Tuberculosis: Prevention, Diagnosis and Treatment

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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.

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Tuberculosis: Prevention, Diagnosis and Treatment

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