Tuberculosis is indeed a potentially terminal illness transmitted through the air and affecting the lungs. The aerosol transmission makes it difficult to control this disease since it is hard to detect all the people who have had contact with a sick person. Furthermore, the detection of this illness is complicated by its disposition to not showing any symptoms until the immune system weakens. Due to an easy way of spreading and the gravity of the consequences, it is necessary to prevent the dissemination of tuberculosis.
It is true that a healthy diet and regular physical exercise may decrease the risk of contracting tuberculosis. However, it is a standard recommendation for preventing many diseases since it maintains the immune system in good condition. If healthy people contact a tuberculosis patient without respiratory protection, they risk becoming infected with the disease and develop latent tuberculosis infection. For this reason, people should be regularly tested for this illness. The state and local governments may engage pharmacists in this process since they are closer to the population than the medical staff in clinics (Glaze & Rowe, 2015). Pharmacists may perform tuberculin skin tests, check their results, and educate people about the actions necessary to prevent contracting tuberculosis.
Restricting tuberculosis patients from attending crowded places is also a reasonable measure. It is necessary to explain to such patients that their interaction with a large number of people may lead to the uncontrolled spread of the disease and cause an outbreak. For this reason, tuberculosis patients are also hindered from traveling using the Do Not Board list (DNB) (Jeffries, Lobue, Chorba, Metchock, & Kashef, 2017). People on this list are not allowed to board a plane either leaving the USA or coming to the country.
Finally, it is the right point that promoting knowledge about tuberculosis is the most effective way of preventing the disease. If people are aware of the gravity of the threat that tuberculosis poses to health, they will make sure to report the suspected illness to the medical staff. This knowledge will also encourage them to undergo a medical examination regularly, which will help healthcare professionals to detect tuberculosis at an early stage.
After being infected with Mycobacterium tuberculosis bacteria, a person may not develop active tuberculosis. Instead, the bacteria will remain viable in their lungs, and the active stage of disease “will develop in 5 to 15% of persons with latent infection during their lifetimes” (Getahun, Matteelli, Chaisson, & Raviglione, 2015, p. 2127). It means that a large segment of the infected population serves as “the ‘seedbeds’ of tuberculosis in the community” (Getahun et al., 2015, p. 2127). Thus, it is essential to prevent the further spread of the disease and avoid developing tuberculosis in the bacteria carriers.
The speaker described the process of getting latent tuberculosis infection (LTBI) in detail. However, it is also necessary to mention that it cannot be diagnosed directly. Therefore, it is detected “by the response to in vivo or in vitro stimulation by M. tuberculosis antigens,” which is the tuberculin skin test and IGRAs (Getahun et al., 2015, p. 2127). Consequently, people should be encouraged to undergo these tests to detect LTBI and prevent the development of active tuberculosis.
It is true that poor and homeless people, as well as substance abusers, are the segments of the population most liable to tuberculosis. It results from their inability to afford balanced nutrition, proper sanitary conditions, and other things necessary for strengthening the immune system. Prisoners usually come from these social groups, so it is logical that they are subject to tuberculosis. The speaker suggested a possible but lengthy way of preventing the spread of tuberculosis in prisons. The state and local governments should modify jails so that they have improved ventilation, more space per person, and protective equipment for the staff (Kamarulzaman et al., 2016). If there is a risk of an outbreak, it is better to test the population as quickly as possible to prevent the further transmission of the infection.
References
Getahun, H., Matteelli, A., Chaisson, R. E., & Raviglione, M. (2015). Latent Mycobacterium tuberculosis infection. The New England Journal of Medicine, 372(22), 2127-2135.
Glaze, L. E., & Rowe, S. L. (2015). Pharmacists’ role in tuberculosis: Prevention, screening, and treatment. Journal of the American Pharmacists Association, 55(2), 118–120.
Jeffries, C., Lobue, P., Chorba, T., Metchock, B., & Kashef, I. (2017). Role of the health department in tuberculosis prevention and control—legal and public health considerations. Microbiology Spectrum, 5(2), 1-22.
Kamarulzaman, A., Reid, S. E., Schwitters, A., Wiessing, L., El-Bassel, N., Dolan, K., … Altice, F. L. (2016). Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in prisoners. The Lancet, 388(10049), 1115-1126.
When do healthcare providers report the occurrence of tuberculosis?
Healthcare providers report the occurrence of tuberculosis within 24 hours after diagnosis. According to Marais et al. (2013), tuberculosis is a highly communicable disease, and thus healthcare providers should report such occurrences even after clinical suspicion. Therefore, given the sensitivity of tuberculosis, healthcare providers look for different issues, which act as pointers to an infection. If any smear test for acid-fast bacilli is positive, then the involved care providers should report the occurrence of TB. Besides, any positive NAA test for M. tuberculosis complex requires healthcare providers to report to the relevant authorities. Any child under the age of five with positive TST is an indicator of TB infection, and thus reports should be made. Moreover, any form of treatment that requires more than two anti-TB drugs is also a potential threat and a pointer to tuberculosis occurrence, and thus it should e reported. Different locations have disparate requirements, but any form of TB occurrence should be reported. This requirement includes any form of the medical outcome on TB medication including discontinuation or completion among others. Finally, patients suspected to have TB should be reported even in cases where there is no bacteriologic confirmation of the disease. The general rule when dealing with TB is that prevention is better than cure.
Explain how the spread of tuberculosis occurs among people?
As aforementioned, TB is a highly communicable disease, as it spreads from one person to the other via air. If a person with TB coughs, sneezes, or does anything that involves the mouth including talking, the germs that cause the disease to get into the air. Therefore, any other person who breathes in the air with the germs s/he gets an infection. This aspect perhaps makes TB one of the most contagious diseases in contemporary times. However, if one is infected, it does not mean that s/he has the disease. After infection, the body’s immune system fights the germs and in most cases, people do not fall sick. For sickness to occur, repeated and prolonged contact with the person suffering from TB is required. Therefore, in most cases, TB affects family members or people close to a TB patient because this scenario creates the necessary environment for transmission. Based on this insight, TB spreads quickly in poorly ventilated and crowded places. However, people with weak immune systems can have full-blown TB after minimal exposure to infection (Fares, 2011). Therefore, such individuals can get microbes from well-ventilated areas. In other words, TB infection progresses quickly to full-blown disease as a secondary infection in a compromised immune system.
How long does it take for tuberculosis infection to manifest signs and symptoms?
Conventionally, the generally accepted incubation period for TB is between two and twelve weeks. However, several issues surround the incubation period for TB. For instance, in most cases with other diseases, the incubation period is defined as the “time required for the infecting pathogen to multiply in the host until it leads to disease” (Esmail, Barry, Young, & Wilkinson, 2014, p. 8). However, with TB, several issues can occur during this period. For instance, reinfections can occur. In this case, it means that the incubation period will be counted from the introduction of the ‘causal’ microbe, as opposed to the initial infection. Therefore, in this case, the incubation period will be longer than expected. Also, the progression of TB infection to a full-blown disease depends on several factors. Therefore, these factors will determine the incubation period. Some of these factors include the presence of HIV infection, cancer, diabetes mellitus, respiratory complications, body weight, and an array of medical treatments among others. Besides, people living in poverty, which contributes to poor living conditions, are likely to have shorter incubation periods as compared to their counterparts living in clean environments due to repeated and prolonged exposures. Therefore, currently, there is no definite incubation period for TB, but the conventional period is 14 to 84 days as aforementioned.
Discuss pathogenesis and pathophysiology of tuberculosis in people living with HIV/AIDS?
As aforementioned, TB microbes are found in the air. When an individual inhales air with the microbes, they enter the lungs via the pulmonary alveoli before duplication in the endosomes of the same cells. Macrophages “identify the bacterium as ‘foreign’ and attempt to eliminate it by phagocytosis where the entire bacterium is enveloped by the macrophage into a phagosome, which combines with a lysosome to create a phagolysosome…M. tuberculosis reproduces inside the macrophage and eventually kills the immune cell” (Sakamoto, 2012, p. 425).
The microbes then enter the bloodstream where they spread to different parts of the body. However, in cases where the host has a strong immune system, the microbes are controlled, which leads to latent TB. However, in cases where the host’s immune system is compromised, the microbes overcome the immune T cells, and thus the person progresses to have full-blown sickness with clear-cut signs and symptoms. Once inside the macrophage, the engulfed microbe is subjected to several defensive mechanisms in an attempt to eliminate it. In a fully functional immune system, the body creates an environment in which the microbe cannot continue replicating or growing, thus creating latency. However, in a compromised immune system, the body cannot fight the microbes, and thus they multiply and move to different parts of the body.
Describe the effective measures that apply to the prevention and control of tuberculosis?
The most effective way of preventing and controlling TB across the world is via vaccination of infants. This exercise creates the necessary immunity that individuals need to fight against the progression of TB infection to full-blown disease. According to Getahun Sculier, Sismanidis, Grzemska, and Raviglione (2012), the only available TB vaccine in contemporary times is bacillus Calmette-Guérin, which is commonly known as BCG. This vaccine reduces the rate of infections by twenty percent and the probability of an infection progressing to disease by sixty percent. Another control mechanism is carrying out public health campaigns to create awareness of the disease and the possible prevention mechanisms. Public facilities should be well ventilated in a bid to reduce the risk of infections. Infected individuals should be treated immediately in a bid to control the spread of the disease. Infected individuals should be encouraged to cover their mouths when sneezing. Also, individuals with latent infections should be put under medication in a bid to prevent the progression to full-blown disease. Finally, those at high risk of infection like family members and close friends of an infected person should be tested in a bid to respond appropriately.
Describe how poverty contributes to the occurrence of tuberculosis in Sub-Saharan Africa?
Poverty is a key predisposing factor in the infection and spread of TB in Sub-Saharan Africa (Barter, Agboola, Murray & Bärnighausen, 2012). Poor people in this region live in crowded areas like slums, which increases the spread of TB microbes. Besides, a family of eight members can be living in a one-roomed house and this aspect increases the risk of exposure to TB infection. Even after infection, poor people cannot access proper medical facilities for testing. Therefore, if an individual is infected, s/he does not get the proper testing and subsequent medication in time to control the progression of the disease. Consequently, an infected individual will continue living amongst healthy people, thus exposing them to the microbe, hence increasing the risk of infection. Amidst poverty, people are more concerned with getting food to eat than preventing the spread of an undetected infection. Also, due to poverty, children might not be vaccinated against TB. Even though the vaccine is free, Sub-Saharan Africa is characterized by poor or missing infrastructures, and thus parents may not be in a position to take their infants for vaccination. Finally, some beliefs restrain individuals from seeking medical care. Some religious beliefs hold that individuals should depend on faith for healing as opposed to taking medication, which aggravates the spread of TB in this region.
How does HIV/AIDS predispose people to tuberculosis?
As aforementioned, in most cases, TB occurs as a secondary infection. HIV/AIDS weakens an individual’s immune system, and thus such a compromised system cannot fight TB infection. Conventionally, HIV/AIDS reduces the number of CD4 T cells in the body of the infected person (Kwan & Ernst, 2011). Besides, HIV/AIDS compromises the quality of the surviving CD4 T cells in the immune system. It is important to note that CD4 T cells form part of the immune system of an individual. Therefore, once these cells are depleted, it implies that the immune system of that particular individual is compromised, and thus it cannot fight effectively against M. tuberculosis, which is a powerful microbe. This microbe has several defensive and survival mechanisms like a thick capsular layer, which cannot be penetrated by the defensive mechanisms of a weak immune system. Also, this bacterium is known to alter its protein synthesis mechanism as a survival mechanism. Therefore, this aspect implies that an immune system has to be strong and fully functional in a bid to fight and eliminate M. tuberculosis. However, in HIV/AIDS victims, this strength and functionality of the immune system are lacking due to the depletion of CD4 T cells. Therefore, these conditions predispose HIV/AIDS patients to TB.
What is the meaning of directly observed therapy in the treatment of patients with tuberculosis?
Directly Observed Therapy (DOT) is a process of drug administration and monitoring whereby a caregiver gives and oversees the consumption of drugs by a patient (Pasipanodya & Gumbo, 2013). In TB, DOT requires the involved caregiver to make sure that the patient swallows every dose of the medication. Therefore, this exercise requires the caregiver to watch as the patient takes his or her medication. The person carrying out this therapy does not necessarily have to be a healthcare provider; however, the individual must be trained. Besides, such a person should not come from the patient’s family. Given the versatility of the TB microbe, individuals are required to take a regimen of drugs within a given time by following specified guidelines in a bid to reinforce the immune system and fight the disease. Therefore, if an individual skips some of the drugs, it becomes difficult to counter TB infections effectively. This aspect explains why a trained individual has to watch over the patient as s/he takes TB drugs. Family members are discouraged from becoming therapists in this case because they can become complicit, and thus overlook their mandate to ensure that the patient takes the required drugs at the right time.
Name the available methods of diagnosing tuberculosis?
The diagnosis of TB takes different steps. Individuals should become worried if they have a loss of weight and appetite, prolonged coughing lasting for over three weeks, fever, sweating at night, and unexplained fatigue. The first diagnosis step involves reviewing one’s medical history. From this information, a caregiver can determine whether one had earlier been exposed to TB among other aspects. Also, the caregiver can determine other predisposing factors like family background among other factors. The second step involves physical examination whereby the caregiver can determine the general health status of the patient. At this point, one can determine whether the patient has other preexisting conditions like HIV/AIDS and obesity among others. The third step is TST, which involves testing the blood for M. tuberculosis (Kasprowicz, Churchyard, Lawn, Squire, & Lalvani, 2011). The third step involves carrying out a chest radiograph to determine the presence of lesions in the chest and the general size and appearance of the lungs. Besides, the presence of acid-fast bacilli in the sputum is a clear indication of the presence of TB infection, and this aspect can be determined by carrying out diagnostic microbiology on a specimen from the patient. Finally, drug resistance is a key indicator of tuberculosis, and thus tests to determine the same are used for diagnosis.
What are the types of medications that apply to the treatment of tuberculosis?
As aforementioned, having a TB infection is different from having the disease. People with the infection are said to have latent TB, which means they have the bacterium in their body systems. Therefore, these individuals are given drugs to prevent the progression of the infection to full-blown disease. The commonly used drugs are “ isoniazid (INH), rifampin (RIF), and rifapentine (RPT)” (Konstantinos, 2015, p. 251).
However, individuals with the disease need a regimen of different drugs, which is taken over a specified duration. The drugs include “isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA)” (Konstantinos, 2015, p. 251). The initial combination of the drugs requires a patient to be under medication for 2 months. After the initial two months, individuals can choose different continuation options, which range from four to seven months. Therefore, the total medication period ranges from six to nine months depending on the preferred route after the initial two months. In the preferred regimen, individuals take “Daily INH, RIF, PZA, and EMB* for 56 doses (8 weeks) and Daily INH and RIF for 126 doses (18 weeks) or twice-weekly INH and RIF for 36 doses (18 weeks) in the continuation phase” (Konstantinos, 2015, p. 252). However, regardless of the regimen of choice, one has to complete the treatment period for desirable outcomes.
Explain why a patient with tuberculosis takes different medications for different durations?
People suffering from TB take a regimen of different drugs for disparate durations due to several factors. The critical factor is the drug resistance of M. tuberculosis. As aforementioned, this bacterium can change its protein sequencing, thus leading to mutations and drug resistance. Therefore, in a bid to avoid this scenario, patients have to take different drugs that can counter the mutative tendencies of the bacterium (Menzies, Al Jahdali, & Al Otaibi, 2011). If one drug is used, the bacterium mutates and thus it becomes resistant to that particular drug, which leads to treatment failure. Besides, one of the survival mechanisms of these microbes is living in colonies of numerous numbers in different places in the body. Different drugs have disparate modes of action under different conditions. For instance, some drugs function well under acidic conditions. Therefore, a regimen of different drugs with disparate modes of action implies that they will act on the microbes irrespective of location and environment in the body. Also, these drugs have different side effects. Therefore, if used in high concentration in a bid to counter the bacterium, it means that the side effects will be amplified. However, a regimen will have different drugs in appropriate concentrations, thus minimizing the side effects.
What are the common side effects associated with medications used in the treatment of tuberculosis?
As earlier mentioned in the above section, TB treatment drugs have varied side effects. Of the different drugs used in the treatment of TB, rifampicin has the greatest number of side effects. This drug interferes with the effectiveness of other drugs like family planning pills (Singla et al., 2010). Besides, this drug stains a soft contact lens coupled with causing discoloration of different body fluids like urine and saliva. On the other side, isoniazid causes fatigue and loss of appetite. Also, it can lead to numbness of different body parts especially in people with compromised immune systems. On its side, ethambutol is known to interfere with the functioning of the eyes, and thus it affects one’s sight. Finally, pyrazinamide causes nausea coupled with the loss of appetite. Also, it can cause rashes and arthritis-like conditions. Therefore, before starting TB treatment, patients and caregivers should discuss the possible side effects based on one’s health status at the time. If a drug causes more side effects than its purpose then it should be discontinued because its utility is counterproductive. Individuals under medication should be very sensitive to note any changes in their body functioning in a bid to alert the caregiver in time to avoid complexions from the usage of the drugs.
When do patients with pulmonary tuberculosis perform their duties normally?
People with pulmonary TB perform their duties normally after proper medication and management practices. Pulmonary TB is complex and the severest of all other forms of the sickness because it attacks the lungs. Lungs are very critical in the functioning of an individual’s body as they facilitate breathing, which conventionally supports one’s life. Therefore, as long as a patient is having symptomatic pulmonary TB, s/he cannot perform his/her duties normally. Conventionally, pulmonary TB causes chest pains and breathing difficulties. Every form of task including sitting upright or lying down requires proper functioning of the lungs. Therefore, if the lungs are infected by pulmonary TB, it means that an individual’s normal body functioning cannot operate optimally, and thus one cannot execute his/her duties normally. In light of this argument, it suffices to conclude that an individual can only resume his/her normal duties after recovering from the effects of the disease. Someone under medication can perform some light tasks, but s/he cannot handle strenuous duties. However, before one resumes normal duties like going back to work, s/he should get a doctor’s approval (Zhang & Guo, 2012). Doctors can assess the extent of recovery and monitor the process before giving the appropriate advice.
References
Barter, M., Agboola, S., Murray, B., Bärnighausen, T. (2012). Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review. BMC Public Health, 12, 980-1001.
Esmail, H., Barry, E., Young, D., & Wilkinson, R. (2014). The ongoing challenge of latent tuberculosis. Philosophical Transactions of the Royal Society of Biological Sciences, 369 (1645), 1-14.
Fares, A. (2011). Seasonality of tuberculosis. Journal of Global Infectious Diseases, 3(1), 46-55.
Getahun H., Sculier, D., Sismanidis, C., Grzemska, M., & Raviglione, M. (2012). Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services. The Journal of Infectious Diseases, 205(2), 216-227.
Kasprowicz, V., Churchyard, G., Lawn, S., Squire, B., & Lalvani, A. (2011). Diagnosing latent tuberculosis in high-risk individuals: rising to the challenge in high-burden areas. The Journal of Infectious Diseases, 204(4), 1168-78.
Konstantinos, A. (2015). Mass treatment to eliminate tuberculosis from an island Population. The International Journal of Tuberculosis and Lung Disease, 19(2), 251-252.
Kwan, C., & Ernst, J. (2011). HIV and Tuberculosis: a Deadly Human Syndemic. Clinical Microbiology Reviews, 24 (2), 351-376.
Marais, B., Lonnroth, K., Lawn, S., Migliori, G., Mwaba, P., Glaziou, P.,…Zumla, A. (2013). Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts. Lancet Infectious Diseases, 13(5), 436-448.
Menzies, D., Al Jahdali, H., & Al Otaibi, B. (2011). Recent developments in treatment of latent tuberculosis infection. Indian Journal of Medical Research, 133(3), 257-266.
Pasipanodya, J., & Gumbo, T. (2013). A Meta-Analysis of Self-Administered vs Directly Observed Therapy Effect on Microbiologic Failure, Relapse, and Acquired Drug Resistance in Tuberculosis Patients. Clinical Infectious Diseases, 57(1), 21-31.
Sakamoto, K. (2012). The Pathology of Mycobacterium tuberculosis Infection. Veterinary Pathology, 49 (3), 423-439.
Singla, R., Sharma, S., Mohan, A., Makharia, G., Sreenivas, V., Jha, B.,…Singh, S. (2010) Evaluation of risk factors for anti-tuberculosis treatment induced hepatotoxicity. Indian Journal of Medical Research, 132, 81–86.
Zhang, X., & Guo, J. (2012). Advances in the treatment of pulmonary tuberculosis. Journal of Thoracic Disease, 4(6), 617-623.
The article discussed the relationship that exists between HIV-infected people and tuberculosis (TB). The article indicates that there exists a biological synergy between HIV and TB. HIV infection lowers the immunity of a person that makes the person become more vulnerable to TB infection. In the U.S., more than 60% of TB cases originate from foreigners who suffer from latent TB infections before migrating to the United States. In 2010, about 8% of active TB cases happened to patients who suffered from HIV. TB infection remains an important aspect of HIV clinicians in the United States of America. However, the United States of America has recorded a great decline in TB infections in the last decade. The article indicated a decrease of approximately 3% of TB infections in 2010. The clinician put a lot of emphasis on TB because the disease is highly infectious, as well as difficult to diagnose. Moreover, TB is a sensitive illness because the improper medication is dangerous as it can result in the illness becoming resistant to drugs to both the patient and the person to who the patient transmits the infection. Even though there are other factors that increase the risks of TB infection, such as diabetes, malnutrition, immunosuppressive drugs, HIV infection remains the prime factor in TB infection.
What the article is about
TB is an illness caused by the Mycobacterium tuberculosis complex, which are organisms that grow gradually and only recognized with special staining techniques. TB mainly attacks the lungs causing chronic pneumonia. However, TB can also affect other body organs such as bones, liver, and spleen. Transmission of TB occurs when healthy persons come- in contact with the sputum of TB patients who suffer from active TB. Patients with positive-smear sputum are highly infectious. In most individuals, the initial TB infection is controllable by an effective immune response. However, in many cases, the infection leads to latent TB, which may turn reactive and result in active TB later in life. TB infection occurs in two phases. The first infection attacks the lungs and is mainly controllable by the immune system. However, before the immune system makes it inert, it spreads to other organs such as lymph and bones. Then, the immune system contains it from spreading further. It remains in that start until the individual gets a further infection when it reactivates into active TB.
Those people who suffer from HIV are more likely to develop active TB after the initial TB infection because of their immunosuppressant. Primary progressive TB cause chronic pulmonary disease and can cause meningitis. Those individuals who suffer from latent TB and develop immunodeficiency because of HIV-infection are at a high risk of developing active TB (Ahuja, King & Munsiff, 2012).
Claims about Treatment
The article gives important claims about the treatment of TB. For instance, the article posits that TB treatment should commence once a proper specimen that guarantees the identification of TB infection has been established. A person who suspects suffering from TB should take a smear TB test. The doctors should confirm the smear results through NAA testing before commencing medication. The article notes that ART decreases mortality in HIV-infected individuals having active TB, irrespective of the number of initial CD4 cell count. This calls for effective ART initiation for anyone with TB/HIV co-infection. Once the treatment of TB starts, adherence to the treatment is fundamental for the successful treatment of TB.
TB patients should seek treatment mainly in public health institutions where there is patients’ enhancement to adherence to medication through Direct Observed Therapy (DOT), where every dose taken by the patient is documentable. The documentation is important in enhancing adherence, as well as decreasing the mortality rate of HIV-infected TB patients. The TB patients who suffer from HIV are encouraged to visit government medical institution in order for the HIV clinicians to coordinate their HIV management accordingly with the health department. This is imperative for the proper management of HIV patients to avoid drug reactivity (Dean, Edwards, Ives, 2000; Narita Ashkin, Hollender, 1998).
In conclusion
The article was very important in educating about how TB occurs. TB infection occurs in two phases. The initial infection occurs when an individual suffers from TB when he/she come into contact with the sputum of a patient suffering from active TB. In most cases, the infection is containable by the immunity system. However, this is not the case for those people who suffer from HIV-infection, as they suffer immune-suppression. Therefore, when HIV-infected people come in-contact with TB, causing organisms from the sputum of TB patients, after the initial infection, the TB infection progresses to active TB. The article highlighted the importance of starting TB medication after properly diagnosing the presence of TB specimens through NAA testing. Once the medication commences, the patient should ensure adherence to medication to avoid TB becoming resistant to drugs. TB patients are encouraged to seek medication from government hospitals. Seeking TB medications from government health care facilities is important in making sure that there is appropriate coordination between HIV clinicians and health care to enhance the HIV management process.
Reference List
Ahuja, S, King, L & Munsiff, S. (2012). TB and HIV Coinfection: Current Trends, Diagnosis and Treatment Update. Web.
Dean GL, Edwards SG, Ives NJ. (2000).Treatment of tuberculosis in HIV-infected persons in the era of highly active antiretroviral therapy. AIDS.16, 5, 75-83.
Narita M, Ashkin D, Hollender ES. (1998).Paradoxical worsening of tuberculosis following antiretroviral therapy in patients with AIDS. Am J Respir Crit Care Med. 158, 45,157-161.
Tuberculosis is not a new problem for public health systems, but in the realities of today is the United States, it still has the potential to pose a public health threat. Tuberculosis has the potential to affect the human body through its airborne transmission. Issues such as screening and control of tuberculosis cases, as well as the problem of selecting effective therapies for the disease, are essential in the development of strategic national and federal programs. This research paper will collect material describing tuberculosis and current statistics on America and New Jersey in particular. In addition, it will provide an overview of current policy programs to combat disease.
Keywords: public health problem, federal programs, New Jersey, control of tuberculosis cases
Introduction
In recent decades, there has been a negative upward trend in tuberculosis prevalence almost everywhere in the US. Tuberculosis, a particularly airborne infectious disease, poses a severe threat to the country’s public health system. It is known that among the states of America, New Jersey is one of those where there is an increased risk factor of tuberculosis infection. The purpose of this research paper is to identify the public health threat posed by tuberculosis in New Jersey and to discuss national programs to combat the disease.
The Problem of Tuberculosis
Tuberculosis is a common, socially dependent infectious disease that affects all human organs and tissues. Statistics show that tuberculosis is one of the leading causes of death in the world (Yu, Wang, Mei, Hu, & Ji, 2020). Each year, this pathology kills about 2 million people on the planet, with the number of cases increasing by 9 million (Yu et al., 2020). The rise in tuberculosis and deaths in recent years has rightly raised concerns among tuberculosis services. This underlines the critical importance of further research on the treatment and prevention of morbidity.
Reasons for Tuberculosis
The causative agent of tuberculosis is mycobacteria, which is common in the environment. The source of infection is a patient with an open disease form (Brown, 2016). The problem of tuberculosis is a priority for various health systems around the world, as negative pathomorphism is noted: the incidence is increasing, and the rate of acute and antibiotic-resistant forms is increasing (Yu et al., 2020). This is due to the socio-economic and environmental situation and a number of aggravating factors: age, chronic non-specific respiratory diseases, diabetes mellitus, and HIV infection (Kreisel, Passannante, & Lardizabal, 2019). Infection with tuberculosis mycobacteria does not always cause the development of the tuberculosis process. Adverse living conditions, inhalation of contaminated air, and a reduction in the body’s resistance play a leading role in the development of tuberculosis (Torres et al., 2019). All of the above aggravates the course of the disease, reduces the effectiveness of therapy, and significantly increases mortality.
New Jersey Statistics
The spread of tuberculosis is not only a problem in countries with weak health system performance. Although the modern U.S. is one of the least affected countries, government programs and national projects must be established to help people already diagnosed and to prevent the potential spread of the disease. Moreover, it is essential to note that there is some geographic inequity in the U.S. to the problem of tuberculosis: New Jersey’s regions, according to studies, have the highest rates of infection and pose serious risk factors for tourists and urban residents (Brown, 2016). Statistics describe five cases of tuberculosis infection per hundred thousand New Jersey residents, while the neighboring states of Delaware and Pennsylvania have no more than four (Brown, 2016). Elevated state cases of tuberculosis infection generate increased interest and trigger a discussion of national health practices that exist to analyze improvements.
Alternative Views
The development of medical technologies undoubtedly has a positive impact on the detection of new cases of tuberculosis and their subsequent treatment. However, for large states of America, in particular, New Jersey, it is not very easy to assess real control figures (Gulati et al., 2019). In this regard, several opinions are emerging in public. For example, Matthau (2018) is convinced that New York City has more infections than New Jersey. In his article, he writes about an unprecedented drop in new infections, pointing out that recently there has been an almost 72 percent drop (Matthau, 2018). However, official statistics based on CDC data do not agree with this information (“Tuberculosis incidence rate,” 2019). The data presented in this online report indicate that tuberculosis incidence among the New Jersey population declined between 2010 and 2019, but only by 31 percent (“Tuberculosis incidence rate,” 2019). Thus, there is some misinformation aimed at creating a more positive public sentiment about the problem of infection with Tuberculosis Bacillus.
Despite the significant differences in the figures presented, the authors agree that most cases of the disease are common to migrants and people from outside the American nation. For example, Asians and Hispanics living in New Jersey are more likely to be infected with tuberculosis (Gulati et al., 2019). According to Elnahal (2018), by 2017, more than 84 percent of tuberculosis cases in New Jersey are registered with foreign nationals. In general, the sources studied show a positive trend in cases of declining incidence among residents.
Medico-Political Programs
Reducing the social and economic burden of tuberculosis is possible with the adoption of a single national program aimed at improving the system of prevention and medical care. Such programs should be based on practical and scientifically based technologies for tuberculosis control and adequate modern measures for medical and social rehabilitation after treatment. The modern U.S. health care system includes several government programs designed to monitor and control the spread of the disease (“Complete health indicator report,” 2018). It is estimated that by 2012 about 46 percent of the population did not have a health insurance policy that could cover the cost of screening and treatment (Balaban et al., 2015). For this reason, in recent decades, the national tuberculosis policy has focused on promoting the maximum inclusion of the American population in the health insurance program.
Monitoring Programs
Furthermore, tuberculosis surveillance programs are not only at the federal level but also the state level. New Jersey has a health policy that postulates the actions of physicians and medical personnel in cases of new cases of tuberculosis (Department of Health and Senior Services, n.d.). The policy states that if a patient is diagnosed with a case of tuberculosis, the health care provider must notify the Department of Health within 24 hours. Each patient is provided with a nurse who oversees the treatment and care process (Elnahal, 2018). In addition, such a patient must be regularly monitored every three months or if the patient’s tests show changes (Department of Health and Senior Services, n.d.). Through such a program, state authorities seek to control and prevent transmission of tuberculosis infection between populations promptly.
Another mandatory public health program in New Jersey is the annual check-up of schoolchildren and educational personnel for Koch’s bacillus. This includes a Mantoux test and chest X-ray for pathological changes in lung structure (New Jersey Department of Health, 2016). The policy is not to treat patients, but instead to help the state administration monitor morbidity.
Treatment Programs
State health programs at the municipal and district levels not only play a regular monitoring role but also contribute to improving current treatments. Research and development carried out by the Global Tuberculosis Institute at Rutgers play a significant role in the development of medical technology (Romano, n.d.). The National Institutes of Health provide grants to universities and research centers on an ongoing basis to improve existing equipment (RGHI, 2019). This encourages the further development of existing projects, which will contribute to the development of more effective methods of analysis and control of tuberculosis.
Federal health programs are echoed in similar programs at the New Jersey level. For example, to improve U.S. health outcomes, the Healthy People 2020 program has set a goal to reduce the proportion of people with different diseases by advancing treatment and screening (“Healthy People 2020,” 2019). The New Jersey State Administration expects to achieve a 93 percent completion rate for tuberculosis patients within 2020 (“Complete Health indicator report,” 2018). All available medical and research resources are aimed at achieving this number.
Conclusion
Tuberculosis is a severe problem that is still a threat to American lives, despite the current negative trend of new infections. Although treatable at an early stage, it does cause significant social harm. The state of New Jersey demonstrates the greatest threat to new infections of healthy people, which may be associated with the abundance of migrants and residents of different ethnicities. Benchmarks for the number of diseases vary from source to source and generally show public attitudes toward tuberculosis. While some believe that the infection is not dangerous for residents of the state, others are afraid because there is only a slight decrease in the number of infections.
To address tuberculosis, national and state governments are developing several strategies aimed at both monitoring the prevalence and improving current treatments. Such programs include regular review of schoolchildren and education center staff and immediate referral to the Ministry of Health if a new patient is found. Grants programs are also being developed, providing financial support to research institutes to develop new methods of tuberculosis control and therapy.
To the Mayor of Elizabeth, Chris Bollwage. About Tuberculosis Prevention
Dear Chris Bollwage, events taking place in the world demonstrate the importance of very rapid response of the health system to outbreaks of various diseases. Even though nowadays citizens are actively informed about the problem of the coronavirus infection COVID-19, the city administration should not forget about another pandemic that has been exterminating the population for more than a hundred years – tuberculosis. At first glance, it may seem that official statistics provide comforting news: in ten years, the incidence in New Jersey has fallen by almost 31%. However, it is worth looking at the situation from a different angle – there are still patients in Elizabeth who need treatment or are not even aware of their diagnosis. In addition, in the current situation, tuberculosis can be a lethal addition to the COVID-19, which affects the respiratory system. The analysis of the existing solutions offered by New Jersey’s Health Care System leads to the conclusion that several additional measures must be taken to ensure the safety of the population. In that regard, Mr. Bollwage, please note the proposed steps.
Diagnostic systems need to be improved, which includes mandatory tests (Mantoux test and fluorography) for all age categories once a year.
It is essential to monitor the implementation of the previously established measure whereby every patient is provided with a nurse. In practice, there may be a shortage of nurses due to understaffing.
A recovered patient is obliged to be diagnosed three months after the therapy. It is essential to control this and impose sanctions in case of bad faith of the patients.
Together with the proposed actions, I express my hope that starting from today, the overall tuberculosis incidence will only decrease. We must do everything possible to achieve the goal set by the World Health Organization, according to which the tuberculosis pandemic should be stopped already in 2030. Mr. Bollwage, I kindly ask you to pay special attention to this issue to ensure the safety of Elizabeth’s population.
References
Balaban, V., Marks, S. M., Etkind, S. C., Katz, D. J., Higashi, J., Flood, J.,… Chorba, T. (2015). Tuberculosis elimination efforts in the United States in the era of insurance expansion and the Affordable Care Act. Public Health Reports, 130(4), 349-354.
Brown, T. L. (2016). The impact of social determinants on tuberculosis incidence trends in New Jersey. Web.
Complete health indicator report of tuberculosis patients who complete curative therapy. (2018). Web.
Department of Health and Senior Services (n.d.). New Jersey administrative code. Web.
Elnahal, S. (2018). New Jersey Department of Health recognizes March 24 as World TB Day. Web.
Healthy people 2020. (2019). Web.
Gulati, N., Ram Pentakota, S., Feja, K. N., Ghoshal, B., Bhavaraju, R., Jindani, A.,… Kalyoussef, S. (2019). 1376. Physician practice patterns for screening and treatment of latent tuberculosis infection in the South Asian population in central New Jersey. Open Forum Infectious Diseases, 6(2), 499-500.
Kreisel, C. F., Passannante, M. R., & Lardizabal, A. A. (2019). The negative clinical impact of diabetes on tuberculosis: A cross-sectional study in new jersey. Journal of the Endocrine Society, 3(1), 62-68.
Matthau, D. (2018). Why is tuberculosis on the rise in NYC but not New Jersey? Web.
New Jersey Department of Health (2016). Tuberculosis program. Web.
RGHI (2019). Improving TB treatment – and survival – in the world’s poorest places. Web.
Romano, F. (n.d.). Tuberculosis Control Program. Web.
Torres, M., Carranza, C., Sarkar, S., Gonzalez, Y., Vargas, A. O., Black, K.,… Páramo-Figueroa, V. H. (2019). Urban airborne particle exposure impairs human lung and blood Mycobacterium tuberculosis immunity. Thorax, 74(7), 675-683.
Tuberculosis incidence rate, New Jersey, by year: Beginning 2010. (2019). Web.
Yu, W. Y., Wang, Y. X., Mei, J. Z., Hu, F. X., & Ji, L. C. (2020). Overview of tuberculosis. In W. Yu, P. Lu, & W. Tan (Eds.), Tuberculosis control in migrating population (pp. 1-10). Singapore: Springer.
Among communicable diseases, tuberculosis is known as one of the oldest and most thoroughly studied infectious conditions. Highly contagious, the illness is easily transmitted during contact with a contaminated individual. Despite its increased danger for patients with chronic immune diseases, such as HIV, tuberculosis has been successfully cured in the majority of cases over the past few decades (World Health Organization, 2018). This paper briefly discusses the agent and environmental characteristics of the disease, its signs, symptoms, and treatment, providing a basis for the public health nurse’s clinical practice.
Overview of the Disease
Characteristics
Agent. The pathological agent of tuberculosis is known as Mycobacterium tuberculosis. As explained by Chai, Zhang, and Liu (2018), during the latency phase of the infection, the pathogen damages the patient’s immune system and resides in granulomas. While causing the development of the disease, Mycobacterium tuberculosis also leads to several autoimmune diseases and pulmonary complications.
Environmental. The likelihood of developing tuberculosis is higher for people with lower socioeconomic status. According to Kanchan, Surya, and Ajay (2015), most tuberculosis patients are susceptible to drug and alcohol abuse, stress, malnutrition, have HIV, or diabetes. Such factors increase the risk of human contact with an infected individual.
Signs, Symptoms, and Treatment
Though easily communicable, tuberculosis is relatively difficult to diagnose at the early stages of the disease for the lack of differentiable signs. As mentioned by WHO (2018), the most prominent symptom of the illness is a persistent cough with sputum and blood. Some patients also report fatigue, weight loss, night sweats, and pain in the chest. While earlier tuberculosis was considered a non-curable condition, modern cases of active, drug-susceptible incidents of the disease are proven to be cured with the help of antimicrobial drugs within half a year (WHO, 2018). Still, improper medicine prescription and delay of the diagnosis may have adverse effects on the course of the treatment.
Incidents of the Disease
Tuberculosis remains one of the top ten death causes worldwide. As noted by WHO (2018), in 2017, approximately 1.3 million patients died from the illness, with 10 million people developing the condition yearly. Incidents of the epidemics vary, depending on the socioeconomic determinants of the country. For instance, in the high-income nations, there were less than 10 cases per 100 000 population. This ratio grew as high as 500 in the African and South American countries with a significantly lower quality of life (WHO, 2018). Georgia Department of Public Health (2017) also reported several cases of tuberculosis in the state. In Forsyth County, in particular, the tendency toward the spread of the disease shows that every consecutive year, there are fewer cases of tuberculosis in the area. The public health department recorded seven incidents of the illness in 2015, whereas, in 2016, the number lowered to five registered patients (GDPH, 2017).
Implications for Public Health Nurses’ Clinical Practice
For a community health nurse, it is of vital importance to educate the public on the signs, symptoms, and possible treatment of tuberculosis. Particular attention should be paid to the testing of socially disadvantageous residents. Therefore, practitioners should advocate for social initiatives that allow screening people with an increased risk of developing tuberculosis, on the legislative level. Apart from the aforementioned factors, public health nurses should inform individuals about the available methods for diagnosis and prevention. Forms of educating the public can include free training, support teams, presentations, and community projects.
Conclusion
Caused by Mycobacterium tuberculosis and a series of socioeconomic factors, tuberculosis is a highly contagious disease, usually diagnosed after the persistent cough with sputum and blood, weight loss, fatigue, and night sweats. Though in most cases, the condition is successfully treated with antimicrobial therapy, the number of people dying from the illness remains relatively high. To minimize the instances of tuberculosis, public health nurses should educate the public through training, social projects, and governmental initiatives.
References
Chai, Q., Zhang, Y., & Liu, C. H. (2018). Mycobacterium tuberculosis: An adaptable pathogen associated with multiple human diseases. Frontiers in Cellular and Infection Microbiology, 8(158), 1-15. doi:10.3389/fcimb.2018.00158
Portsmouth, Virginia, is a city located on the East Coast of the United States. It is a port town with an unusual racial makeup, as roughly half of the population is African American, with a further approximately 40% white and the rest composed of various other minorities. The author has found Hispanics to have a particularly high incidence of tuberculosis. This result is consistent with statistics in broader Virginia, where they are ten times as likely to contract it as while people, second only to Asians and Pacific Islanders (OTIS TB data, 2020). The community is small and generally impoverished, which is why it was chosen as the primary target for the author’s praxis.
As a BSN-prepared community health nurse, Debbie needs to implement measures that reduce the danger of a tuberculosis outbreak in the community. The primary prevention measure that the author would recommend would be to promote BCG vaccination in children across the area. Infants are particularly at risk from tuberculosis, and vaccination can help reduce the danger that they face. The secondary prevention would involve testing the farmworkers using the tuberculin skin test to determine whether there is a present danger of the infection spreading and treat those already affected. Finally, for tertiary prevention, Hasnain et al. (2019) recommend promoting lower tobacco consumption among the affected communities. All of these methods are relatively inexpensive and can help control the spread of tuberculosis, assuming that active infections emerge.
In the case of the author’s community, the interventions should remain mostly the same, but there is a notable concern that needs to be addressed. Per Zuniga et al. (2014), there is a tendency among Mexican Americans to stigmatize community members who are known to be ill with tuberculosis even as they need family support. As such, it will be necessary to provide a higher degree of privacy and confidentiality to the patients to ensure that they are comfortable disclosing their symptoms. This measure will reduce their tendency to conceal their condition and help with the early prevention of the illness before it can develop. Combined with the other steps, this approach can improve the monitoring of tuberculosis and prevent outbreaks.
References
Hasnain, S. E., Ehtesham, N. Z., & Grover, S. (eds.). (2019). Mycobacterium tuberculosis: Molecular infection biology, pathogenesis, diagnostics and new interventions. Springer Singapore.
OTIS TB data 1993-2019 results. (2020). Centers for Disease Control and Protection. Web.
Zuniga, J. A., Munoz, S. E., Johnson, M. Z., & Garcia, A. (2014). Tuberculosis treatment for Mexican Americans living on the U.S.–Mexico border. Journal of Nursing Scholarship, 46(4), 253-262.
South Africa is ranked by the world Health Organization among the top countries with a high tuberculosis strain. Studies have shown that the highest prevalence of TB is at the Western Cape Province. A significant risk has been noted in healthcare facilities
at Tygerberg hospital in Kwa Zulu natal province where a considerable risk in nosocomial transmission of tuberculosis has been noted. An infection prevention and controls programme in the country has established that although there is an adequate supply of protective training, great emphasis needs to be directed on training and understanding of the infection and controls programs. Studies have continued to indicate that concurrent human immunodeficiency virus, poverty, ignorance, overcrowding and other related factors have continued to hamper the control efforts from those tasked with the responsibility of controlling the disease.
Consequently, high treatment interruption rates, the HIV epidemic, low cure rates have contributed to the emergence of multi drug resistance tuberculosis in South Africa; this has been blamed on the adoption of inappropriate treatment programmes as well as patient factors that include a lack of adherence to the treatment regimen. The emergence of the multi drug resistance strain of TB can be adduced to a systematic failure in the global community to contain the disease which is curable (Gandhi, et al, 2006).
Efforts have been directed in the prevention and containment of TB in South Africa. Primary prevention aims to stop communicable diseases from spreading. This effort is therefore directed at people in the community who have not yet been infected. The most notable aspect of primary prevention is through vaccination this helps in the abolition of the routes of disease transmission. Other measures such as behavioral counseling have been high in a bid to contain transmission.
That coupled with early diagnoses, risk counseling, training of prevention services are primary strategies that have been adopted to contain new infections in the highly affected areas and most vulnerable groups of South Africa. However, a lack of systematic health behavior training, patient resistance to change and a low self efficacy has been challenges that have affected the adequate deployment of effective primary strategies (Weyer, 2006).
Secondary prevention strategies in South Africa have been aimed in trying to impede the spread of the disease from already infected persons. This has been directed at early detection, isolation of the patients and subsequent treatments of infected persons. This has been through evaluation and diagnosis by means of sputum examination and chest X-ray to diagnose the disease, ensuring the collection of sputum for microscopy as the basic means of detection and monitoring of treatment in health facilities while also ensuring that patients with a productive cough are subjected to sputum test for TB in designated laboratories; this has always been followed by the isolation and confinement of TB suspects in specialized facilities for treatment.
An emphasis has also been placed in communication where patients already infected have been informed that TB is curable hence the importance of complete treatment as well as seeking medical attention incase of the symptoms occur. Nutrition interventions come in handy due to the change in metabolism, the compromised immunity and lack of appetite. Health care facilities have also been instrumental in the provision of therapy during the continuation phase of treatment this has made it possible for filing reports on any complications that arise from the treatment (Gandhi, et al, 2006).
Tertiary prevention efforts are directed toward people living with TB and are intended to reduce the negative and challenging effects of the illness. This may include rehabilitation and patient education for example on the importance of cough etiquette so as to minimize infectious droplet nuclei the use of surgical masks though not efficient in eliminating infectious nuclei has been encouraged so as to prevent the generation of the nuclei. This is also involves counseling due to the stigma attached on TB patients.
A number of complex environmental control have been used to reduce the number of infectious droplets, the simplest method being ventilation through open windows other methods include mechanical ventilation using exhaust ventilation systems in health facilities, filtration of air and germicidal irradiation as well as the use of HEPA filtration These measures are useful in wards, TB clinic waiting and inpatient areas (Fourie, 1996).
Reference
Gandhi, N., Moll, A., Pawinski, R., Zeller, K., Lalloo, U. et al. (2006). Favorable Outcomes of Integration of TB and HIV Treatment in a Rural South Africa. New York: Oxford University Press
Weyer, K. (2006). Centers for Disease Control and Prevention Emergence of Mycobacterium Tuberculosis with Extensive Resistance to Second-Line Drug Worldwide. New York: Oxford University Press.
Fourie, P. (1996). WHO review of the tuberculosis situation in South Africa. Epidemiology Journal, 34 (2), 54-6.
The article is written by Peter Crosta and is about tuberculosis. It gives information about the causes of tuberculosis and how the disease can be prevented. The article also explores various ways through which the disease can be treated. The article was first written in the year 2009 but was later updated on 12th December this year.
Tuberculosis, commonly referred to as TB, is a condition that is caused by bacteria. The name of the bacterium causing tuberculosis is Mycobacterium Tuberculosis. The disease mainly affects the lungs. Patients suffering from tuberculosis experience chest pain and persistent coughs. If not treated in its early stages, tuberculosis can cause pneumonia. The disease is rampant in Africa and Asia. Research has shown that people suffering from HIV/AIDS are at a higher risk of contracting the disease. The disease spreads through the air when a person infected with tuberculosis coughs or sneezes (Crosta 2013). The symptoms of the disease include fever, fatigue, lack of appetite, a cough lasting for more than 2 weeks and weight loss. The disease can be tested in most health care centers around the world. There are two types of tests that can be used to detect Mycobacterium Tuberculosis. The blood test is a widely used test used to detect tuberculosis compared to the skin test which does not give instant results.
Treatment
The treatment administered on patients suffering from tuberculosis depends on whether the patient is suffering from active tuberculosis or latent tuberculosis. Latent tuberculosis can be treated by administering a drug by the name Isoniazid (INH). This drug is an antibiotic that is usually administered for 6-12 months on a patient. Research has shown that Isoniazid (INH) can have dire effects on pregnant women and doctors have since discouraged the use of the drug by pregnant women (Crosta 2013). Doctors use Isoniazid (INH) together with a combination of other recommended drugs to treat active tuberculosis. They include Streptomycin, Rifampin, Pyrazinamide and Ethambutol.
There have been reports that some patients are becoming drug-resistant to the drugs used to treat tuberculosis. This has prompted medical practitioners to use a combination of drugs other than the four that are usually used. Doctors have in the past used surgery to remove damaged tissue among their patients. Patients need to complete their medication. Research has shown that most patients stop taking tuberculosis drugs after feeling better. Patients need to complete their medication so that the bacterium causing tuberculosis can be eliminated completely. Tuberculosis can be prevented by eating a balanced diet that will boost a person’s immune system. It is also important to be tested for tuberculosis regularly in case a person is living in a region that is considered risky.
Tuberculosis is more prevalent in Africa and Asia. According to the article, in the year 2007 research conducted showed that over 100,000 people are infected with tuberculosis every year in each country (Crosta 2013).
Conclusion
The article offers important information about tuberculosis. The article also discusses the various treatment options that can be used to treat patients infected with tuberculosis. Further, the article offers insightful information concerning the prevalence of the disease over the past few years. The article also gives information as to how people can prevent themselves from contracting the disease.
Tuberculosis is among the disease category of rare bone diseases, and the problem is estimated to occur in the range of 1 to 3 %. Despite the fact that the disease is termed as rare, its occurrences are increased with the provision of certain favorable environments/conditions such as malnutrition, drug, and medical abuses, presence of certain diseases and/or conditions like HIV, diabetes as we as immune-compromising factors among others. In addition, bone tuberculosis is usually noticed as lesions occurring singly, but the disease sometimes presents with multiple lesions in different patients. Whereas certain diseases show specificity in the area or parts of the attack, bone tuberculosis appears to be least specific, and thus universally infects any type of bone regardless of size and position. The spinal bones are most likely to be infected while attacks are less commonly found in long bones, as it is according to Madkour and Warrell’s (1) knowledge and understanding of the nature of the disease.
It is also noted that the problem is likely to originate in parts that are more vascularized in nature. This is evidenced by its common origination at metaphyses in children. Moreover, tuberculosis cases though are noticed in all ranges of the demographic population of people, young children and adults depict high prevalence of all tuberculosis forms. In this view, Golden and Vikram (2) believe the above generalization of the disease’s ability to attack the various body part (tissues and bones) is a clear indication and suggestive of how the disease might present itself as a global threat.
Diagnosis
There are various diagnosis methods available for detection of the bone tuberculosis. The diagnosis of the bone tuberculosis may be done through the employment of imaging techniques, laboratory probing and/or utilization of clinical methods. However, the employment of the laboratory technique is generally not encouraged for results do not count much in the diagnosis and intervention process due to their high level of unreliability.
Imaging method/ techniques
Bone tuberculosis can be detected and diagnosed by the use imaging techniques. This implies the methods are much more reliable during establishment of the disease problem together with the subsequent intervention process. Fausto et al (3) suggests some of the most commonly used imaging techniques for the bone tuberculosis include magnetic resonance imaging, which is plays crucial role in the detection of bone marrow edema during the initial bone attack by the disease. Computerized tomography- used in the detections of vascular malfunctioning and problems such ischemia and vascular congestions. The last method is use of plain radiography, which is normally employed when the bone disease activities are already eminent and clear.
Fig. showing swollen part of the elbow under MRI focus
X-ray radiography
During the diagnosis of bone tuberculosis, radiologists require to examine various parts of the bone area. This means that depending on the problem description by the person seeking medical help, radiologist may perform a single radiographic view or several of them. However, Madkour and Warrell (1) warns individuals on the risk associated with radiographic processes and further wisely advises that it’s better to carry a single radiographic investigation to minimize the risks associated with radiation effects. Generally, a radiologist may investigate the disease problem through carrying out of a frontal projection or lateral view.
Example in elbow TB
Goroll and Mulley (4) describes that in case a client express an enlarging joint accompanied with restriction on movement, the radiologists take a lateral radiograph at the elbow point of the specific hand but no any other part of the body. The isolation of the hand from all other parts is a measure taken to ensure that the X-ray radiation does not fall on any other body part. This prevents causing damage to the cells and organs that lies outside area of target. The part is also specifically selected because it has the high possibility of being attacked by the disease problem. The idea is that the investigation is localized and therefore the technique helps to save time during the process of probing
The adoption of these radiographic techniques therefore has several advantages and benefits in the carrying out routinely diagnostic procedures. The method helps radiologists to obtain immediate relevant information of the anatomical structure of a mal-positioned or misaligned part of the body. They give structural details and information of both the tissues, cells as well as the bone structure during radiologic analysis which be used by nurses and other persons to gain deeper knowledge and understanding of the anatomical parts which they might have not studied before. Thus, there is possibility of discovering new research topics, or even resolving structural/anatomical problems that have been contradictory over the years. Under the proper use of the technique, Deshmukh et al, (5) states that the patient’s risks are quite minimal as nothing is gained nor lost from the patient.
Above is X-ray Images showing lateral and front radiographs of the elbow.
Conclusion
Finally, the method is seen as of great advantage as it quicker in diagnosis process, and ensures precision besides permitting the checking a diversified number of disease problems, that is, during the diagnosis of tuberculosis, the medical practitioner can also determine problems of edema and diabetes.
References
Madkour M. and Warrell D. Tuberculosis. New York: John Wiley & Sons; 2006.
Golden, M., and Vikram, R. Extra-pulmonary tuberculosis: an overview. American Farm Physician; 2005. 72:1763–7.
Fausto N., Mitchell, N. and Vinay K., Robbins Basic Pathology. Philadelphia: Saunders Elsevier; 2007.
Goroll A. and Mulley G. Primary Care Medicine: Office Evaluation and Management of the Adult Patient. Lippincott Williams & Wilkins; 2009.
Deshmukh T., Hoskote S., Iyer R., and Sanghvi A. MRI features of tuberculosis of the knee. Journal of Skeletal Radiology; 2009. 38:269–74.
Tuberculosis is a communicable disease that results from the action of germs on the human body. The causative agent is referred to as Mycobacterium tuberculosis. It causes infection to the lungs although in other instances it could affect the brain or the kidneys of the victim (Dyer, 2010). The development of the disease is gradual with only an eighth of those infected with the mild form of the disease developing secondary infection. Once infected, however, a tuberculin skin test that determines presence of the bacterium will always be positive for the entire life of the individual (Schiffman, 2012).. The period of progression from the primary to the secondary stage could take up to two years. Nevertheless, the period of reactivation cold be accelerated by the presence of other critical ailments such a diabetes mellitus or HIV infection (Finer, 2009).
Symptoms of the disease
Some of the most common symptoms of TB include a general feeling of sickness and weakness that is often marked by the loss of weight, rising body temperature and heavy night sweats (Centers for disease controls and treatment, 2012). Once the lung infection has set in, a rough cough accompanied by chest pains could result. For critical cases, the cough could be dotted with spots of blood. Depending on the area of infection, the above symptoms could vary from patient to patient.
Spreading process
A cough or sneeze from a person infected with TB especially in areas of the breathing system such as lungs or throat releases TB germs into the air. In other instances, speaking or singing could also release the germs into the atmosphere. The surrounding environment influences the duration taken by the germs before they die. Once a healthy person inhales this air, they acquire the TB infection. This kind of infection is referred to as the latent TB infection. It refers to a situation in which TB germs are present in a person’s body but remain inactive. These people are not infected and therefore do not exhibit any symptoms of the disease. Moreover, there is a zero chance of these people spreading the disease (Scott, 2009). At this point, prescription of treatment from a medical professional is necessary to prevent the development of the disease in future. It is due to this reason that persons who have spent time with a patient infected with latent TB infection do not need to be tested, as there is no risk of infection (Samandari, 2011). However, spending time with someone infected with the TB disease would necessitate a test to alleviate the risk of developing the same disease in future.
TB test
In case one portrays the symptoms above having been exposed to the TB germs, two tests can be applied to determine whether TB germs are present in their body (Wouk, 2009). The first is the Mantoux tuberculin skin test. Under this, a small fluid known as tuberculin is injected in the lower skin section of the arm (Chatman, 2008). The reaction on the arm within the next forty-eight or seventy-two hours determines the presence or absence of the TB germs (Vassali, 2009). Alternatively, the QuantiFERON- TB Gold test could be applied. This test is conducted on a person’s blood to evaluate one’s immune reaction to the presence of the TB germs. Positive results indicate the presence of the TB germs in the person’s body (Ting, & Florsheim, 2007). However, the overall disease progression cannot be assessed by these methods. A chest X-ray inspection or sputum may often be necessary for this to be determined (Kabra, S. & Seth V, 2006).
To reduce the chances of acquiring the TB infection, Bacille Calmette-Guerin (BCG) vaccine is administered (Spiegelburg, 2007). Nonetheless, it is vital to note that this vaccine does not completely alleviate the chances of acquiring the disease and could result in a positive TB test (Blackwell, 2003). For those with latent infection, the decision to kill the germs and prevent possible future development of the disease is dependent on one’s chances of disease progression (Lawn et al., 2007). People with medical complications such as HIV infections are often at a higher risk of disease progression. This is due to a weakened immune system (Walcott, 2009).
Treatment of TB
The known treatment for TB is the administration of drugs for a period of one year or six months. Unlike other forms of medication for other diseases, it is completely necessary that individuals complete the entire dosage prescribed (Bakina, 1998). Inconsistent consumption of the drugs could result in a re-infection in the future that invalidates the first treatment process (Zablocki, 2005). Moreover, incorrect taking of the drugs could result in the active germs becoming resistant to treatment. Resistance of the germs to treatment complicates the treatment process and increases the costs incurred (George, 2011). Therefore, infected individuals should ensure they do not fall victim of either of the two situations. To ensure this, some hospitals assign medical stuff to TB patients who ensure the prescribed medication is followed precisely (Yancey, 2008). This is termed as directly observed therapy (DOT). It is meant to help the patient recover from the disease in the quickest time possible (Finer, 2009). This will not only be beneficial to the patient but I will also reduce the incidences of spread of the disease to other people in future (Maluniu, 2011).
References
Books
Chatman, J. (2008). Tuberculosis: Arresting Everyone’s Enemy. New York, NY: Joint Commission Resources.
Dyer, C. A. (2010). Tuberculosis: Biographies of Disease. Toronto: ABC-CLIO.
Finer, K. (2009). Tuberculosis: Deadly Diseases and Epidemics Series. New York, NY: Facts on File.
Kabra, S. & Seth V. (2006). Essentials of Tuberculosis in children. New Haven: Jaypee Brothers Publishers.
Kabra, S. & Seth V. (2006). Essentials of Tuberculosis in children. New Haven: Jaypee Brothers Publishers.
Spiegelburg, D. (2007). New Topics in Tuberculosis Research. New York, NY: Nova Publishers.
Vassalli, A. (2009). The Costs and Cost-Effectiveness of Tuberculosis Control. Amsterdam: Amsterdam University press.
Wouk, H. (2009). Tuberculosis: Health Alert. New York: Marshall Cavendish.
Yancey, D. (2008). Tuberculosis: Twenty-first century medical library. New York, NY: Nova Publishers.
Blackwell, E. (2003). Understanding tuberculosis. Unpublished manuscript.
George, F. (2011). BCG administration and Tuberculosis. Unpublished manuscript, Yale University, New Haven, Connecticut.
Ting, J. Y.,& Florsheim, P.(2007). Infectious diseases and their symptoms. Manuscript submitted for publication.
Walcott, B. (2009). Tuberculosis, symptoms and treatment. Manuscript submitted for publication.
Periodicals
Bakina, A. (1998, Mar 22). Tuberculosis remains a concern of Russia. ITAR – TASS News Wire, 6(2):53-64.
.Lawn, S. D., Bangani, N., Vogt, M., Bekker, L., Badri, M., Ntobongwana, M., &… Wood, R. (2007). Utility of interferon-γ ELISPOT assay responses in highly tuberclosis-exposed patients with advanced HIV infection in South Africa. BMC Infectious Diseases, 7(1), 99-109.
Samandari, T., Agizew, T. B., Nyirenda, S., Tedla, Z., Sibanda, T., Shang, N. (2011). 6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: A randomised, double blind, placebo-controlled trial. The Lancet, 377(9777), 1588-98.
.Zablocki, E. (2005). DRUG CLASS OVERVIEW: Tuberculosis often curable with six-month treatment, observation. Managed Healthcare Executive, 15(7), 28-29.
