Category: Tuberculosis

Introduction

Tuberculosis is a contagious disease, which mainly affects pulmonary system, but can affect kidneys, brain, and bones. The causative agent of tuberculosis is a bacterium called Mycobacterium tuberculosis. Tuberculosis is among the leading causes of deaths globally because it is an infectious disease, which spreads through the air.

Epidemiological studies have revealed that tuberculosis is prevalent among people living with HIV/AIDS in low-income countries because of compromised immune system and poor accessibility to healthcare services (Pang et al., 2014; Pawlowski et al., 2012). The revelation implies that immune system and accessibility of healthcare services play an important role in prevention of tuberculosis.

World Health Organization (2014) reports that tuberculosis 9 million people contracted tuberculosis in 2013 out of which 1.5 million people died (360,000 living with HIV/AIDS). These statistics indicate that tuberculosis is the leading cause of deaths globally and is prevalent among people with HIV/AIDS in epidemic regions, such as low-income countries. In this view, the essay examines global epidemiology of tuberculosis in epidemic regions such as the United States, Sub-Saharan Africa, and Asia.

Epidemiology

The United States

The prevalence rate of tuberculosis in the United States is the lowest when compared to the prevalence rates in Sub-Saharan Africa and Asia. According to Centers for Disease Control and Prevention (2011), 10,528 cases of tuberculosis occurred in 2011, which amount to an incidence rate of 3.4 cases in every 100,000 persons.

Epidemiological statistics indicate that tuberculosis is prevalent in states such as Alaska, District of Columbia, and Hawaii for they have incidence rates of 9.3, 9.1, and 8.9 respectively (Centers for Disease Control and Prevention, 2011; Pawlowski et al., 2012). The epidemiological statistics, therefore, indicate that prevalence of tuberculosis varies from one state to another with Alaska, District of Columbia, and Hawaii having the highest incidence rates.

In the United States, there is disproportionate prevalence of tuberculosis according to race. According to the report of Centers for Disease Control and Prevention (2011), the incidences rates of American Asians, African Americans, and White Americans are 20.9, 6.3, and 0.8 respectively.

Epidemiological study undertaken to establish the prevalence of tuberculosis among American Indians shows that their mortality rate is 5 times that of national average (Pang et al., 2014). The incidence rates of tuberculosis among African Americans are considerably higher than that of White Americans owing to poverty (Hotez, 2008). Place of birth determine predisposition to tuberculosis in the United States.

Other epidemiological studies have indicates that children of foreign parents and foreigners have higher incidences of tuberculosis when compared the children of Americans and Americans (Pang et al., 2014). Regarding co-infections, World Health Organization (2014) holds that HIV/AIDS contributes to the occurrence of tuberculosis. Hence, it is evident that the prevalence of tuberculosis in the United States varies according to race, place of birth, HIV/AIDS.

Sub-Saharan Africa

The prevalence of tuberculosis in Sub-Saharan Africa is very high because it has predisposing factors such as HIV/AIDS and poverty. Countries in Sub-Saharan Africa such as Congo, Kenya, Uganda, Tanzania, Nigeria, Zambia, Liberia, and Mali, amongst other have high incidences of tuberculosis.

Mboowa (2014) states that the incidence rate of tuberculosis is 255 cases in every 100,000 people in Sub-Saharan Africa because it has about 70% of all cases of HIV/AIDS globally. The prevalence of HIV/AIDS cases in Sub-Saharan Africa implies that a significant number of people have compromised immune system, which predispose them to tuberculosis.

A study done to reveal the association of tuberculosis and HIV/AIDS indicates that 50% of people living with HIV/AIDS, who are infected with Mycobacterium tuberculosis, develop tuberculosis in their lifetime (Adeiza, Abba, & Okpapi, 2014). Such a revelation indicates that HIV/AIDS is a major predisposing factor of tuberculosis in Sub-Saharan Africa.

The incidences of tuberculosis are very high in Sub-Saharan Africa because of poverty, ignorance, and human activities. Barter, Agboola, Murray, and Barnighausen (2012) explain that conditions associated with poverty such as poor nutrition, overcrowding, and inaccessibility of healthcare services are responsible for the occurrence of tuberculosis in Sub-Saharan Africa.

Poor nutrition reduces immunity of the body, while overcrowding promotes the spread of tuberculosis because it is an infectious disease. Moreover, inaccessibility to healthcare services implies people do not perform early diagnosis and treatment. According to Bain et al. (2012), ignorance, illiteracy, corruption, and big family size are social factors that predispose Africans to tuberculosis.

Human activities, such as mining also contribute to the occurrence of tuberculosis. Stuckler, Basu, McKee, and Lurie (2011) state that 10% increase in mining activities cause an increase in the incidence rates of tuberculosis by 0.7%. Therefore, high incidences of tuberculosis in Sub-Saharan African emanate from poverty, ignorance, and mining activities.

Asia

Asian countries that have the high incidence rates of new cases of tuberculosis are Bangladesh, India, China, Philippines, and Pakistan. In the Asian region, South-East Asia has high incidences of tuberculosis. According to Nair, Wares, and Sahu (2010), 4.9 million cases of tuberculosis are present in South-East Asia. Tuberculosis is prevalent among young adults, and thus, affecting their economic contribution in the society.

Verma and Mahajan (2007) state that 40% of global cases of tuberculosis and 18% global cases of HIV/AIDS are present in South-East Asia. India has 1.8 million cases of tuberculosis and 2.5 million cases of HIV/AIDS (Sandhu, 2011). These epidemiological statistics indicate that HIV/AIDS a major predisposing factor of tuberculosis, just like in the case of the United States and Sub-Saharan Africa.

Other predisposing factors of tuberculosis in Asia are poverty and inaccessibility of healthcare services. The conditions make people to have poor nutrition and live in slums where overcrowding occurs, and thus, promote the spread of tuberculosis among people.

Cambodia is the poorest country in Asia with an incidence rate of 495 cases of tuberculosis in every 100,000 people (Wu, & Dalal, 2012). Countries such as India and Indonesia also experience high incidence rates of tuberculosis owing to their poverty level. The poor do not only live in poor conditions but also they do not access healthcare services. According to Shen et al.

(2009), China has 1.31 million cases of tuberculosis, which are associated with HIV, smoking, alcohol, poverty, and inaccessibility of healthcare services. The epidemiological studies of Asia show that the tuberculosis is prevalent among the poor and people living with HIV/AIDS.

Conclusion

The epidemiological studies of indicate that the prevalence of tuberculosis in the United States, Sub-Saharan Africa, and Asia varies due to a number of factors. In the United States, the major predisposing factors of tuberculosis are race and HIV/AIDS.

However, in Sub-Saharan Africa and Asia, HIV/AIDS and poverty are major predisposing factors. Therefore, comparative analysis of the epidemiological studies indicates that social determinants of health are responsible for the disproportionate occurrence of tuberculosis in the three geographical regions.

Questions

1. When do healthcare providers report the occurrence of tuberculosis?
2. Explain how the spread of tuberculosis occurs among people?
3. How long does it take for tuberculosis infection to manifest signs and symptoms?
4. Discuss pathogenesis and pathophysiology of tuberculosis in people living with HIV/AIDS?
5. Describe the effective measures that are applicable in the prevention and control of tuberculosis?
6. Describe how poverty contributes to the occurrence of tuberculosis in Sub-Saharan Africa?
7. How does HIV/AID predispose people to tuberculosis?
8. What is the meaning of direct observed therapy in the treatment of patients with tuberculosis?
9. Name the available methods of diagnosing tuberculosis?
10. What are the types of medications that are applicable in the treatment of tuberculosis?
11. Explain why patient with tuberculosis take different medications for different durations?
12. What are the common side effects associated with medications used in treatment of tuberculosis?
13. When do patients with pulmonary tuberculosis perform their duties normally?
14. Explain the difference between latent tuberculosis and active tuberculosis.
15. Differentiate between prolonged exposure and close exposure in the spread of tuberculosis?
16. What are the incidence rates of tuberculosis in the United States, Sub-Saharan Africa, and Asia?
17. What are the measures that World Health Organization advocates in the prevention and control of tuberculosis?
18. Describe how healthcare providers can protect themselves from contracting tuberculosis from patients they are treating?
19. What are the appropriate tests that people undergo before commencing medications for latent tuberculosis?
20. What are the factors that contribute to the recurrence of tuberculosis after treatment?

References

Adeiza, M., Abba, A., & Okpapi, J. (2014). HIV-associated tuberculosis: A Sub-Saharan African Perspective. Sub-Saharan African Journal of Medicine, 1(1), 1-14.

Bain, L., Awah, P., Geraldine, N., Kindong, N., Sigal, Y., Bernard, N., Tanjeko, A. (2013). Malnutrition in Sub–Saharan Africa: burden, causes and prospects. The Pan African Medical Journal, 15(120), 1-12.

Barter, D., Agboola, S., Murray, M., & Barnighausen, T. (2012). Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa: A systematic review. BMC Public Health, 12(980), 1-22.

Centers for Disease Control and Prevention. (2011). Reported Tuberculosis in the United States. Web.

Hotez, P. (2008). Neglected infections of poverty in the United States of America. PLoS Neglected Tropical Diseases, 2(6), 1-11.

Mboowa, G. (2014). Genetics of Sub-Saharan African Human Population Implications for HIV/AIDS, Tuberculosis, and Malaria. International Journal of Evolutionary Biology, 1(1), 1-8.

Nair, N., Wares, F., & Sahu, S. (2010). Tuberculosis in the WHO South-East Asia Region. Bulletin World Health Organization, 88(3), 164.

Pang, J., Teeter, D., Katz, J., Miranda, W., Wall, K., Ghosh, S., & Graviss, E. (2014). Epidemiology of tuberculosis in young children in the United States. Pediatrics, 133(3), 494-504.

Pawlowski, A., Jansson, M., Skold, M., Rottenberg, M., & Kallenius, G. (2012). Tuberculosis and HIV co-infection. PLoS Pathogens, 8(2), 1-7.

Sandhu, G. (2011). Tuberculosis: Current situation, challenges, and overview of its control programs in India. Journal of Global Infectious Disease, 3(2), 143-150.

Shen, X., DeRiemer, K., Yuan, Z., Shen, M., Xia, Z., Gui, X., & Wang, L. (2009). Deaths among tuberculosis cases in Shanghai, China, Who is at Risk? BMC Infectious Disease, 9(95), 1-8.

Stuckler, D., Basu, S., McKee, M., & Lurie, M. (2011). Mining and risk of tuberculosis in Sub-Saharan Africa. American Journal of Public Health, 101(3), 524-530.

Verma, S., & Mahajan, V. (2007). HIV-Tuberculosis Co-Infection, The Internet Journal of Pulmonary Medicine, 10(1), 1-9.

World Health Organization. (2014). Tuberculosis: WHO global tuberculosis report 2014. Web.

Wu, J., & Dalal, K. (2012). Tuberculosis in Asia and the Pacific: The role of socioeconomic status and Health System Development. International Journal of Preventive Medicine, 3(1), 8-16.

Tuberculosis is a relatively widespread infectious disease that can be found in many countries around the world. Environmental and social factors significantly influence its incidence. Therefore, the roles of stakeholders must be clearly defined in order to improve community health outcomes.

Description

Tuberculosis (TB) is caused by Mycobacterium tuberculosis, a microorganism that is spread by an infected individual (Mayo Clinic Staff, 2016). Its mode of transmission is through airborne droplet nuclei containing the said bacteria. The nuclei are formed from the saliva of the infected person and become airborne during coughing, sneezing, and speaking. They can remain suspended in the air for several hours. However, skin contact does not cause infection – in order for the disease to be transmitted; these particles have to be inhaled (Mayo Clinic Staff, 2016). The symptoms of tuberculosis include prolonged coughing (more than three weeks), chest pain, and blood during a cough, fever, chills, night sweats, fatigue, and weakness accompanied by loss of appetite and weight.

Importantly, the symptoms are only observable after the bacteria become active. In the case of a healthy immune system, the bacteria remain inactive, do not produce symptoms, and are not contagious (this state is known as latent tuberculosis). Untreated tuberculosis can spread from the respiratory system to other organs, leading to serious complications. Depending on the affected areas, the complications may include liver and kidney damage, stiffness and pain in the spinal cord, joint damage and arthritis, and fluid collection around the heart leading to heart tamponade (Mayo Clinic Staff, 2016). Unless addressed in a timely manner, some of the complications can be fatal.

Tuberculosis can be treated with antibiotics. The most common medications include pyrazinamide, ethambutol, rifampin, and isoniazid (Mayo Clinic Staff, 2016). Most commonly, three or four antibiotics are taken during the initial months of the treatment, and the number is decreased to two for the rest of the process. For drug-resistant tuberculosis (i.e., MDRTB), the length of treatment and the number of medications is increased.

According to the latest report from the World Health Organization, the morbidity rate of tuberculosis on a global scale was 10.4 million incidents per year (WHO, 2016). The mortality rate among HIV-negative persons was 1.4 million deaths (WHO, 2016). It is worth mentioning that the incidence rate of the disease is currently decreasing on a global scale.

Determinants of Health

Several social determinants are associated with tuberculosis incidence. Poverty is the most notable one as it contributes to several factors that increase the risk of acquiring the disease. First, the poor population often has no access to adequate sanitary conditions. Specifically, poorly ventilated air increases the likelihood of infection. Inadequate nutrition and disrupted sleep patterns, which are common among the poor population segment, weaken the immune system and contribute to the transmission from latent to the active state of the disease. The same can be said about substance abuse, which is common among poor individuals (Millet et al., 2013).

Smoking also seriously weakens the immune response of the respiratory system and, by extension, increases the likelihood of infection and development of active TB. Finally, the social determinant of poverty is characterized by the increased incidence of HIV, which, in turn, greatly increases the mortality rate of tuberculosis (Millet et al., 2013). Certain environments, such as correctional facilities, have a negative impact on the immune system and thus increase TB incidence. Finally, poverty has a significant indirect effect resulting from the lack of possibilities to acquire the necessary help. The gaps include the financial barriers (inability to pay for treatment), infrastructural issues (scarcity of healthcare providers in the region), and insufficient education. The lack of awareness about the problem leads to the inability to recognize symptoms and seek professional assistance on time.

Epidemiologic Triangle

From the epidemiologic triangle perspective, the agent factor is the organism that causes the infection, Mycobacterium tuberculosis. The list of host factors includes the initial state of health of the individual, presence of other diseases in the system, habits that weaken the immune response (e.g., smoking and substance abuse), nutritional and sleep patterns, and, most importantly, the HIV presence, which seriously decreases the likelihood of successful treatment and increases the risk of a fatal result. The environment factors include the quality of ventilation in the building, the proximity to an infected individual, the frequency of communication with the ill person, the crowding of the residence, the quality of sanitary conditions, the fact of traveling to high-risk areas, the conditions in specific institutions (e.g., correctional facilities), state of healthcare in the region (e.g., presence of providers, availability of resources, and proficiency of the staff), cultural background (e.g., the existence of discriminatory behaviors among healthcare workers), social characteristics of the region (e.g., prevalent behavior of peers), and the available informational background (e.g., presence of education and awareness programs and availability of accessible media).

Role of Community Health Nurse

The most important issue to understand about tuberculosis is that it is largely preventable and curable. The likelihood of developing an active form of the disease is relatively low in a well-established environment. Therefore, a range of responsibilities can be identified for community health nurses that are expected to improve the situation. First, despite the significant progress made in recent years, the demographics of tuberculosis are still incomplete in some areas due to the scarcity of the possibilities of the population at risk. Therefore, nurses are expected to assist the data collection on morbidity and mortality of the disease in order to assess the causes and adjust the interventions. The assistance can be both direct (through participation in data collection) and indirect (by communicating the importance of reporting to the population at risk).

Next, public health nurses can provide useful insights by analyzing the existing data. While the overall picture on causes and social determinants of health is relatively clear, the situation may vary significantly for each specific area. A better understanding of the issue can result in more effective intervention and could decrease the number of necessary resources. In addition to data collection, nurses are expected to assist in the development of evaluation and monitoring techniques and ensure their effective execution. The appropriate level of control ensures the timely detection of inconsistencies and allows adjusting the process. Next, the knowledge generated during data collection and analysis should be utilized in assisting the development of effective policies by the authorities.

Community health nurses are closely familiar with issues pertinent to specific communities and can provide insights on relevant resources and assist in establishing communication and collaboration between the organizations pursuing the same goal. Most importantly, the nurses can increase awareness of the characteristics of the disease, which, by extension, will empower the people to self-diagnose and seek medical help, thus contributing to the progress. Finally, the nurses can promote collaboration between the patients, their families, and the healthcare providers, which will eliminate some social and cultural barriers to treatment. Once reliable communication channels are established between key stakeholders, the patient outcomes are expected to improve, and the community, on the whole, would be able to prevent the infection in a larger number of cases.

Contribution of National Organizations

One of the most notable national organizations that target the issue of tuberculosis is the National Tuberculosis Controllers Association (NTCA). The organization identifies the advancing of tuberculosis as its mission and aims at a tuberculosis-free world as its ultimate goal (NTCA, n.d.). The organization works primarily through policymaking in order to meet its objectives. Specifically, it coordinates the efforts of individual activist groups that advocate for the elimination and control of tuberculosis in the United States (NTCA, n.d.). Next, NTCA informs and counsels external organizations, agencies, task forces, and committees on effective means of prevention and control of the disease.

In other words, it establishes information exchange and ensures the availability of the relevant data to the stakeholders. The organization also provides support to the entities which indirectly contribute to the resolution of the issue. For example, the agencies which specialize in substance abuse and smoking minimization create an environment where the spread of infection is less likely. Finally, NTCA provides support and advocacy for laws, regulations, and policies that contribute to the understanding, control, and eventual prevention of the disease. The NTCA is responsible for the organization of the National TB conference, which gathers the specialists in the field and allows them to exchange knowledge and experience. The scope of the organization includes the territorial, local, and national levels.

Conclusion

Tuberculosis incidence depends on the large part of the environmental and social factors. Therefore, active involvement of community health nurses, activist groups, educational agencies, and advocacy organizations has great potential for improving the issue. The fulfillment of the described roles is expected to assist the identified trend of decreasing the mortality and incidence of the disease.

References

Mayo Clinic Staff. (2016). Tuberculosis. Web.

Millet, J. P., Moreno, A., Fina, L., Del Baño, L., Orcau, A., de Olalla, P. G., & Caylà, J. A. (2013). Factors that influence current tuberculosis epidemiology. European Spine Journal, 22(4), 539-548.

NTCA. (n.d.). NTCA. Web.

WHO. (2016). Global Health Observatory (GHO) data. Web.

A disease cluster is a sudden incidence in which many people are diagnosed to be suffering from a certain illness in a given region during a certain period of time (Meehan, 2006). Disease cluster can be suspected when a large number of people such as family members, neighbors, schoolmates, workmates and among other groups are diagnosed with a similar illness (Meehan, 2006). On the other hand, disease outbreak is a phrase used to refer to a sudden occurrence of a disease, which has a bigger impact than expected (Toshiro, 2010). Disease outbreak may affect thousands of people in a region, a country or even in a continent.

Numerous cases of tuberculosis were reported early this August. To determine whether these cases are either a cluster or an outbreak, there are a number of steps that should be followed.

When investigating whether a disease is a cluster, a researcher should gather adequate information, which will help him/her to make a conclusion. Researchers need to gather information such as frequency of the disease and infection statistics (Meehan, 2006). Researchers should also have information about the environmental condition of the affected region. Such information is vital since it helps scientists to distinguish actual disease excess. Getting to know whether the suspected cluster could have prompted a disease outbreak is also vital information (Meehan, 2006). Lastly, a researcher should also have adequate information in regard to the number of cases reported (Toshiro, 2010). This information is crucial in determining whether the affected populatio is significantly greater than what is expected.

When investigating whether a disease is an outbreak, a good researcher should gather the following information. To begin with, one should confirm background information of the affected group. This will help in determining whether the affected group is usually normal for that period of the year. Secondly, researchers should inquire about the cause of the outbreak (Meehan, 2006). This information is useful in developing a good hypothesis.

Information that is also useful in this investigation is acquiring valid data about who/ what has been affected (Kumar, 2005). This data is useful in making a conclusion to come out with reliable data. Since diseases outbreak in many patterns, there is also a need for researchers to gather information and understand outbreak methods for each disease. This information is vital in predicting the future infection rates and determining the disease category (Meehan, 2006).

The procedure for gathering all these vital information is thorough. There is a need to carryout survey in the affected region, country or continent. A researcher should therefore develop questionnaires to gather very important information from the affected people (Kumar, 2005).

Information that can be gathered using survey include who/ what have been affected, the environmental condition of the affected region, and whether the affected group is usually normal during the specific period. Other information like statistics of patients, disease frequency, and cause of outbreak can be acquired through visiting local healthcare facility as well as working with other research bodies (like Center for Disease Prevention and Control).

In summary it is very important to distinguish between a disease outbreak and a disease cluster. For a researcher to distinguish clearly between these two classes, one must gather adequate information that will help in making a valid conclusion. Doing extensive researcher and carrying out surveys are useful in gathering the much needed information.

References List

Kumar, K. (2005). Research Methods. New Delhi: Delhi Publishers.

Meehan, K. A. (2006). Quick Reference to Outbreak Investigation and Control in Health Care Facilities: Burlington: Jones & Bartlet Press.

Toshiro, T. (2010). Statistical Methods for Disease Clustering. New York: Springer.

Tuberculosis (TB) is a disease which was first isolated by Robert Koch, a German physician in 1882. It is an infectious disease which mostly affects the lungs but it can cause effects to other bodily organs. The causative parasite for Tuberculosis is a bacterium that takes the shape of a rod (measuring two to four micrometers in length and 0.2 to 0.5 micrometers in width), non-motile, and fairly large, called Mycobacterium tuberculosis. The parasite is of the Actinomycetes relationship. The bacterium’s physiology of a 15-20 hour generation time has been thought to result to its virulence. The cell wall is however, due to the presence of concentration of lipids, thought to be the main contributor for the virulence of the bacterium. The bacteria possesses a characteristic of resistance to attack from oxygen radicals among other agents like oxygen radicals, cationic reagents and lysozomes in the phagocytic granules due to, as thought, the lipids-alpha branched type-in the cell wall. They may also render the bacterium unlikely of attack by complement deposition in serum (Todar, 2008).

In the mycobacterium family is also the mycobacterium bovis which is the bacteria responsible for causing atypical tuberculosis. They are known as colonizers due to their living together with other bacteria in human bodies, and although they do not cause disease they may cause an illness which is clinically like typical tuberculosis. It is usually difficult to diagnose the types of illnesses that are caused by the atypical mycobacterium since they require repetitive attention by medicines and a period of about 1 and 1 and a half to two years for dosage. Atypical mycobacterium was the often cause of tuberculosis in children but chances have decreased because most of the milk fed to children is now pasteurized. Extrapulmonary TB may develop as a result of the consumption of unpasteurized milk by humans. A disease that is similar to TB and that prevails in people suffering from AIDS is caused by Mycobacterium avium. Leprosy is caused by a similar genus mycobacterium leprae. A human being is the only reservoir for mycobacterium tuberculosis where as the bovis type can reside in cows and humans but is rare in humans (Todar, 2008).

How the disease is passed on

During the breathing process, very small particles in the air carrying infected sputum from a sick person may be taken in. The infected person may have taken out the said sputum via normal processes like shouting, coughing, sneezing (majority cause), or spitting. People who are nearby can then pick these bacteria into their lungs through inhalation. A diameter of five micrometers is the tendency size for most effective droplet nuclei, which may be produced also through coughing and talking (Todar, 2008). A person who is about 10 feet away may be affected by inhaling the particles, and this forms the initial stage for the takeoff. The second stage involves the multiplication of the bacteria which happens in a virtually unrestricted way in macrophages that are un-activated. The microphages may burst due to the continued multiplication of the bacteria, which (bursting) can take effect at up to about 21 days from the first stage. More macrophages may emanate from the peripheral blood, but cannot destroy the bacteria since they are inactivated after the phagocyte of the bacteria. In the third stage, the lymphocytes-specifically the T-cells-which are beginning to infiltrate will recognize the mycobacterium antigens in the context of MHC molecules. The macrophages are activated due to IFN-gamma interferon’s liberation. Cytokines’ liberation and activation of the T-cells may also occur. The mycobacterium will not be controlled by AMI-antibody mediated immune if it is intracellular, whereas this immune may not kill it complementary if it is intracellular (the actual state), owing to much of the present lipids. The host at this stage will produce a vigorous cell-mediated immune (CMI) response, which makes the individual tuberculin-positive. In addition, Todar (2008) observes that the formation of tuberculosis starts at the third stage. The semi-solid or “cheesy” consistency of the mycobacterium is the characteristic of the tubercles, and owing to low pH and anoxic environment, the mycobacterium cannot multiply within the tubercles but will persist within them for extended periods. The mycobacterium uses the inactivated or poorly activated macrophages among the many that surround the tubercle during the fourth stage. The tubercle will grow as a result of the mycobacterium using these inactivated macrophages. Spreading of the bacterium to other areas will occur if arteries and bronchi are invaded by the tubercle which is growing. This may result to formation of milliary tuberculosis-millet seed-sized metastasizing tubercles (extrapulmonary tuberculosis), which may end up with the formation of secondary lessons. A characteristic with the fifth stage is the liquefaction-that leads to more growth of the bacterium which then starts to multiply extracellularly-of the tubercles caseous center whose reason is unknown. The walls of the bronchi may then rapture, letting the bacterium spread to other areas. Small percentage of the mycobacterium will mostly develop to the advanced stages and small percentages of the mycobacterium infections will result into diseases. This is because the host will begin to resist the effects of the mycobacterium or the infections.

Although the mycobacterium tuberculosis lacks classic bacteria virulence factors like fimbriae, capsules, and toxins; virulence has been contributed to physiological properties of the bacterium such as the following (Todar, 2008);

• Mycobacterium tuberculosis can counteract the toxic effects of reactive oxygen intermediates produced during phagocytosis.
• The ability of the mycobacterium tuberculosis to grow intracellularly is an effective way to attack the immune system of the host
• The mycobacterium tuberculosis possesses special cell entry mechanism which enables it to directly bind to the mannose receptors of the macrophages or indirectly through certain complement receptors or Fc receptors.

Drinking un-pasteurized milk may lead to transmission of the atypical bacteria.

After inhalation of the tuberculosis bacteria, a local lung infection-pneumonia may formerly be the result. Hilar lymph nodes near the heart organ are usually swelled.

Tuberculosis in its first stage is referred to as primary tuberculosis and here neither spreading of the bacteria does not occur nor does development of symptoms occur (Schiffman, 2008). The body’s immune system may succeed by rendering the bacteria inactive by forming scar tissues around the bacteria. Thus the spread of bacteria is hampered. The body may further react by depositing calcium from the blood stream onto the scar; a condition called calcification and causes the scar and the lymph nodes to harden. X-ray examination may reveal these scars as round marbles called a granuloma. They are easily differentiated from cancerous infection indicators by the evidence of the calcium on x-ray examination.

Secondary or the reactivation tuberculosis may occur if the body’s immune system is not strong enough to prevent the breakage of the bacteria through the aforementioned scar tissue. The inability of the immune system to stop break through of the bacteria may result from several issues which may include but are not limited to old age, attack by other infections such as cancer, some medications such as those used to treat inflammatory bowel or arthritis disease, anti-cancer drugs, and cortisone medications. Pneumonia may re-occur when the bacterium breaks through. The most involved parts affected beyond the lungs are the brain lining, kidney, bones, and spinal cord.

Figures indicating that around ten to fifteen million people carry TB and that close to 22,000 new cases in a year have been produced (Schiffman, 2008). People with higher risk of being infected with the TB include those in nursing care hospitals or units, diabetics and HIV infected victims of some cancerous illnesses, alcoholics and drug addicts among others. This may be used as a preventative precaution by anyone who intends to put first-hand measures towards the prevention of attack by this disease.

The symptoms

Patients may only show symptoms after several months of initial infection. The following are symptoms indicating an active TB (Staszewski & Boulinier, 2004).

• General body weakness, tiredness, fever, coughing, and chest pains
• Coughing out a sputum
• Coughing out of sputum with blood or blood
• Shortage of breath
• Loss of weight
• Sweating at night

Vaccination and effects

Vaccination assists the bodies through production of antibodies when it is exposed to a dead or attenuated live parasite. The production of these antibodies is necessary to render the body protective from the targeted illness or disease in the future or at present. Other products with antigenic properties may be utilized in place of killed microorganisms or attenuated ones. An example of the products with antigenic properties is the red blood cells of a sheep. Many aspects of the evolutionary ecology of a particular disease like TB can be addressed when experimental exposure to controlled amounts of antigens is applied to natural populations (Grenfell, 1995). Production of the antibodies is known as humoral immune response. The spread of tuberculosis can be controlled through vaccination. It is believed to be important in areas with common cases of TB, unlike the United States. Vaccination with BCG-Bacille Calmette Guerin (mostly helping infants and children) does not remove the likelihood of being infected at adulthood on exposure to the bacteria, and this calls into question the effectiveness and the utility of this vaccine.

As observed by Grenfell (1995) selection pressure caused on the bacteria like TB and other parasites by a vaccination program may lead to the evolution of such parasites. There have been escaping mutants that display epitopes that are not recognizable by the immune systems of the vaccinated individuals which have arisen. A parasite may respond to counteract the vaccine (Virulence) and this has been linked to the life-history trait of the pathogens. The transmission rate is another theoretical development. Trade-offs between virulence and transmission may result in the evolution of higher virulence due to competition among parasite strains. According to Staszewski and Thierry (2004), the pathogens become fitter when their life-history traits undergo evolution.

Drug-resistant Tuberculosis

Certain populations in some countries are at a danger of exposure to tuberculosis that does not respond to treatment. Patients in Southeast Asia have been indicated to have a drug-resistant TB resistant to INH. The INH-resistance of TB may be as a result of presence of INH-like substances in the cough syrups in Southeast Asia. Proper Tuberculosis management can help avoid the resistance of TB to drugs. Prison populations are also at high risk of exposure to Drug-resistant TB. Doctors and health personnel should be warned and alert over bad prescription, inappropriate and inadequate dosage since they can increase the likelihood of resistance of tuberculosis to drugs. The case of drug-resistant TB reveals to us that the third world countries and extremely poor countries which do not have adequate access to good medicine are at a higher risk of TB infection than the developed world where the majority have access to proper medical care and attention. Third world countries as well as the poorest countries which have poor economies cannot support the best health systems and programs to counter the TB disease. Implications concerning the price of medication arise causing the poor to wait until the disease develops to complex forms and/or develops resistance to drugs as a result of compromised medical attention at a lower cost (Thierry, 2004). Furthermore, these countries do not have full access to recent methods and technology to care for the patients.

As noted by Schiffman (2008) there has been found out that tuberculosis can develop resistance to even at least two drugs introduced to patients first, namely INH and the Rifampin, and the extremely resistant types which also show resistance to drugs offered in the second-line dosage. These are referred to as Multi-drug resistant tuberculosis-MDR-TB and XDR-TB respectively. Countries reported to have common cases of the latter are those found in Asia and the former Soviet Union, although it is locatable in the rest of the parts of the world. Increased HIV disease in Africa has been linked to the development of multiple and extremely drug-resistant types of TB.

The resurgence of TB may be checked by control of HIV which increases the chances of patients contracting TB as an opportunistic infection because of the decreased body immune system. The danger of exposure to TB is, therefore, higher in the countries with higher figures of HIV infections than those with lower figures. Citizens in countries faced with extreme poverty and thus poor medical access due to partially/inadequately funded programs to counteract HIV are also at a higher level of danger of TB. Other constraints that make these people at a higher risk include inaccessibility to good food and child immunization programs. Good laboratories in all countries can help people detect drug-resistant types of TB and proper TB care can reduce or eliminate the development of drug resistance. Since the spread of Tuberculosis is closely tied to HIV infection, for example in Africa, it is important that the HIV and TB care be carried out hand in hand to curb the spread of TB (Schiffman, 2008).

References

1. Grenfell, B. and Dobson, A.P. (1995) Ecology of Infectious Diseases in Natural Populations. Cambridge University Press
2. Todar Kenneth. “Tuberculosis”. 2008.
3. Schiffman George. “Tuberculosis” Schoenfield Leslie (ed). 2008. Web.
4. Staszewski Vincent & Thierry Boulinier. Vaccination: A way to address questions in behavioral and population ecology? 2004. Trends in Parasitology. Vol.20 No.1

Patient History and Physical Exam Roles

In this case study, a 44-year-old male complains about non-productive cough and chest pain. Since the patient has the history of HIV/AIDS and hepatitis C, his immune system should be regarded as compromised (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). Adults having concomitant diseases such as hypertension in the given case are at a higher risk of developing pulmonary health issues. The physical examination helps to reveal the critical details associated with the patient’s conditions: tachypnea, rhonchi, tachycardia, dullness, and egophony. Most importantly, an X-ray image also allows considering differential diagnoses based on the comprehensive view of the reported symptoms and objective data assessment.

Primary Diagnosis and Differential Diagnoses

1. Tuberculosis. It is an infectious disease that is caused by Mycobacterium tuberculosis. The bacterium penetrates the body through the respiratory tract and then migrates to the bronchial mucosa, the alveoli, and the blood flow (Grossman, Hsueh, Gillespie, & Blasi, 2014). The most representative symptoms may be noted in the given patient such as high grade fever, weight loss, non-productive cough, chest pain, and dyspnea at rest. X-ray results also pinpoint consolidation in lungs along with hilar enlargement caused by lymphadenopathy. The symptomatology of tuberculous inflammatory process is similar to the clinical picture of other respiratory diseases of the viral and bacterial etiology.
2. Bacterial pneumonia. This microbial infection of the respiratory parts of the lung proceeds with the development of intraalveolar exudation and inflammatory infiltration of the pulmonary parenchyma, fever, and productive cough with mucopurulent sputum (Grossman et al., 2014). Patients may feel weakness, headache, dyspnea, myalgia, arthralgia, pleural pain in the chest, and tachycardia.
3. Viral pneumonia. In the inflammation of the lungs of the viral nature, the cells lining the respiratory tract as well as the alveoli are destroyed, in which liquid accumulates later under the action of leukocytes (Grossman et al., 2014). These factors lead to disruption of oxygen metabolism and hypoxia. Productive cough and fever are the key symptoms.
4. Pulmonary embolism. It is a sudden blockage of the trunk or branches in the artery supplying the lungs with blood. Symptoms include severe dyspnea, dizziness, fainting, tachycardia, a sharp decrease in blood pressure, hemoptysis, cyanosis, and cough (at first – dry, later – sparse sputum with blood) (Sharifi, Bay, Skrocki, Rahimi, & Mehdipour, 2013).

Potential Treatment Options

The treatment of tuberculosis requires the long-term medication intake, namely, from six months to one year period. In the presence of HIV in combination with tuberculosis, specific anti-HIV therapy is used in parallel with the anti-tuberculosis therapy, while rifampicin should be considered with great attention in such patients. Raltegravir 400mg twice per day should be prescribed to this patient as the one who is co-infected with HIV and tuberculosis (Grinsztejn et al., 2014). The alternative medication is the administration of efavirenz 600mg daily, as recommended by the World Health Organization (WHO) (Bhatt et al., 2015).

The immune system of the patient should be supported by means of proper nutrition, adequate physical activity, and avoiding drug and alcohol abuse. Self-care is of great importance for patients diagnosed with tuberculosis since timely medication administration affects the effectiveness of the whole recovery process (Buttaro et al., 2017). It is stated that bacteria remain in the air even when a patient leaves a room; therefore, it is essential to consider preventative measures and abstain from communicating with others without a mask at least for a few weeks.

References

Bhatt, N. B., Baudin, E., Meggi, B., da Silva, C., Barrail-Tran, A., Furlan, V.,… ANRS 12146/12214-CARINEMO Study Group. (2015). Nevirapine or efavirenz for tuberculosis and HIV coinfected patients: Exposure and virological failure relationship. Journal of Antimicrobial Chemotherapy, 70(1), 225-232.

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

Grinsztejn, B., De Castro, N., Arnold, V., Veloso, V. G., Morgado, M., Pilotto, J. H.,… Vorsatz, C. (2014). Raltegravir for the treatment of patients co-infected with HIV and tuberculosis (ANRS 12 180 Reflate TB): A multicentre, phase 2, non-comparative, open-label, randomised trial. The Lancet Infectious Diseases, 14(6), 459-467.

Grossman, R. F., Hsueh, P. R., Gillespie, S. H., & Blasi, F. (2014). Community-acquired pneumonia and tuberculosis: Differential diagnosis and the use of fluoroquinolones. International Journal of Infectious Diseases, 18, 14-21.

Sharifi, M., Bay, C., Skrocki, L., Rahimi, F., & Mehdipour, M. (2013). Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). American Journal of Cardiology, 111(2), 273-277.

Executive Summary

Among all infectious diseases, tuberculosis is the leading cause of death worldwide, and Nigeria is among the states characterized by the highest burden of this infection. While tuberculosis is especially prevalent in patients with HIV and other immune system impairments, there are many other risk factors contributing to the development of the infection. They include such unhealthy behaviors as smoking and unfavorable life conditions resulting in increased exposure to Mycobacterium tuberculosis, malnutrition, and overall poor health status. Considering that the treatment of different forms of the disease is costly yet it affects poor populations most, it is pivotal to invest in its prevention through awareness-raising campaigns and promotion of screening.

Introduction

Among different infectious diseases, tuberculosis is a leading cause of mortality on the global scale and its various forms, including the drug-resistant ones, pose a significant threat to public health and security. Whereas every country in the world is affected by tuberculosis, Nigeria is among the states where the prevalence of this disease is especially high. A high rate of death due to tuberculosis has multiple economic and social implications, which make it pivotal to address this public health issue urgently and with the help of effective methods.

Considering this, the present policy brief will discuss the nature of the infection, its risk factors and the populations it affects most, the scope of infection spread in Nigeria, and the consequences of the problem in order to demonstrate why the intervention of tuberculosis on the national scale is important. The final section of the brief will outline a few evidence-based action steps that could be used to alleviate the burden of this infectious disease in the country.

Nature and Magnitude

Tuberculosis is an airborne disease caused by a pathogen known as Mycobacterium tuberculosis. The main distinguishing feature of the etiological agent of the disease is that “it can persist in the host during long-term latency without causing significant damage or transmission unless the host immunity is compromised” (Chai et al. 2). It means that even though the pathogen may be present in the host’s body for the long term, it causes actual disease and serious complications only in a relatively small number of cases (Cardona 2).

However, in an active phase of infection, M. tuberculosis affects the lungs and leads to a multitude of pulmonary symptoms. They include coughing, breathlessness, and chest pains, which may considerably range in severity and increase the risk of mortality due to respiratory problems (Fogel 527; Ravimohan et al. 1).

It is worth noting that tuberculosis can be either drug-susceptible or drug-resistant. The treatment of the former type of the infection is usually highly effective, “with 85% (66 million cases) of reported cases estimated to have been successfully treated between 1995 and 2015” (Ravimohan et al. 1). The treatment of the latter form of tuberculosis that can be non-responsive to either isoniazid or/and rifampicin, two antibiotic drugs commonly utilized in the course of pharmacological intervention for this infection, is usually more complicated, toxic, costly, and prolonged (Onyedum et al. e0180996). These characteristics of the second-line tuberculosis treatment make the prevention of the infection essential.

The scope of the public health emergency due to infection with M. tuberculosis is significant. In 2014, 1.5 million individuals died and 9.6 million persons fell ill due to this disease worldwide (Hassan et al. 1). As for Nigeria, the country is currently ranked the 4th most contributing to the global tuberculosis burden, with only India, Indonesia, and China outperforming it in this regard (Hassan et al. 1). The total number of diagnosed tuberculosis cases in Nigeria equated to 90,584 in 2015 (Hassan et al. 1).

In 2012, the prevalence rate of all forms of the infection was 323 per 100,000 of the population and the incidence rate of 338 per 100,000 (Hassan et al. 1). As the study by Onyedum et al. revealed, the prevalence of drug-resistant tuberculosis among all diagnosed patients ranges between 32% and 53% (e0180996). As reported by Adebisi et al. (2019), of multi-drug resistant 93,000 cases that took place in West Africa in 2016, 20,000 occurred in Nigeria (3).

These numbers make Nigeria the leading country in terms of all types of tuberculosis incidence in the African region. The high prevalence of drug-resistant tuberculosis can become one of the major factors that would slow down the progress in the eradication of this disease in Nigeria.

Affected Populations

Like in the case with many other disorders, tuberculosis affects different population groups unequally. According to Fogel, younger adults, especially males, healthcare workers who deal with the infection regularly, people with compromised immune systems, and those with human immunodeficiency virus (HIV) are susceptible to the disease more than others (528). According to the World Health Organization, mortality and morbidity due to tuberculosis are indeed higher in young adult men than in women: in 2017, nearly 6 million men fell ill due to the infection worldwide and 840,000 died (“Tuberculosis and Gender”).

In contrast, only 3.2 million adult women fell ill and about 500,000 died the same year (World Health Organization, “Tuberculosis and Gender”). Similarly, in Nigeria, the age groups of 25-34 and 35-44 were affected by the disease the most in 2018 (World Health Organization, Nigeria 1). Besides, 58% of new tuberculosis diagnoses that year occurred in the male population and only 34% in the female population (World Health Organization, Nigeria 1).

Noteworthily, the majority of affected healthcare practitioners frequently working with infected patients tend to be males as well. The study by Kehinde et al. revealed that among 271 employees (43.2% males and 56.8% females) of the centers specialized in the treatment of tuberculosis in Nigeria, 6 were positive for culture and all of them were men (613). Besides, approximately half of the individuals with positive acid-fast bacilli samples identified in the study (n=9) worked there for over five years (Kehinde et al. 613). It means that the duration of one’s employment in tuberculosis-related facilities seems to be a contributing factor as well since it is associated with increased exposure to M. tuberculosis pathogens.

Lastly, the high prevalence of tuberculosis in Nigeria is closely linked to the high prevalence of HIV. According to Chang et al., “tuberculosis is the leading cause of mortality among HIV-infected persons in Africa,” and the risk of having tuberculosis is about 20 times higher in patients with HIV than in non-infected individuals (1). It is observed that of 50,320 adult patients with HIV who participated in President’s Emergency Plan for AIDS Relief (PEPFAR) and the Harvard/AIDS Prevention Initiative in Nigeria (APIN) from 2005 to 2010, 11,092 (22%) were diagnosed with an active form of tuberculosis prior to the administration of antiretroviral therapy (ART) (Chang et al. 1).

Besides, 2,021 program participants were diagnosed with tuberculosis even after the initiation of ART (Chang et al. 1). These findings verify the assumption about the susceptibility of immunodeficient persons to the negative impacts of M. tuberculosis.

Risk Factors

Besides improper functions of the immune system, other risk factors that may contribute to the development of active tuberculosis are associated with poor living conditions, unhealthy lifestyles, and overall health status. For instance, along with HIV, such disorders as diabetes, silicosis, rheumatoid arthritis, and some other chronic illnesses frequently have tuberculosis as their co-morbidity (Duarte et al. 116). However, such lifestyle-related and environmental factors as malnutrition and smoking are considered to contribute to the disease progression even more than HIV and chronic disorders in some populations.

For instance, 27% of tuberculosis cases are attributed to poor nutrition in 22 countries with a high prevalence of this disease (Duarte et al. 116). At the same time, smoking may be responsible for 23% of cases of the infection in those states (Duarte et al. 116). Overall, it is valid to say that unhealthy lifestyles and poor living conditions are both closely interrelated with general social-economic factors. People living in poverty are frequently exposed to environmental hazards, lack access to healthy food options, and may tend to adopt unhealthy behaviors dominant in their communities.

The abovementioned assumption is verified by the findings of a study conducted by Iroezindu et al. in a sample of 339 HIV-positive individuals receiving ART in Nigeria (120). Iroezindu et al. revealed that the majority of HIV patients with tuberculosis belonged to a lower social class (120). Overall, besides undernutrition and propensity to engage in risky and unhealthy behaviors, a possible reason why people living in socio-economic deprivation an in overpopulated areas are at a higher risk of tuberculosis is that they tend to contact already infected individuals more often than those living in higher social classes (Duarte et al. 117).

However, non-adherence to ART, the presence of anemia, and previous history of tuberculosis were positively correlated with the development of infection in HIV-positive persons in the study by Iroezindu et al. as well (120). Thus, the health status of individuals plays a crucial role in one’s ability to withstand the onset of the disease and, in turn, can be defined by a combination of several environmental and behavioral factors.

Economic and Social Consequences

Tuberculosis and its poor management lead to an excess in various types of economic and social costs. The most obvious and direct ones are associated with the treatment of the infection, and it is valid to say that the economic burden of the disease is especially high in developing countries. For instance, in India, the leader in terms of the infection incidence, direct costs (drugs, hospital visits, hospitalization, and so forth) induced by disease care per individual equate to US $195 on average (Prasanna et al. 1).

In addition, a mean amount of indirect costs of care, including changes in income, loss of productivity, loss of savings, and so forth, equals approximately US $50.2 per person (Prasanna et al. 1). It means that regardless of whether these costs are covered by the public health insurance or are paid from patients’ pockets, the total yearly amount needed to cover tuberculosis-related healthcare expenses in high-burden states is immense.

Considering that the prevalence of the infection is particularly high in lower-income households, it is impossible to ignore the devastating economic impact of the disease on economically deprived families and individuals. For instance, among 102 Indian patients studied by Prasanna et al., about 32% experienced catastrophic costs due to tuberculosis treatment (1). At the same time, the national study with a significantly larger sample size conducted in Nigeria revealed that “at least 71% of the [tuberculosis]-affected households face catastrophic financial burdens as a result of the disease” (World Health Organization, “Nigeria Study”). Noteworthily, the impact is more severe in the case of drug-resistant tuberculosis.

While the drug-susceptible form of the infection leads to catastrophic costs in 69% of patients, multi-drug resistant infection negatively and seriously affected the economic status of 89% of diagnosed persons in the country (World Health Organization, Nigeria Study). The major reason for such a substantial adverse impact is that about 60% of all Nigerian patients with tuberculosis live below the poverty level (World Health Organization, “Nigeria Study”). This factor not only interferes with individuals’ ability to receive high-quality care but also threatens their overall long-term welfare since, due to infection-associated morbidity, they cannot engage in professional activities and earn money to sustain their existence.

Besides the risk of job loss and drop-out from schools, tuberculosis has severe negative effects on individuals’ quality of life and psychological well-being. The study by Brown et al. revealed that depression and anxiety symptoms are frequently observed in patients with tuberculosis and are particularly pronounced in those with multi-drug resistant forms of the infection (73). Combined with such potential negative and irreversible consequences of the disease as hearing loss and neuropathies, psychological consequences of tuberculosis interfere with one’s functioning, reduce their ability to perform daily activities, and may contribute to the deterioration of relationships with others (Brown et al. 73; Onazi et al. 131).

Overall, direct and indirect costs of tuberculosis are diverse and significant since the disease influences multiple spheres of patients’ lives simultaneously. At the same time, it is valid to conclude that by interfering with individuals’ capability to perform, the infection inhibits the economic development of the country since psychological and physiological morbidity leads to reduced functionality and, thus, is linked to low productivity rates and increased absenteeism.

Priority Action Steps

To eradicate tuberculosis in Nigeria, efforts must be directed at the prevention of the disease through awareness-raising activities and promotion of screening. Firstly, it is important to provide high-risk populations with greater opportunities for screening and promote this practice among them. Screening allows detecting tuberculosis in the latent stages of its development and undertaking timely measures to prevent it from transition into the active and contagious ones (Bloch). In this way, it will be possible to minimize the costs associated with the treatment of the infection.

Secondly, knowledge of risk factors contributing to the development of tuberculosis, as well as positive individual and public attitudes to this infection, are considered to be linked to engagement in protective behaviors and favorable perceptions of such preventive practices as screening (Kasa et al. 1). In contrast, the lack of knowledge and tuberculosis-related stigma characterized by perceived incurability, beliefs in myths about the etymology of the infection, and negative views on associations of tuberculosis with HIV often result in non-disclosure of the disease, non-compliance with treatment, low self-esteem, ridicule, social exclusion, and so forth (Cremers et al. e0119861).

It means that poor understanding of the origins and pathophysiology of tuberculosis and adverse attitudes to it increase individuals’ risk of infection and contribute to its spread through improper compliance with treatment or the lack of thereof. Thus, public education campaigns aimed to promote the knowledge of the disease and reduce the related stigma will assist in the prevention efforts. For better effects, it is essential to include information about such manageable exacerbating risks of tuberculosis as smoking, malnutrition, and access to health services to motivate individuals to adopt healthier behaviors.

Works Cited

Adebisi, Yusuff Adebayo. “Burden of Tuberculosis and Challenges Facing Its Eradication in West Africa.” International Journal of Infection, vol. 6, no. 3, 2019, pp. 1-8.

Bloch, Alan B. “Screening for Tuberculosis and Tuberculosis Infection in High-Risk Populations Recommendations of the Advisory Council for the Elimination of Tuberculosis.” CDC, 1995. Web.

Brown, James, et al. “Health Status and Quality of Life in Tuberculosis.” International Journal of Infectious Diseases, vol. 32, 2015, pp. 68-75.

Cardona, Pere-Joan. “What We Have Learned and What We Have Missed in Tuberculosis Pathophysiology for a New Vaccine Design: Searching for the “Pink Swan”.” Frontiers in Immunology, vol. 8, no. 556, 2017, pp. 1-11.

Chai, Qiyao, et al. “Mycobacterium Tuberculosis: An Adaptable Pathogen Associated with Multiple Human Diseases.” Frontiers in Cellular and Infection Microbiology, vol. 8, no. 158, 2018, pp. 1-15.

Chang, Charlotte A., et al. “Tuberculosis Incidence and Risk Factors Among Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy in a Large HIV Program in Nigeria.” Open Forum Infectious Diseases, vol. 2, no. 4, 2015, pp. 1-11.

Cremers, Anne Lia, et al. “Assessing the Consequences of Stigma for Tuberculosis Patients in Urban Zambia.” PloS One, vol. 10, no. 3, 2015, p. e0119861.

Duarte, R., et al. “Tuberculosis, Social Determinants and Co-Morbidities (Including HIV).” Pulmonology, vol. 24, no. 2, 2018, pp 115-119.

Fogel, Nicole. “Tuberculosis: A Disease Without Boundaries.” Tuberculosis, vol. 95, 2015, pp. 527-531.

Hassan, A. O., et al. “Knowledge about Tuberculosis: A Precursor to Effective TB Control-Findings from a Follow-Up National KAP Study on Tuberculosis among Nigerians.” Tuberculosis Research and Treatment, vol. 2017, no. 6309092, 2017, pp. 1-8.

Iroezindu, M. O., et al. “Factors Associated with Prevalent Tuberculosis Among Patients Receiving Highly Active Antiretroviral Therapy in a Nigerian Tertiary Hospital.” Annals of Medical and Health Sciences Research, vol. 6, no. 2, 2016, pp. 120-128.

Kasa, Ayele Semachew, et al. “Knowledge, Attitude and Preventive Practice Towards Tuberculosis Among Clients Visiting Public Health Facilities.” BMC Research Notes, vol. 12, no. 276, 2019, pp. 1-6.

Kehinde, A. O., et al. “Pulmonary Tuberculosis among Health Care Workers at Two Designated DOTS Centers in Urban City of Ibadan, Nigeria.” The Indian Journal of Medical Research, vol. 133, no. 6, 2011, pp. 613-617.

Onazi, O., et al. “Estimating the Cost of TB and Its Social Impact on TB Patients and Their Households.” Public Health Action, vol. 5, no. 2, 2015, pp. 127-131.

Onyedum, Cajetan, et al. “Prevalence of Drug-Resistant Tuberculosis in Nigeria: A Systematic Review and Meta-Analysis.” PloS One, vol. 12, no.7, 2017, p. e0180996.

Prasanna, Thirunavukkarasu, et al. “Catastrophic Costs of Tuberculosis Care: A Mixed Methods Study from Puducherry, India.” Global Health Action, vol. 11, no. 1477493, 2018, pp. 1-9.

Ravimohan, Shruthi, et al. “Tuberculosis and Lung Damage: From Epidemiology to Pathophysiology.” European Respiratory Review, vol. 27, no. 170077, pp. 1-20.

World Health Organization. “Tuberculosis and Gender.” WHO, 2019. Web.

—. Nigeria. 2018. Web.

—. “Nigeria Study Confirms that TB Is Utterly Impoverishing for Many in the Country.” WHO, 2019. Web.

Abstract

The 20^th century has witnessed a lot in the medical field. The coming into existence of deadly diseases and the escalation of the already existing epidemics, to name but a few, are some of the key characteristics of this century. One such disease that has caused much suffering to the human race is Tuberculosis whose rates of infection have greatly increased ever since it was discovered in the late 19^th century.

Introduction

Tuberculosis was also known as TB is a disease that mostly affects the lungs. The infection is known in scientific terms as tubercle bacillus is a deadly disease caused by a mycobacteria infection most commonly the Mycobacterium tuberculosis (MedicineNet, 1996)). The bacteria was first isolated by a German named Robert Koch in 1882. Though it affects the lungs it is not uncommon for it to attack the central nervous system, lymphatic system, reproduction system, and circulatory system. The disease can also be caused by other mycobacteria like Mycobacterium bovis and Mycobacterium Canetti. According to the World Health Organization (WHO), a third of the world is currently under the scourge of this disease. WHO further estimates that the disease is being transmitted at the rate of one person per second.

Material and methods

The bacteria that causes TB is very contagious as is easily transmitted via air. For instance, when an infected person coughs or sneezes the disease-causing bacteria is transmitted to any person who inhales the air potent with the bacteria. On average if left untreated a carrier will infect twelve people in a year. The TB bacteria generally weakens the immune system of its patient thus making them more prone to other infections.

When the inhaled bacteria enter the lungs, they multiply and cause lung infection for example pneumonia. It may also attack the lymph nodes associated with the lungs and thus inflaming them. The bacteria may further spread to other parts of the body. The body’s immune mechanism can and often does fight the infection and stop its progression. The immune system does this by isolating the bacteria from the body. This it does by forming scar tissue around the TB bacteria. The isolation ensures the bacteria stays in an inactive state and thus containing its activities. Such individuals exhibit no symptoms and cannot spread TB. The process of calcification makes the scars harder and the scars appear as small, round stones referred to as granuloma.

TB is a very common infection as it records over seven million new cases in one calendar year. It is quite true that anyone can be attacked by bacteria. But certain situations make one more vulnerable to the bacteria. First being in constant with persons who are infected makes one more vulnerable for example nursing a TB patient. Secondly, living in unhealthy conditions for example poor and homeless people generally weakens your immune system leaving you vulnerable.

Next, people born in countries with a high prevalence of TB are generally more prone to TB infection. Furthermore, drug addicts and alcoholics are more prone as they have a weakened immune system and often have bad eating habits. It has further been shown that being infected with certain diseases for instance HIV or diabetes increases the risk of infection.

The immune system can only hold the bacteria in its inactive state for some time after which the bacteria, having reproduced in the inactive state, overwhelm the system. The time after which the immune system becomes susceptible is determined by the health condition of the patient. The symptoms of a TB infection include infection general body weakness, loss of weight and appetite, and sweating at night. As the conditions worsen, the patient starts to experience chest pains, coughing, and at times coughing up sputum and blood, and shortness of breath. As the disease spreads further to other organs the affected organ will show signs of infection.

The infection is diagnosed in varied ways which include chest x-rays, analysis of sputum, and skin tests. The chest x-rays can either show scarring, calcification or reveal evidence of tuberculosis pneumonia. The presence of the Tuberculosis causing bacteria in a patient can be tested by viewing his/her sputum on a smear slide under a microscope. Bacteria in the mycobacteria family stain positive with special dyes that is the AFB. A culture of the sputum sample is usually made to ease the identification of the specific bacteria type.

Results and Discussion

Several studies were taken after the initial discovery of the TB bacteria which led to the discovery of Bacille Calmette Guerin also referred to as BCG. This is a vaccine administered throughout the world. Though it is derived from a mycobacterium it provides protection from developing active tuberculosis, especially in infants and children. It should be noted with great concern that BCG is quite effective at the childhood stage of development but as an adult one can still be infected if exposed to the bacteria.

Once a person has been diagnosed to be suffering from TB he is put under antibiotics. This is so for the patient who is deemed to have the disease in its inactive state. The antibiotics commonly used are (INH) and are taken for a period of up to one year and their main working mechanism is to prevent TB from turning active. On the other hand, active TB can only be treated by a combination of medication administered along with antibiotics. The common drugs used include Rifadin and Myambutol. To kill the bacteria four drugs are taken in the first two months, this is then reduced to two for the remainder of the treatment period. Streptomycin is an injection administered to persons with poor compliance. Success in the treatment of TB depends on the patient’s compliance and may take a long period of time.

In the recent past, the medical world has witnessed the emergence of a new strain of TB that is drug-resistant. This has been attributed to the presence of TB treating substances in common medication like cough syrup. Cases of drug resistance lead to the complication of the treatment process as such patients show a very small degree of compliance. Multi-drug resistance is a term used to refer to the resistance to more than one first-line drug like INH. WHO has advised on the improvement in the administration of basic TB care to curb the emergence of new drug resistance cases that are very expensive to treat.

It is common knowledge that HIV/AIDS and TB are closely related. This is due to their opportunistic nature and thus they can easily be mistaken for one another as they even share symptoms. It is also true that the infection by either TB or AIDS makes one more prone to the other as they weaken the body’s defense mechanism.

It was earlier thought that with treatment and vaccination TB would have been history by 2000. The emergence of the AIDS virus in the ’80s brought a new dimension to the fight against this epidemic. Currently, it is more effective to prevent TB by vaccinating and keeping of situations that may place you at a higher risk of contracting the disease, than it is to treat the disease. The future of TB prevention lies in preventive measures rather than curative measures.

References

Medicine Net (1996) Tuberculosis. Web.

The danger of acquiring tuberculosis has been proven not only by numerous historical references but also by real cases of registering this disease in recent history. Today, when the medicine is developed sufficiently, a significantly smaller number of patients are at risk. However, according to the subject of descriptive epidemiology, there is no complete guarantee that this ailment will be completely eradicated, and statistical indicators prove this assumption. As an example, the spread of tuberculosis in Pennsylvania will be considered and based on the data obtained, key causes will be given, as well as hypotheses regarding the methods of prevention.

Distribution of Tuberculosis in Pennsylvania

To obtain a comprehensive picture of the issue, it is necessary to identify the main categories of the population at risk. Since descriptive epidemiology studies not only the causes of certain diseases but also their implications for a specific environment, it is essential to determine groups under threat (Centers for Disease and Control Prevention, 2012). Over the past year, in Pennsylvania, 212 cases of tuberculosis infection were recorded, while in 2017, this figure was 192 (“CDC reports 2018,” 2019, para. 1). Such statistical results are alarming, and a more detailed analysis is necessary. According to the study conducted by Lande et al. (2019), in 2010-2012, the most susceptible category of the population to Mycobacterium avium infection, which is known for its anti-tuberculosis resistance, included people over 80. At the same time, white residents were much more prone to the illness than black, and such variables as smoking or the presence of lung diseases did not have a significant role (Lande et al., 2019). These findings prove that tuberculosis is an extremely dangerous and unpredictable disease that can be transmitted either by infected people or indirectly, for instance, through the water supply.

Recommendations to the Administrator

One of the main recommendations is the need to test the population at risk for infection regularly. Also, permanent water samples should be taken to prevent the ingress of pathogenic bacteria into the overall system. Lande et al. (2019) describe the cases of infection transmitted in such a way, which is a reason for vigilance. Preventive work should be done both with older adults and young people to promote knowledge concerning health safety.

Types of Epidemiologic Study Designs

As a theoretical background for researching and solving the problem of tuberculosis infection, special epidemiological study designs may be applied. Ghebrehewet, Cleary, Kliner, and Wilkinson (2016) note that there are such mechanisms as “descriptive, observational, or experimental designs” (p. 240). Each of the principles has its nuances and can be utilized by healthcare employees to identify such essential features as the causality and frequency of the spread of the disease. Ghebrehewet et al. (2016) also state that descriptive studies constitute the largest category and may be used both at an individual and group level. Therefore, in the considered state, this technique is the most relevant.

Conclusion

Due to statistical analysis, it can be noted that the epidemiology of tuberculosis in Pennsylvania is at its progressive stage, and additional efforts need to be made to reduce the risk. The causes of the transmission of the disease may be different, and continuous testing of the population along with water sampling is mandatory measure. Among the available epidemiological study designs, the descriptive methodology is the most appropriate for the chosen state.

References

CDC reports 2018 U.S. TB case data. (2019). Web.

Centers for Disease and Control Prevention. (2012). Principles of epidemiology in public health practice (3rd ed.). Atlanta, GA: US Department of Health and Human Services.

Ghebrehewet, S., Cleary, P., Kliner, M., & Wilkinson, E. (2016). Conducting epidemiological studies in health protection. In S. Ghebrehewet, A. G. Stewart, D. Baxter, P. Shears, D. Konrad, & M. Kliner (Eds.), Health protection: Principles and practice (pp. 240-252). New York, NY: Oxford University Press.

Lande, L., Alexander, D. C., Wallace Jr, R. J., Kwait, R., Iakhiaeva, E., Williams, M.,… Falkinham J. O. (2019). Mycobacterium avium in community and household water, suburban Philadelphia, Pennsylvania, USA, 2010-2012. Emerging Infectious Diseases, 25(3), 473-481. Web.

Introduction

Tuberculosis (TB) is a treatable infectious disease caused by Mycobacterium tuberculosis bacteria. Other bacteria of this complex, such as M. africanum, M. canetti, M. caprae, M. microti, and M. pinnipedii, can rarely be the cause of TB, too. TB can be asymptomatic, which is also called latent TB. Immune system response usually keeps latent tuberculosis under control, preventing it from activation. People with latent TB are also unable to infect others, as tuberculosis is spread through the air by a cough or sneeze of people with pulmonary TB. Tuberculosis commonly affects the lungs but, in some cases, can affect other organs of the human body. The symptoms usually include chronic cough, fever, and weight loss. The mortality rate has drastically decreased with the help of modern treatment by multiple antibiotics (Glaziou, Floyd, & Raviglione, 2018). However, antibiotic resistance has become a new problem for doctors and scientists, as this eventually led to the new types of TB: multiple drug-resistant tuberculosis and extensively drug-resistant tuberculosis (Glaziou et al., 2018). Although TB is not considered a severe threat to humanity, the elimination of this infection faces many challenges and factors to be considered, depending on certain areas.

Tuberculosis

Epidemiology

Although the mortality rates and the spread of the disease dramatically decreased during the 20th century, tuberculosis is still a significant threat. According to researchers, nowadays, roughly one-quarter of the entire world population is infected with TB (Glaziou et al., 2018). It is possible to note that about 10 million people fall ill with TB each year globally, and it is a stable trend in recent years (World Health Organization [WHO], 2019). Tuberculosis affects both HIV-positive and HIV-negative people, both sexes in all age groups, but men under 15 years old accounted for most of the TB cases in 2018 estimated at 57% (WHO, 2019). Moreover, not only tuberculosis is still a threat, but drug-resistant TB is also a significant issue. According to the World Health Organization, three countries share the global drug-resistant TB burden: India (27%), China (14%), and Russia (9%) (WHO, 2019). As far as the global TB situation is concerned, India also has the highest rates of TB, followed by China, Indonesia, and the Philippines (WHO, 2019). Thus, South-East Asia is the region most affected by tuberculosis.

Risk Factors

Several factors contribute to the spread of this infectious disease. Firstly, it is necessary to note the TB prevention methods are not available worldwide. Usually, the Bacillus Calmette–Guérin (BCG) vaccine is considered an effective preventative method against tuberculosis and recommended to be applied to all healthy babies in countries with higher tuberculosis rates (WHO, 2019). The good news is that 153 countries reported that the BCG vaccine became a part of a standard program of child immunization in 2018 (WHO, 2019). However, this is still not enough as financial situations in developing countries are not stable, and health-care systems are different. Health-care systems in some countries are not able to diagnose TB or treat it correctly. For example, in India, Indonesia, and Nigeria, the number of underreported detected TB cases is extremely high (WHO, 2019). It means that underdiagnosis and challenged access to health care in these countries is a big problem and a risk factor for the continuing spread of the disease.

Nevertheless, access to health care and the quality of treatment are not the only factors contributing to the resurgence of TB. Researchers note that people with chronic diseases have a higher risk of TB infection (Glaziou et al., 2018). For example, according to the recent research, having HIV or diabetes increases the risk of obtaining active tuberculosis (Glaziou et al., 2018). Among other factors, there are undernutrition, smoking, or alcohol abuse (Glaziou et al., 2018). Researchers also state that “patients infected with HIV had higher odds of TB diagnosis at death and death during TB treatment than patients who were HIV negative” (Hannah, Miramontes, & Gandhi, 2017, p. 373). It means that countries with a statistically high HIV-positive population are at risk as well as the prevalence of cigarettes or alcohol can affect the decline in TB incidents around the world in the future.

Another factor contributing to the spread of TB is drug resistance. There are new types of tuberculosis that are resistant to antibiotics. Although scientists work on new methods of treatment of these drug-resistant TB types, only one in three people are enrolled in the latest treatment programs (WHO, 2019). According to the World Health Organization, the global drug-resistant TB treatment success rate is 56% (WHO, 2019). Although scientists made good progress, the world still has not overcome tuberculosis.

The US Statistics and TB Control Challenges

Although TB is not eliminated in the USA, the government achieved much success in lowering TB rates in the past 30 years. According to researchers, tuberculosis rates have drastically decreased since 1993 (LoBue & Mermin, 2017). In 2018, 9,025 cases of TB were reported in total, with almost 70% of them among non-U.S.-born people (“Trends in tuberculosis,” 2018). The state of Georgia has also experienced a slight decrease in TB cases in recent years, with 53% of cases among non-U.S.-born people in 2017 (Georgia Department of Public Health, 2017). It means that most infected people might have obtained this disease in countries with high TB rates before moving to the USA. In general, the state of Georgia is no exception to the average U.S. TB statistics. As compared to the worldwide statistics, the U.S. is not included in the list of countries with high TB cases rates (WHO, 2019). The U.S. has a significant potential to eliminate TB in the future.

Like many other countries, the U.S. is challenged by TB drug-resistance. The researchers note that the number of drug-resistant TB cases has remained unchanged for the last 20 years (“Trends in Tuberculosis,” 2018). The state of Georgia experienced 3 cases of drug-resistant TB in 2017, and one of them was born in the country with high TB burden (Georgia Department of Public Health, 2017). Besides further research on the new TB antibiotics, it is also necessary to work on the prevention methods. For example, TB testing for high-risk groups such as health care workers, people traveling to the countries with high TB rates, or homeless people and prisoners is very important.

Conclusion

Although tuberculosis is not eliminated worldwide, much success has been achieved in the past decades. There is a stable downward trend in TB rates worldwide due to effective prevention methods such as vaccines, as well as TB antibiotics research. However, the world is still challenged by TB drug-resistance and faces future problems with TB treatment as it correlates with chronic diseases. The highest TB rates around the world are still in East-Asia. Although the US does not suffer as much as developing countries, it is necessary to work on eliminating TB in the USA.

References

Georgia Department of Public Health (2018).2017 Georgia tuberculosis report.Web.

Glaziou, P., Floyd, K., & Raviglione, M. C. (2018). Global epidemiology of tuberculosis. Seminars in Respiratory and Critical Care Medicine, 39(3), 271-285.

Hannah, H. A., Miramontes, R., & Gandhi, N. R. (2017). Sociodemographic and clinical risk factors associated with tuberculosis mortality in the United States, 2009-2013. Public Health Reports, 132(3), 366-375.

LoBue, P. A., & Mermin, J. H. (2017). Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA. The Lancet Infectious Diseases, 17(10), e327-e333.

Trends in tuberculosis, 2018. (2019). Web.

World Health Organization (2019). Global tuberculosis report. Executive summary 2019.

Introduction

As an Assistant Manager of a Home Health Care Agency, my responsibility is to make sure everyone in the agency is happy with their job as well as no rules and laws are violated. The current situation with the employee being mistreated after a severe illness should be thoroughly investigated and the proper policies defined. I suggest the following first three steps to be taken as soon as possible.

Key Steps

Firstly, I would do the research about the disease. Tuberculosis is an infectious disease that can seriously affect people. In 2018, 9,025 cases of TB were reported in the U.S. in total, with almost 70% of them among non-U.S.-born people (“Trends in tuberculosis,” 2018). It means that most infected people might have obtained this disease in other countries. TB tests for such groups of people, including those who travel to countries with high TB cases rates should be necessary at our agency.

Secondly, I would talk to the agency’s Human Resources Department. I would find out if telling the employee’s diagnosis to her co-workers violated her privacy and if the corresponding policies exist. Such situations may occur in the future, and the agency needs proper policies on how to handle these emergencies with care about their employees. After that I would interview the employee’s boss as I need to know why he was acting so estranged. If there is a lack of information about contagious diseases, the company should provide training for all employees. Not only tuberculosis but also other infections may occur, and the employees should understand when such conditions are dangerous.

Conclusion

The lack of policies concerning such situations in the agency led to the unsettling consequences. A thorough investigation of this case should help develop new strategies on how to deal with infectious diseases in the workplace in order to provide safety for all employees. As a part of them, TB tests, training for employees about tuberculosis and other infections, and HR policies should help to prevent such situations in the future.

Reference

Trends in tuberculosis. (2018). Web.