Tuberculosis (TB) is an infectious disease that is caused by Mycobacterium tuberculosis (Dheda et al., 2017). This organism belongs to the mycobacteriacea family and actinomyecetales order. This mycobacterium is a rod-shaped, aerobic, acid-fast bacteria, non-sporing and weakly gram positive. There are generally two types of tuberculosis; pulmonary and extrapulmonary tuberculosis. Pulmonary TB affects the lungs while extrapulmonary TB affects other organs except for the hair, nails, and teeth.
Transmission of Tuberculosis
The transmission of tuberculosis occurs through the nuclei of airborne droplets which may have less than ten bacilli. One is exposed to TB when he/ she shares common airspace with someone who is infected with tuberculosis (Dheda et al., 2017). This transmission occurs when persons infected with pulmonary TB cough, sneeze, shout or sing.
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Risk Factors of Tuberculosis
There are various risk factors for developing active tuberculosis. These include malnutrition, use of steroids, history of chemotherapy, HIV infection, and cancer. (World Health Organization, 2015) Most people usually have latent tuberculosis which can only be expressed when the immunity of the body deteriorates just like in the above cases. Other risk factors for developing active TB include alcoholism, end-stage renal disease, diabetes mellitus, smoking of tobacco, previous tuberculosis that was poorly treated and male gender.
Symptoms of Tuberculosis
Specific symptoms are constitutional to TB. These symptoms are chest pain, shortness of breath, night sweats, weight loss, and low-grade fever (Dheda et al., 2017). If one has pulmonary tuberculosis cough is a definitive symptom. Initially, the cough is dry; however, later it becomes productive of sputum that is purulent and sometimes blood. However, in some instances, symptoms may be absent, and the physician may only diagnose tuberculosis during an autopsy. Other symptoms which can occur include the shift of trachea, tachypnoea, dull note on percussion, and bronchial breath sounds. When the patients are physically examined, they may seem chronically ill, and frail.
Complications of Tuberculosis
Complications of tuberculosis usually occur when the tuberculosis is not treated, or management is inadequate. The common complications include effusion, lung fibrosis, spontaneous pneumothorax, lung abscess, bronchiectasis, cor-pulmonale, and dissemination (Dheda et al., 2017). One of the complications, disseminated disease, usually occurs in people who are severely immune-compromised and infants. Disseminated disease occurs after two to six months. When Mycobacterium tuberculosis disseminates from hematogenous spread, the condition is referred to as miliary tuberculosis.
Treatment of Tuberculosis
During the treatment of TB, certain outcomes are targeted. These outcomes include prevention of relapse, achievement of complete cure, prevention of the complications of TB, prevention of TB transmission and prevention of the development of resistance to drugs. During treatment certain principles should be taken into consideration. First, a single drug should not be used to manage TB. Second, only drug combinations should be used in the treatment of TB. Also, the weights of the patients are used to calculate the dosages of the drugs (World Health Organization, 2015). Moreover, physicians should directly observe the intake of drugs. Also, doctors should ensure that the patients adhere to the entire six to eight months treatment plan.
Four drugs are usually used in the first two months of treatment to decrease the load of the bacilli. These first two months are referred to as the intensive phase. After this phase, another phase of four to six follows. This second phase is termed the continuation phase. The four-drug combination used in the intensive phase is Isoniazid (H), Pyrazinamide (Z), Rifampicin (R) and Ethambutol (E) (Dheda et al., 2017). In the continuation phase, two drugs are used.
In some cases, Isoniazid and Rifampicin are used whereas in other cases Isoniazid and Ethambutol are used. When Isoniazid and Rifampicin are used, the duration of treatment is four months. On the other hand, when Isoniazid and Ethambutol are administered, the treatment duration is six months. In the event of a relapse, failure of treatment and resumption of treatment after disruption, then the treatment schedule changes. In such a case, there is an initial two-month treatment with Isoniazid, Pyrazinamide, Rifampicin, Ethambutol, and Streptomycin. After these two months, Isoniazid, Rifampicin, Ethambutol, and Pyrazinamide are administered for one month. After that, Isoniazid, Rifampicin, and Ethambutol are administered for five months (Dheda et al., 2017). In the case of extra-pulmonary TB, the treatment schedule incorporates two initial months of treatment with Rifampicin, Isoniazid and Pyrazinamide followed by six months of treatment with Ethambutol and Isoniazid.
Demography of Tuberculosis
According to the centers for disease control and prevention, people infected with TB account for a quarter of the world’s population. Ten million people became infected with TB in the world in 2017 (Dheda et al., 2017). In 2017, 1.6 million people died as a result of TB related conditions. For HIV infected people, TB is the leading cause of death. In the United States, a total of 9,105 cases of TB were reported in 2017. One million children became infected with TB in 2017. Unfortunately, 230,000 children succumbed to TB (Dheda et al., 2017). One of the threats to the health security of the world is multidrug-resistant TB. In 2017, the estimation by WHO was that 558,000 people became resistant to Rifampicin. Most of the people who are infected with TB re adults who are in their reproduction age.
Determinants of Health
Policy making is one of the health determinants linked to TB. Since one of the risk factors associated with TB is cigarette smoking, policies can be formulated to increase the takes on tobacco sales hence resulting in high prices of tobacco ( HealthyPeople.gov, 2013 ). Another policy that can be formulated by organizations is the incorporation of screening for tuberculosis as a medical test that one should undergo before employment to aid in curbing the spread of tuberculosis.
Social determinants include socioeconomic conditions including poverty, unavailability of enough resources to meet daily needs, and stigmatization of patients having tuberculosis. Physical determinants incorporate overcrowding of houses and exposure to physical hazards such as tobacco smoke. Health services determinants of TB include the high cost of health services, unavailability of health services, lack of coverage by insurance and language barrier in the provision of health services ( HealthyPeople.gov, 2013 ). Also, individual behavior determinants of health in TB include physical activity and cigarette, alcohol and the use of other drugs.
Epidemiologic Triad of Tuberculosis
The triad is composed of the agent, the host, and the environment. In TB, the causative agent is Mycobacterium tuberculosis. The hosts of tuberculosis are humans. Most people with active tuberculosis are those who have immune-suppression (Dheda et al., 2017). The environment that is known to enhance the spread of tuberculosis is that where people with people infected with tuberculosis reside. This is because tuberculosis is transmitted through the air.
These nurses are involved in the care of patients diagnosed with tuberculosis. They administer the drugs to these patients and observe patients for response to the treatment. These nurses also educate the patients, families, and communities regarding transmission, causes, and management of TB (Lewenson, 2017). Public health nurses also collect sputum for testing to determine whether treatment has reduced the load of bacilli. Public health nurses are also involved in the screening of patients for tuberculosis through conducting tests such as the tuberculin skin test. Some public health nurses are involved in research about TB. They liaise with the health care centers to assess the statistics of the people with TB, those on treatment for TB, and the reported treatment outcome for those patients (Lewenson, 2017).
References
Dheda, K., Gumbo, T., Maartens, G., Dooley, K. E., McNerney, R., Murray, M., ... & Theron, G. (2017). The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. The lancet Respiratory medicine , 5 (4), 291-360.
HealthyPeople.gov (2013). Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health .
Lewenson, S. B. (Ed.). (2017). Public Health Nursing: Practicing Population-Based Care . Jones & Bartlett Learning.
World Health Organization. (2015). Global tuberculosis report 2015 . World Health Organization.
