Communicable disease Health, Medicine, Nursing Term Paper

Tuberculosis
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Tuberculosis
Tuberculosis (TB) causes ill health in millions of people each year, and thus remains a major global health problem. It ranks among the top deadly infectious diseases. TB is primarily an airborne disease caused by the bacteria Mycobacterium tuberculosis. The bacteria are spread from one person to another through the air and mainly affects the lungs (pulmonary TB) but can have adverse effects on other body organs (extra-pulmonary TB). Extra-pulmonary TB can affect lymph nodes, kidneys, bones, and joints, among others. A person can contract the disease by inhaling bacteria-infested air expelled by people who a sick with pulmonary TB through coughs, sneezing, or spitting. The transmission risk depends on the concentration of the bacteria in the airspace, frequency and duration of exposure, and the virulence of the TB bacteria. Besides being a preventable and curable disease, the overall impact of Tuberculosis on public health is alarming.
* General Overview
It is estimated that about 2-3 billion people are exposed to the bacteria each year, but only a small fraction (5-15%) develop Tuberculosis throughout their lifetime. Anyone can contract the disease regardless of age (Duarte et al. 2018). The infected and asymptomatic are considered latent TB cases. They include those infected with TB bacteria but are not yet ill or active cases. A person with Latent Tuberculosis Infection (LTBI) have M. tuberculosis in their bodies, but do not have TB disease and cannot spread the infection to another person. Young children (below 5 years of age) and people with substantially impaired immunity such as people infected with HIV have a much higher probability of developing TB disease (Ozcaglar et al, 2012). Other groups at a higher risk for TB are people who were recently infected with M. tuberculosis, persons with a history of untreated or inadequately treated TB disease, persons with diabetes mellitus, and cigarette smokers, among others. TB disease is a progressive stage of LTBI that can occur anytime, from soon to many years.
Persons with latent TB have no signs or symptoms of the infection. Despite being infectious, active TB is usually accompanied by signs and symptoms. The clinical presentation of TB disease depends on the location of the infection within the body. In most cases, respiratory TB disease develops and its systemic signs and symptoms are drastic weight loss, night sweats, loss of appetite, fever, and fatigue (Ozcaglar et al. 2012). In addition to the systematic signs and symptoms, active respiratory TB disease may manifest itself via cough (dry or productive) for more than 2-3 weeks, shortness of breath, chest pain, and hemoptysis (blood-stained sputum). On the other hand, active non-respiratory TB disease has the systemic signs and symptoms as well as pain, swelling, and/or dysfunction of the involved body sites, usually signified by swollen lymph nodes (Glazioun et al. 2013) LTBI is detected via the Tuberculin Skin Test (TST). Active TB can develop rapidly when a person’s immune response is inadequate. Unlike in LTBI, persons with TB disease are infectious and may spread the bacteria to other people. TB disease is diagnosed by collecting body fluid or tissue from the disease site for acid-fast staining and mycobacterial culture.
Effective prevention and control of TB infection in facilities and the community requires prompt identification of individuals with signs or symptoms of active TB disease. Upon identification, appropriate measures to interrupt or prevent further transmission are initiated immediately. Some of the widely accepted measures include airborne precautions, home isolation precautions, and guidelines on the collection, handling, transport, and preparation of specimens suspected to have TB bacteria (Ozcaglar et al. 2012). It should be noted that there must be a balance between balancing the rights of the individual and the duty to protect the public when executing TB infection and prevention control measures. Airborne precautions include wearing of fit-checked disposed N95 particulate respirators by health care providers and others during exposure to infectious cases and while in contaminated airspaces.
TB cases in the community need to wear surgical masks when interacting with health care providers during directly observed treatment and essential medical appointments (“World Health Organization”. 2015). They are, however, not necessarily required to wear masks in their places of residence unless in the presence of health care providers. Cases should avoid sharing indoor airspaces and personal items with non-household members. They are encouraged to keep a distance from other people and to always cover their mouths and noses when coughing or sneezing. Generally, exposure to TB can be prevented by limiting contact with active cases, prompt detection of active cases, maintaining adequate ventilation, and seeking proper treatment and patient care.
Tuberculosis is a curable disease. Most people who develop TB can be cured upon timely diagnosis and correct treatment. Previously reported high mortality rates are attributed to late diagnostics and poor treatment practices. A large percentage of TB bacteria strains are classified as drug-resistant and require special medications (“Center for Disease Control and Prevention”. 2020). The ability of some strains of TB to grow and multiply even in the presence of certain drugs that would normally kill them is known as Multidrug-resistant Tuberculosis (MDR-TB). There exists another category of strains of TB bacteria that are resistant to almost all drugs used in TB treatment. Such strains of bacteria are referred to as Extensively Drug-resistant TB (XDR-TB). Drug-resistant TB is as infectious and transmissible just like the drug-susceptible TB. It should be noted that late diagnosis of drug resistance increases transmission and intensifies resistance to drugs.
Drug-resistant TB disease develops either through primary or secondary resistance. A person can be infected by already resistant bacteria, and the infection is termed as primary resistance. In secondary cases, the infection is passively acquired during TB treatment as a result of inadequate or inappropriate regimen prescription, or other conditions including unanticipated drug interactions and malabsorption. According to the World Health Organization, countries with the highest prevalence of drug-resistant TB cases are China and India. Others include the Philippines, Bangladesh, Nigeria, South Africa, Pakistan, and Indonesia (“World Health Organization”. 2015). To curb the issue of drug resistance, active TB patients are required to take a series of medications for several months to eradicate the infection and prevent reinfection. For the drug-susceptible TB, regimental antibiotic drugs are prescribed for 6-12 months. Multi-drug resistant TB calls for prescription of special TB drugs and medical attention (D’Ambrosio et al. 2018). The whole treatment cycle must be completed to effectively eradicate the disease and prevent further reinfection.
* Social Determinants of Health and Their Role in The Development of Tuberculosis
The risk of exposure, progression to active TB, and treatment involves a process influenced by numerous risk factors. They include HIV, young age, and inadequate immunity as already discussed. However, there are social and behavioral aspects that contribute significantly to high susceptibility to infection and poor response to the TB treatment process (Glaziou, Falzon, Floyd, & Raviglione, 2013). In addition to the prevention measures discussed earlier, there social, political, and economic factors that determine the success or failure of such measures. The condition from which people are born, grow, live, work, and age affect their health and development...