reality that tuberculosis is real and can affect any family member. The sick end up transmitting the disease from one person to the other without knowing. The public health ministry is in charge of curtailing the effects of the disease, but it is reluctant to liaise with the community to resolve the issue.

Apart from the government, through the public health ministry, other stakeholders are also involved in dealing with the disease. However, other stakeholders, which are mostly non-governmental organizations, have failed in addressing the challenges that the disease poses. Many stakeholders are quick to provide curative measures instead of providing preventing measures.

Tuberculosis is a communicable disease implying that preventive measures would be better than even curative measures. Currently, the community utilizes isoniazed drugs to cure the disease because it was very effective in the 20^th century.

Moreover, the drug was cost effective and safe as compared to other forms of drugs in the market at the time. However, the drug is no longer effective in curing the disease in the 21^st century because of the emergence of multidrug-resistant tuberculosis (Reamer, 1994).

In this paper, it is recommended that some strategies should be adopted, which will go a long way to prevent the spread of the disease. The intervention strategies will go a long way to help the locals in understanding the spread of the disease. This will definitely help them in controlling the spread of the disease in the community.

First Part: Analyzing the Community

The local community is a mid-level income community that does not have the highest level of education as compared to other Americans. The community lives peacefully meaning that interactions in society are based on traditional beliefs and principles. Members of society will never leave one of their own to suffer, even though the disease is said to be communicable.

The social bonds tying the community are very strong. In the community, the rate at which tuberculosis kills the locals stands at 32%. Similarly, the community relies on case management, direct-observed treatment, and short course as the only methods of prevention. Even though the community utilizes the above-mentioned strategies, the disease is still the burden among locals because its prevalence is shocking.

In this regard, correct knowledge and positive perception are considered some of the strategies that would bring to an end the effects of the disease. This means that the community must change its attitudes and practices if it is to wipe out tuberculosis. For this to happen, some community workers work must intervene using some of the best intervention strategies.

In the project, community members will be involved in discussions aimed at coming up with the techniques through which people suffering from the disease would be handled and treated. In one of the studies conducted in the community, it was established that tuberculosis is still a major public health problem.

The report suggested that the disease is mainly transmitted air. Based on this, the project will aim at sensitizing the community to ensure that fresh air is always available in closed places. The community lacks sufficient knowledge regarding the transmission of the disease.

When community members suspect the disease, they simply rush into self-medication treatment instead of seeking professional advice and treatment. In other words, the community has a tendency of addressing the disease without seeking consultation from the local clinics. According to medical records, the cure of tuberculosis takes at least eight months.

This knowledge is unavailable in the among the community members. Those suspecting to be suffering from the disease rely on friends and relatives for critical information regarding the cure and management of tuberculosis.

Tuberculosis is a serious disease that causes death if treatment is not sought at the early stage. The disease is transmitted in almost all settings implying that proper hygiene and other preventive measures play a critical role in keeping off the spread of the disease. Healthy individuals are at risk of contracting the disease in case they are exposed to the affected individuals.

In 1960s, countries utilized isoniazed drugs to cure the disease because it was very effective. Moreover, the drug was cost effective and safe as compared to other forms of drugs in the market. However, the drug is no longer effective in curing the disease because of the multidrug-resistant tuberculosis (Agrawal, Udwadia, Rodriguez, & Mehta, 2009).

A number of countries have come up with policies and practices aiming at containing the influence of the disease in society. In the United States, management policies are based on a systematic evaluation of spread risks, either in the facility or in homes. In this regard, priority is always given to policies aiming at detecting the disease at an early stage because it is easy to manage it at a tender stage.

Upon detection of the disease, those with the symptoms of the disease are usually isolated in order to prevent further spread. This practice is usually considered a precaution because the disease is easily transmitted through the air. In country, the treatment of the disease takes place after detection and isolation.

It should be noted that practices aiming at preventing the spread of the disease in the local community are different from those applied in other parts of the country. This is because of low level of understanding and high ignorance. The level of supervision, funding, support, and monitoring of the policies and practices are poor in the local community.

While the main concern of other parts of the country is to detect the cases of tuberculosis in society, the main concern of this local community is to ensure that technical excellence is achieved in the treatment of the disease (Vijay, Swaminathan, & Vaidyanathan, 2009). This project will aim at ensuring that stakeholders play their roles to bring about technical excellence.

While the sick are taken to hospitals, clinics, emergency care giving centers, correctional facilities, home-based healthcare centers, long-term care centers, outreach settings, and homeless shelters in many parts of the country, the sick in the local community are taken care by their families mainly because many people are unable to afford the costs associated with specialized care.

Moreover, the local government is yet to come up with extensive policies aiming at helping those suffering from the disease in the community. In the community, caregivers are perceived to be in danger of contracting the disease because they interact with the sick quite often.

Though the main worries of the government are that those suffering from the disease and are not yet diagnosed pose a great danger to the healthy population, no solution has ever been provided. In this regard, this project will ensure that policies will be made to ensure that those with the disease and are not diagnosed are identified as quickly as possible to avoid any further infection.

In the care giving institutions, those with the disease are usually identified, secluded, estranged, and relocated to prevent patient-patient transmission. In any care giving institution, caregivers are trained to diagnose the disease before proceeding to offer any form of help.

In diagnosing the disease, some of the symptoms are usually observed, including frequent coughing, which is usually longer than three weeks, extreme pains around the chest, bloody sputum, serious loss of weight, persistent fever, colds, sweating in the night, malaise, and exhaustion. The project will ensure that the community is sensitized to understand the above symptoms.

Intervention Strategies

To reduce the cases of tuberculosis infections, a number of strategies intervention strategies are recommended. The social worker will be working hard to pass these strategies to the concerned stakeholders. Some of the strategies would be communicated to the community while others would be passed to the ministry and health, as well as the non-governmental organizations.

The intervention strategies include administrative controls, environmental controls, and respiratory controls. It is understood that the community has some policies and practices aimed at controlling the disease, even though they are not usually applied fully.

In fact, people rely on traditional control mechanisms and practices, which are highly ineffective. Administrative controls are meant to reduce the risk at which an individual is exposed to tuberculosis (Small, & Madhukar, 2010).

Ecological management strategies are employed majorly to prevent the absorption of globule nuclei. The community would be advised to employ respiratory control policies mainly to reduce the spread of the disease in certain areas.

Regarding administrative control, a number of policies would be suggested. Unlike in the current state of affairs whereby people with tuberculosis are allowed to interact freely in society, the campaign will aim at sensitizing society to assign caregivers the responsibility of ensuring that infection control is perfected in any setting.

In this case, the caregiver would always be assigned the role of ensuring that infection control assessment is undertaken in any setting. Apart from using the services of caregivers, the government would be urged to established a plan, which would outline the procedures related to detection, separation, and treatment of the affected.

In this case, the support of the government would be crucial in accomplishing this mission. The public would be sensitized that it is the responsibility of the regime under the administrative control policy to provide the suggested laboratory dispensation and testing apparatus.

Assessing the Project

To establish whether the plan would have worked, an analysis would be conducted. The worker would conduct a SWOT analysis before executing the project before it might be having some strengths, as well as weakness. For any project, there are usually some strengths, weaknesses, opportunities, and threats. One of the strengths of the project is that it incorporates the affected into the program.

This means that they will be willing to comply fully. The weakness is that the project would not have sufficient funds since organizations would be reluctant to fund a sensitization project. Apart from conducting a SWOT analysis, the social worker will also conduct an evaluation before, during, and after the project.

Before the project, an analysis regarding the preparedness and readiness of the community to participate will be conducted. During the project, an evaluation on how the project is doing would be of essence.

If the project seems not achieve its objectives, the social worker would be forced to terminate and find out what could be the problem. After the project, an evaluation on the impact of the project on the local community would be performed.

References

Agrawal, D., Udwadia, Z., Rodriguez, C., & Mehta, A. (2009). Increasing incidence of Fluoroquinolone-resistant Mycobacterium tuberculosis in Mumbai, India. International Journal of Tuberculosis &Lung Disorder, 13(1), 79–83.

Anderson, J. (1988). Foundations of social work practice. New York: Springer Pub. Co.

Reamer, F. G. (1994). The foundations of social work knowledge. New York: Columbia Univ. Press.

Small, M., & Madhukar, P. (2010). Tuberculosis Diagnosis, Time for a Game Change. New England Journal of Medicine, 363(11), 1070-1504.

Vijay, S., Swaminathan, S., & Vaidyanathan, T. (2009). Feasibility of Provider-Initiated HIV Testing and Counseling of Tuberculosis Patients under the TB Control Program in Two Districts of South India. PLoS ONE, 4(11), 1-7.

A Programme Plan for the Control of Tuberculosis in Swaziland TB Problem

Tuberculosis (TB) is potentially dangerous infectious disease caused by different strains of mycobacterium, usually Mycobacterium tuberculosis. In most cases, TB affects the lungs. Infected people may spread TB bacteria to others through spitting, sneezing, and coughing respiratory tiny droplets. Most TB infections do not have obvious symptoms and tend to be latent. However, asymptomatic TB may progress to an active status over time and cause death if not treated.

People with strong immunity systems may have bacteria that cause TB, but they may not display symptoms. Hence, there are latent TB and active TB infections. Latent TB infection is inactive, and it does not cause any observable symptoms. Active TB is contagious and dangerous.

Today, there are several strains of TB, which are drug resistance and difficult to treat. People infected with TB require a combination of medications for a given period (usually up to eight months) in order to destroy TB bacteria and eliminate possibilities of developing drug resistance cases.

TB was rare in developed countries. However, after the HIV/AID epidemic, it became rampant among people with HIV/AID because of the weakened immunity system of the body. As a result, TB and HIV have remained major concerns for many countries, particularly developing countries. This is a programme plan for controlling the TB epidemic in Swaziland as one of the developing countries with highest prevalence of TB infections in the world.

TB Problem in Swaziland

The Government of the tiny Kingdom of Swaziland declared that TB as a national emergency as it intensified the fight not only against the ancient disease of TB, but also against the now well established link between TB and HIV (2). The kingdom faces a health emergency crisis in large proportions.

The United Nations Swaziland observes that the country has the highest TB incidence in the world (1198 per 100,000 population), and it has the highest TB/HIV co-infection rates where 80% of incident TB cases are already HIV positive (2). TB kills more than 2,780 people in the country every year.

This number consists of the most productive population in Swaziland. Swaziland’s prevalence of MDR TB is at the rate of 7.7 percent as new cases while 33 percent represents past cases. The country has recorded increasing cases of drug-resistant TB strains (nearly ten percent of diagnosed cases are resistant to TB medication). As a result, life expectancy in Swaziland has dropped from 60 years to 41 years today.

There are ongoing efforts to control the spread of TB in Swaziland. For instance, the Ministry of Health and Social Welfare works together with Médecins Sans Frontières (Doctors without Borders) implemented an integrated model of HIV/TB in different locations.

Many factors could be responsible for the rise of TB cases in Swaziland. The emergence of the drug-resistant TB has created treatment challenges for many TB patients. The National TB Control Programme of Swaziland noted that health care facilities have reported poor success rates in treatment.

Moreover, in 2008, the World Health Organisation (WHO) observed that failure rates were high with up to seven percent in new cases and 11 percent in retreated cases (3). Still, Swaziland borders South Africa at the Province of KwaZulu-Natal where majorities cross the border to mining zones. In 2005, an outbreak of TB was reported with high numbers of HIV infections. This is where many miners work. There are common cases of occurrences of TB and HIV infection among the most susceptible populations.

High HIV rates in Swaziland have also played a role in the increasing number of TB infections. In most cases, people living with HIV (co-infection) also have TB infections. However, any association between the drug-resistant TB infection and HIV infection has remained controversial (2). Some studies have indicated that malabsorption outcomes of anti-TB drugs have association with HIV-positive patients. This situation increases the risk for acquired rifampin resistance.

Many scholars have linked HIV and TB infections with high socioeconomic challenges in Swaziland. This state of poverty has contributed to patients’ vulnerability, poor treatment adherence, and lack of access to proper treatment, which result in the development of drug resistance cases among TB patients. People with HIV/AIDS may also interact with others who have MBR TB infections.

People who have MDR TB conditions require several visits to health care facilities for effective management of the condition. These frequent visits may expose and increase chances of people with HIV getting TB bacteria from TB patients. This is nosocomial transmission of multidrug-resistant TB strain to other patients, who may be vulnerable to TB bacteria, especially HIV patients (1). TB infections in people with HIV progress fast. This is most likely to lead to other infections due to reduced immunity of the body.

Swaziland’s national TB control programme developed the Directly Observed Treatment Short Course (DOTS) in order to curb the rapid spread of TB infections. However, high prevalence of HIV infections in Swaziland has undermined the DOTS programme. Moreover, few health care outlets, lack of proper equipment, MDR TB and Extensively Drug Resistant TB (XDR TB) have also hampered the fight against TB in Swaziland.

All TB initiatives and programmes in Swaziland require consistent supports in order to ensure that such initiatives are successful. Any programme should focus on delivering effective DOTS, combating TB/HIV infections, and MDR TB cases in Swaziland.

Given the escalating cases of new TB and HIV infections, Swaziland requires urgent interventions in several ways.

• The country needs sustained prevention, treatment, and care to TB and HIV patients. There is a need to introduce effective integrated programmes for managing both HIV and TB infections. These programmes should also focus on prevention of malaria and effective support to malaria patients because malaria kills many pregnant women and children fast.
• Swaziland TB prevention programmes require a special attention to MDR TB, XDR TB, HIV, and TB infections. Such programmes should emphasise the need to ensure equitable distribution of essential drugs and reasonable use by patients.
• TB and HIV infections require continued monitoring and evaluation in order to determine outcomes. Monitoring and evaluation programmes should also focus on observed changes in drug resistant TB, malaria, and HIV.
• Swaziland government is an important stakeholder in fighting TB epidemic in the country. As a result, the government should mobilise resources, show political commitment, and form partnership with other stakeholders to develop programmes that could effectively fight TB and HIV infections at all levels of the country.

It is also important to focus on knowledge and attitudes of TB patients in order understand their views. This process requires a well-designed study that can identify various causes and outcome of TB infections in Swaziland.

Studies from other regions of the world have shown that effective and sustained approaches to TB treatment and management have led to decline in cases of TB infections. Moreover, there are high success rates in treatment.

Unfortunately, Swaziland has registered high rates of defaulters, death rates, and transfer rates among HIV and TB patients (2). These situations have led to unfavourable outcomes in TB and HIV treatment and management. Hence, all stakeholders in fighting TB infections in Swaziland must improve their efforts and conduct follow-ups to evaluate patients after treatment.

TB Decentralisation and Integration in the Health System of Swaziland

Decentralisation and integration of TB management in Swaziland have taken some approaches to ensure that treatments are effective and successful.

Community-Based and Home-Based Approaches

Majorities of TB patients in Swaziland live in rural areas in small isolated villages. Normally, many TB patients cannot afford costs of travelling and long journeys to health care facilities.

As a result, health care service providers, such as MSF (Doctors without Borders), have developed decentralised and community-based programmes in order to combat TB and HIV infections. The MSF has trained some people in the community to take the roles of counsellors, who can also test both HIV and TB infections. The decentralisation effort aims to increase the number of people being tested for HIV and TB in Swaziland.

This is an initiative to start early treatment of both infections. In addition, decentralisation efforts would ensure that few people default treatment, improve their health, and ensure high success rates.
Decentralisation aims to support local clinics in poor, remote locations of Swaziland. As a result, these clinics are able to offer integrated programmes to treat both HIV and TB. They have increased the rate of testing patients every month. Moreover, patients on antiretroviral (ARV) have increased significantly.

This is also the case with TB treatments where many patients have registered for medication, including patients with multidrug resistant conditions. Many patients have regarded TB treatments as long and complex process, but decentralisation has ensured sustained treatments for these patients.

Swaziland has recognised that managing drug resistant TB strain is a major challenge in the health sector. In this context, MSF has provided support to decentralisation efforts in several health care centres in different parts of the country as a way of improving accessibility to health care services. In fact, MSF now constructs modern laboratories in such locations.

Decentralisation efforts require collaborative approaches with the Ministry of Health. In addition, this approach also aims to integrate both HIV and TB treatments in various parts of the country. The Ministry of Health alongside other stakeholders have rolled out national TB decentralisation programmes to focus on drug resistant strain of TB.

Decentralisation and integration efforts have also focused on patients who live in towns. Specifically, these approaches target people working in industries.

Research indicates that such programmes were effective in rural Swaziland. TB detection through intensified case finding (ICF) was feasible and aided in TB and HIV integrated care. The programme enhanced accessibility to underserved, rural TB patients. However, home-based care is effective in rural areas because patients lack adequate space in health care facilities as cases of TB increase and overwhelm care providers.

Staffing Crisis

Swaziland desperately needs adequate health care providers and physicians. Inadequate training facilities have led to low number of nurses in the country. In this regard, it would be effective to train many nurses and allow them to tackle simple cases of TB infections, prescribe drugs, and provide required support.

Many patients have lived with HIV and TB for long in Swaziland. According the MSF, these are ‘expert patients’, who play critical roles in screening, advising, and informing new patients about HIV and TB medications. Moreover, these patients also conduct awareness campaigns in their communities.

The MSF has also organised several workshops in order to discuss the problem of increasing cases of new infections in Swaziland. The major aims of such workshops are to search for alternative and innovative method of offering effective treatments and supports to people infected and affected with HIV and TB in Swaziland. The country lacks health care professionals. On this note, workshop participants have developed health care programmes, which have provided care to patients at the village and local levels.

Despite these efforts to combat the spread of TB infections in Swaziland, there are new cases of infections. Swaziland tries to use integrated programmes to combat TB infections, which affect people with HIV/AIDS. This process requires a partnership with external professionals and other stakeholders.

The situation challenges the goals of eradicating TB as a communicable health problem globally by 2050. Cases of TB infections are rampant in people living with HIV/AIDS (2). This explains why most integrated intervention programmes focus on these two diseases together. Most TB patients are in Africa, and the WHO has attributed this state to high prevalence of HIV infections in the continent.

Stakeholders in the fight against HIV and TB have noted that people with HIV are prone to TB infections. As a result, these stakeholders have noted that it is effective to provide HIV Testing and Counselling (HTC) in TB clinics. These programmes also integrate TB-HIV services to the community.

According to the group of researchers (2), in Swaziland, about eight in ten individuals who have TB are HIV positive. However, URC launched an integrated strategy with TB clinics that offered HTC care to patients, but few patients received these services. Many TB centres referred TB patients to VCT centres to know their status. Swaziland has few centres, which implies that all VCT centres receive a large number of patients, which they cannot manage. Patients often face challenges in such overburdened facilities.

Hence, the quality of treatments and counselling may not meet the minimum threshold required.
Given such conditions, health care providers have recognised the need to address TB and HIV infections collectively and focus on underserved and underreported areas. Decentralised and integrated TB and HIV programmes work collaboratively with the National TB Control Programme alongside other stakeholders. These programmes aim to increase the number of TB and HIV clinics at the local levels.

Important Stakeholders of TB Problem

Swaziland has several stakeholders because of the unique nature of the problem. It is important to engage all stakeholders when developing an intervention programme for controlling and evaluating TB infections. Stakeholders are important for the day-to-day implementation of the TB control programmes, advocate for the programme, and support or authorise funding of the programme. There are three main groups of stakeholders in this programme.

• People involved in the programme operations
  These include programme managers, administrators, staff, outreach staff, nurses, clinicians, and government health agencies
• People affected by the programme
  These include patients, community members, families, visitors, and community planning boards
• Intended users of the evaluation outcomes
  These include policymakers, health care providers, health educators, researchers, business communities, funding groups, and others.

The level of involvement among these stakeholders will differ considerably based on their roles in the project. Generally, there are priority stakeholders who will give the programme its credibility, implement it, and advocate for its improvement and funding.
The Approach for TB Problem and Evidence for Effective Strategies

The goals of this TB control programme in Swaziland are to break off and eliminate TB transmission, reduce cases of drug-resistant TB, lower death rates from TB complications, HIV-TB complication, and reduce challenges related to TB trauma, emotional trauma, social stigma, and TB ill health.

The control programme notes that TB is potentially dangerous, but preventable and treatable disease. The programme will focus on the most vulnerable members of the community, such pregnant women, children, older people, and HIV-positive patients.

This is a collaborative programme, which would include other stakeholders, such as health care providers, government agencies, research institutions, and funding organisations. TB surveillance would involve treatment, identification of latent and active TB infections, and managing existing conditions.

Swaziland TB Control Programme Activities

Creating awareness about TB and identifying all people, who have TB or suspected of having TB at the community levels. They should report to TB clinics and laboratories at community levels.

• Gathering and analysing TB risk factors in Swaziland
• TB testing
• Monitoring prescriptions and patients’ adherence to medication
• Offering DOTS and directly observed preventive therapy (DOPT)
• Analysing people exposed to TB and ensuring their protection through TB therapies
• Providing TB and HIV tests and conducting evaluation among vulnerable groups to prevent active TB
• The programme will work collaboratively with the local government health agencies, home-based programmes, and prison services.

How the Impact of the Programme will be Measured

Evaluation of the programme would focus on its effectiveness, assessment of the progress, identify optimal performing initiatives for replication, and help in redistribution of TB resources.

The process shall involve conducting surveys by gathering data from all stakeholders involved in the TB control programme in Swaziland. Data shall then be analysed and outcomes disseminated to interested stakeholders.

The programme outcomes would show the intended activities of the programme. However, the programme notes that it may or may not be possible to realise all its goals. The programme shall measure the desired changes in TB and HIV-TB patients, health care providers, and the community. The programme has short-term, mid-term, and long-term outcomes for evaluation. The focus of the programme would be on measuring:

• Changes in knowledge and attitudes of TB patients.
• TB patients adherence to treatment.
• The success of identifying patients contacts.
• Patients use recommended drugs.
• Patients complete treatments as scheduled.
• Local cases of readmission.
• Reduced cases of defaulting rates.
• Low TB transmission.
• Patients facilitate identification of contacts.
• Reduced stigma.
• Improved quality of TB-HIV patients lives.
• Building trust.

General health of patients

The programme measures shall indicate whether the programme would realise these outcomes. Stakeholders shall suggest various methods of evaluating and measuring these goals. For instance, open discussions with community members may indicate that stakeholders have built trust with other stakeholders. An outcome on stigma may indicate open discussions with friends and other contacts about the disease.

References

1. Crudu V, Merker M, Lange C, et al. Nosocomial transmission of multidrug-resistant tuberculosis. The International Journal of Tuberculosis and Lung Disease. 2015;19(12):1520-1523.
2. Mchunu G; van Griensven J, Hinderaker S, et al. High mortality in tuberculosis patients despite HIV interventions in Swaziland. Public Health Action. 2016;6(2):105-110.
3. World Health Organization. Global tuberculosis control 2010. [Geneva, Switzerland: WHO]; 2010. Web.

Introduction

TB, a contagious chronic disease that primarily affects the lungs is caused by the inhalation of Mycobacterium bacilli (Hanif & Garcia-Contreras, 2012). Today, TB remains a serious public health concern in many parts of the world (Hanif & Garcia-Contreras, 2012).

Surveys by WHO indicate TB infections and fatalities were especially high in the 90s and early this decade but since 2006, massive awareness and treatment campaigns have seen a gradual decline in incidence rate, prevalence and fatalities (Hanif & Garcia-Contreras, 2012).

Infection is triggered by inhalation of air droplets containing Mycobacterium tuberculosis bacilli (MTB) from an infected person. Although a strong immune system can contain the pathogen, in an immunosuppressed individual, the MTB is capable of multiplying and rupturing the host’s macrophages, resulting in the destruction of the body’s primary line of defense against it.

Upon rupture of infected macrophages, monocytes leave the systemic circulation under the influence of chemotactic factors and initiate granuloma formation (Hanif & Garcia-Contreras, 2012). It is believed that before the body mounts an active defense against MTB, the bacilli would have already escaped from the lungs into the bloodstream and spread to other parts of the body (Hanif & Garcia-Contreras, 2012).

Tuberculosis Skin Test that utilizes a Purified Protein Derivative (PPD) has long been used to diagnose TB. However, the main drawback of PPD is that it is unable to distinguish the real pathogenic bacilli for TB from that of BCG vaccination and environmental non-tuberculosis mycobacterium (Hanif & Garcia-Contreras, 2012).

For a long time, BCG vaccine has been used to offer protection against TB. The vaccination involves injecting attenuated MTB strains into a child’s body to stimulate an immunity that confers resistance against future infections.

Despite being taken as the standard protection against TB in many parts of the world, BCG clinical studies have revealed variations in its efficacy. The variations have been attributed to strains mutations, enviromental factors(e.g sunlight and cold exposure), genetics, nutritional as well as prior exposures to the microbacterium (qtd. in Hanif & Garcia-Contreras, 2012).

Treatment of TB is a long and demanding process(qtd. in Hanif & Garcia-Contreras, 2012). The duration of drug therapy may range from a minimum of 6 months to a high a 24 months depending on the combination administered. Treatment is further complicated by unwanted toxic effects and mutations of M. tuberculosis which may call for slowing or dropping of the treatment altogether.

This papers is an attempt to examine newer therapies currently being tested or proposed to augment traditional drug therapies for TB. These therapies are gaining attention from different health quarters given the shortcomigs of BCG as the primary protection method and increasing health challenges brought about by changing aetiology of the disease.

The first section discusses the use of pharmaceutical aerosols in treatment and prevention of TB. The second part deals with nutritional intervention specifically, Vitamin D while the last section examines the same in light of systemic physical therapy. A conclusion is then made on how the above three inform clinical and pharmaceutical practise partaining to TB.

Pharmaceutical Aerosols

Pharmaceutical aerosols represent attempts to produce more effective novel drugs for prevention and treatment of TB. Although studies in test animals have been promising, no pharmaceautical aerosol for TB has been produced so far (Hanif & Garcia-Contreras, 2012).

Aerosol formulations of drugs and vaccines for TB treatment have produced desired effects in animals they have been tested. Notably, higher drug concentration at target site, reduced systemic side effects, as well as carrier properties that could be applied in vaccine development have been reported.

A number of tubercular formulations tested have produced positive results. Capreomycin powder aerosol attains high deposition in lungs giving hope that similar concentrations are attainable in human subjects. Dry powder PA-824 aerosol has shown even more promising results in guinea pigs.

Low or high dose of this compound in guinea pigs was associated with reduced manifestation of TB in lungs and spleen, lower number of the bacteria as well as less tissue damage (qtd. in Hanif & Garcia-Contreras, 2012). Similar results have also been achieved with vaccines aerosols. BCG particles administered by pulmonary route were found to produce lower bacterial burden compared to unimmunized controls.

Mircroparticles have also been found effective in acting as transporters of vaccines to target cells in order to iniate cell mediated immunity. Similarly, r-Ag 85B-PLGA microsphere has been found effective in delivering antigens to macrophages for processing and presentation to CD4 cells. This has led scientist to cite this findings as potential vaccine strategy for preventing TB.

Systemic physical training and TB prevention

It has been observed in the medical field that long, narrow, flat chested individuals are more susceptible to TB and suffer TB related fatalities the most (Ingals). This has led some to reason that physical training to build respiratory muscles and expand thoracic walls could be important in the prevention and cure of TB.

According to this line of reasoning, physical training promotes deep breathing. The deep breathing is said to aid in the emptying of pathogenic agents from lungs. The kind of breathing advocated in this therapy involves a long, deep breath with the abdominal walls drawn in, shoulders pushed backwards and accompanied with elevation of ribs and sternum (Ingals n.p).

This technique of breathing is said to completely inflate and deflate most, if not all of the air cells in the lungs thus faciliting the removal of pathogenic agents that may cause TB. Cases of increased chest circumference have been cited in studies of college students involved in weekly physical activities over period ranging from 6 months to 24 years.

However, it has been acknowledged that the increase cannot be conclusively attributed to the physical activity as other factors such as natural growth could be the cause (Ingals n.p). Further controversy regarding this theory is the observation in many studies that athletes, despite high physical activity in their early life, tend to die young with pulmorary tuberculosis accounting for a good number of such deaths (Ingals).

By and large, systemic physical activity training as an intervention for treating and preventing TB lacks sufficient empirical evidence to support it and more research is needed for it to be taken seriously.

Vitamin D in prevention and treatment of TB

Treatment of TB using cod liver oil, an extract highly rich in vitamin D dates back to the 19^th century. In addition, many studies have also proved the efficacy of the active form of Vitamin D in destroying and preventing the growth of mycobacterium TB in-vitro (Dini & Bianchi, 2012).

Diani and Bianchi (2012) list numerous studies that show low vitamin D to be a risk factor in development of active TB. The corroborating studies were conducted in Spain ,South Africa, Tanzania, Australia, Pakistan, Viatman, UK, Indonesia, Kenya, Thailand, Hong Kong, and India.

Notable differences in association between vitamin D and TB in countries near or on geographic equator and those far away from equator have been documented suggesting sunlight influences vitamin D levels (Dini & Bianchi, 2012) It has also been reported that TB patients tend to have lower than recommended levels of Vitamin D compared to healthy individuals (Dini & Bianchi, 2012).

Vitamin D is reported to play a central role in activation of Cathelicidin, a compound found to have a destructive effect not only on Mycobacterium tuberculosis but also on a host of other viruses. Researchers are particularly interested in understanding the working mechanism of cathelicidin at cellular level in initiating cell mediated immunity during Mycobacaterium tuberculosis infection.

It is believed deciphering the working mechanism of this compound could greatly contribute to development of multi-faceted therapies that could be effective even for the obstinate multi-drug resistant TB (MDR-TB) (Dini & Bianchi, 2012).

As many studies have shown, antibacterial chemotherapy coupled with vitamin D supplements could be more effective in treatment of TB than either of the interventions alone (Dini & Bianchi, 2012). This mode of treatment of is particularly attractive due to its low cost and easy administration.

Conclusion

TB is a serious public health concern in many parts of the world. The most recognised traditional intervention of choice is BCG vaccination during childhood.Given the evolving nature of the disease’s causative agent, newer approaches have become necessary. Aerosols formulations to treat TB yield promising results in test animals although the benefits in human subject are far from being concluded.

Studies have proved the debilitating effects of Vitamin D on development of active TB and efforts are underway to make it part of anti-bacterial chemotherapy. Systemic physical training to enlarge the chest has also been suggested. However, this approach lacks sufficient empirical evidence to support it.

References

Dini, C., & Bianchi, A. (2012). Potential role of Vitamine D for prevention and treatment of tuberculosis and infectious diseases. Ann Ist Super Sanita, 48(3), 319-327.doi: 10.4415/ANN_12_03_13.

Hanif, S. N., & Garcia-Contreras, L. (2012). Pharmaceautical aerosols for the treatment and prevention of Tuberculosis. Front Cell Infect Microbiol, 2, 118.doi:10.3389/fcimb.2012.00118.

Ingals, F. (n.d.). Value of systemic physical training in the prevention an cure of pulmorary tuberculosis. Chicago.