Tuberculosis.docx

 

 

 

 

 

 

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Tuberculosis (TB)

Tuberculosis (TB) is a well-known disease that affects the lungs of a human being. It is an infectious disease that is caused by tuberculosis which is a causal bacterium. The bacteria are spread from one person to the other. Getahun et al., (2015) claims that the bacteria is spread through tiny droplets which are released to the air we are breathing through coughing and sneezing.

Tuberculosis infections began to spread in the year 1985, sometimes back in the developing countries. This was partly as a result of the emerging of the HIV, which is the causative virus causing AIDS. The virus weakens the immune system of a human being so that it weak to fight the TB germs. Tuberculosis was decreasing in some parts of the United States in the year 1993 because of the active control programs that were instituted. However, tuberculosis did not stop but remained to be a big concern to the people.

Numerous tuberculosis strains are mainly resisting the drugs which are often used to cure the disease. Some individuals having active tuberculosis are advised to take various types of medications for a more extended period. This aims at eradicating the infections and prevent the development of resistance to antibiotic.

Symptoms

The body of a person can harbor the bacteria causing tuberculosis (TB). However, the immune system is much active in preventing someone from getting sick. As a result, doctors usually differentiate between Latent TB and Active TB.

Latent TB

Although in Latent TB condition, one has the TB infection; however, the bacteria will constantly remain in an inactive state in the body, and it cannot cause symptoms. The Latent TB is also referred to as inactive TB or TB infection, and it is not contagious. However, it turns to active TB later if it is not treated at an earlier stage. It is crucial for a person with Latent TB to undertake treatment and help in controlling the spread of TB. The people with latent TB are estimated to be 2 billion.

Active TB

Active TB condition can make someone sick and in some cases, end up spreading to other individuals. In most cases, it occurs within the first few days after infection with the TB bacteria. However, sometimes it happens in some years later.

Signs and symptoms of active TB include

Coughs with blood

Persistent coughs that go more than three weeks

Fatigue

Unintentional loss of weight

Chest pains or pains when coughing or breathing

Night sweats

Fever

Chills

Loss of appetite

Also, Tuberculosis can sometimes affect some body parts such as the spine, brain, or kidney. In case the TB occurs outside the person's lungs, the signs and symptoms are varied according to the organs that are involved. For instance, spine tuberculosis gives an individual back pain, and tuberculosis in the kidney is feared to cause blood in the urine.

Transmission

Tuberculosis (TB) is transmitted from a person who is infected to a susceptible person in airborne particles. The particles are referred to droplet nuclear, and they are 1-5 microns in diameter. The infection droplet nuclear is small water droplets having the bacteria. The bacteria are released when a person with laryngeal or pulmonary tuberculosis sneeze, coughs, laughs, and shouting. The tiny droplet nuclear are suspended within the air for up to several hours. Mycobacterium tuberculosis, which is tuberculosis bacteria, are passed through the air but not by any surface contact. In this case, touching someone can hardly spread the tuberculosis bacteria unless they are taken in through breathing.

In essence, transmission only takes place when an individual takes in droplet nuclear that have tuberculosis bacteria through inhaling. The droplet nuclear travels through the mouth or nose and then move into the upper respiratory tract (Hatherell et al. 2016). Eventually, the droplets reach the bronchi and ultimately to both the lungs and the alveoli. 

Complications

The common complications of tuberculosis include spinal pain, back pain, and stiffness.

There is still damage to the joints whereby tuberculosis arthritis has effects on the knees and hips of the person.

There could be Meningitis which describes the swells of the membranes that covers the person's brain.

Kidney or liver problems

Heart disorders

Treatment of TB

The cornerstone of tuberculosis treatment is medications. However, treating TB can take a much more extended period to cure, unlike treating any other type of bacterial infection. TB disease can be treated, and it is curable. Active, drug-susceptible TB disease is often cured with a course of 4 antimicrobial drugs for a standard of 6 months. The antimicrobial drugs used are given with dosage information. The patient is supervised and supported by a qualified health worker or any other volunteer who is trained. In essence, the disease can spread if there will be no enough support treatment adherence. According to Horsburgh Jr et al., 2015, the previous majority cases of TB are believed to be cured when medication is appropriately provided and taken.

In the case of active tuberculosis, the patient ought to properly take antibiotics for a minimum of six months or a maximum of nine months. The age of the patient determines the specific drugs to be recommended and the length in which the patient is to be treated. Also, it depends on possible drug resistance, overall health, as well as the body's infection's location.

Most common TB drugs

It is recommended to take one to two types of TB drugs for anyone who has latent tuberculosis. Other patients are administered several drugs at once like for instance, any drug resistance strain with active tuberculosis. However, there are other various well-known medications that are used to cure tuberculosis. They include the following;

Isoniazid

Rifampin (Rifadin, Rimactane)

Ethambutol (Myambutol)

Pyrazinamide

The World Health Organization (WHO) highlighted the mortality rate of TB like for instance deaths caused by TB amongst peoples who are infected by HIV per 100000 populations per year to be falling at around 3% yearly. The overall reduction within that time to be 42 percent between 2000-2017.

In a year within the world, TB incidence rates are dropping at around 2 percent. However, the fastest regional drops from the year 2013 to 2017 happened to be in the WHO European regime and the WHO African Regions. Within the period of five years, particularly impressive reductions of about 4 to 8 percent in a year took place within southern Africa, like for instance, Lesotho, South Africa, Eswatini, Zimbabwe and Zambia after the noted HIV epidemic peak as well as the TB expansion, and prevention and care of HIV and in the Russian Federation a percentage of like five in a year, following the persistent efforts aimed at reducing the burden of TB as well as scrutiny of progress that came from the highest political levels.

Reporting

For any person who has been confirmed or is suspected to be having active TB disease, the person is required by law to be presented within a working day of identification to the control section of TB epidemic. This will comprise of any patient who just begun empiric multi-drug therapy for active pulmonary or extrapulmonary TB.

Social Determinants of Health

The wide range of health risk and outcomes can be affected by the living conditions in places where people live, work, learn as well as play. For instance, we are all aware how poverty can have adverse effects to people in terms of accessing health foods and security within the neighborhood and that access to more education can be a predictor of accessing better health. However, health differences currently are striking the poor communities with the poorest SDOH like, for example, unstable housing, insecure neighborhoods, low income as well as poor education standards. In this case, we can join hands together to ensure we improve both the population and individual's health as well as advancing health equity by applying what we all know about the SDOH. In essence, the health people have tried to highlight the advantages that may come our way when we address SDOH by including creating a social and physical environment which aim at promoting recommendable health for all. Uplekar et al., claims this to be known as amongst the four overarching objectives for the decade (2015)

Also, all stages of TB pathogenesis can as well be influenced by socioeconomic status. In essence, there is a close relationship amongst the risk exposure and the underlying disease burden and the surrounding environment where human beings live. The highest risk of exposure is on the individuals who live or work in high burdened places. Besides, the risk of exposure is always influenced by the characteristics of the environment, the airflow, as well as the number of individuals who are sharing the space.

The Epidemic Triangle of TB

According to the Center for Disease Control and Prevention (CDC), the epidemic is defined to be the occurrence of more disease cases, injuries, or even other health conditions which expected in a particular area or amongst a given group of individuals in a specific period. The epidemiology triangle tool is not ideal for analyzing the way a disease spreads and the means of combating it. According to Hutton (2018), the triangle is comprised of three parts which include; the agent, host, and environment. The epidemiology triangle of TB is,

The agent is the Mycobacterium tuberculosis.

Role of community health nurse

The community health nurses are responsible for providing healthcare to the patients as their primary role. Besides, they can as well offer education to the communities to enlighten them to maintain their health to reduce the occurrence of diseases and deaths within the community. They come up with education seminars, hand-out flyers, dispense medication, and administering immunizations as well as conducting health screening (Smolowits, 2015).

The community health nurses employ their acquired skills in supporting population health in eight domains:

a)                  Analyzing and assessing the community using the data available and also collecting more data for the provision of the information essential for assessing, planning, implementing, and evaluation of community health.

b)                  Program planning and developing policies that aim ant supporting the community health, individuals as well as families.

c)                  Communicate effectively with the community stakeholders, as well as the individuals and families to determine their knowledge and the required attitudes as well as available healthcare facilities and health services.

d)                  Cultural competencies which enable effective practice with various individuals, groups, and families among the community of care. 

e)                  Community practice dimensions that comprise of health service planning, advocacy, as well as evaluation of program efficiency within the community.

f)                   Public health science that comprises of utilizing the available research conducted, the design as well as implementing varieties of new research, and using epidemiology as well as other methods of analysis to determine the disease distribution and determining it in the community.

g)                  Planning skills and financial management aimed at arriving for having reasonable budget management and utilization of public resources.

h)                  Both system thinking and leadership skills that help uphold a professional practice and public health development of a team.

The most significant aspect is the demographic data that is used while referring to the occurrence of disease while making a sound decision on the appropriate treatment methods.

USAID on TB

The U.S Agency for International Development (USAID) supports high-quality screening diagnosis as well as free services such as treatment for over a large number of patients who are suffering from TB and multidrug resistance tuberculosis (MDR TB). (Fauci, 2018). USAID works jointly with other partner governments aiming at controlling and preventing the transmission of TB and renew efforts working out to find out the missing cases of TB, upholding the capacity and strength of the national TB programs. The organization as well builds the ability of the country to use the available resources and turning evidence into policy as well as the expansion of the development of new TB diagnostics, vaccines, and drugs.

Global Implications

Tuberculosis (TB) is a well-known disease in the world, and it is everywhere in the countries worldwide. It has been pointed to the deadly infection that is causing most deaths in the world. The World Health Organization estimated a total of 1.8 billion people almost a quarter of the peoples' population in the world to be infected with Mycobacterium tuberculosis (Mtb). This is the TB causal bacterial. There have been over 10 to 16 million cases of TB infections that led to deaths over the few decades. TB is one among the deadly airborne diseases that are spread through coughs, sneezing thus being the worlds. the leading cause of infectious disease. TB disease plays a part in the economic devastation and the poverty cycle as well as the illness that entrap the community, families, and even the nation at large. The women, children, and people living with HIV/AIDS are the most vulnerable groups who are in danger. The disease is growing sharp and deadly and thus being hard to be treated due to the persistent and increasing drug resistance by the patients, thus becoming a threat to the community. According to Houben & Dodd (2016), in the previous year, there have been cases of over 558,000 TB drug resistance cases.

TB disease is striking in every corner of the world. The nations that have registered a large number of TB cases include the South East Asia and Western Pacific regions which had a percentage of 62 of the new TB cases. African region followed with a percentage of 25 of the new cases.

Lastly, 87 percent of the new cases in 2017 occurred in the 30 high TB burden nations. Some counties such as China, the Philippines, Indonesia, Pakistan, Bangladesh, Nigeria, and South Africa are the eight nations accounted for two-thirds of the new cases of TB.

Conclusively, tuberculosis infection and disease have remained to be prominent in populations within the community, and that has been figured by the poor living conditions of the community, poor housing conditions, HIV infection, as well as drug use. The practical means to conquer TB is linking a primary medical provider with the community-based organization and provision of high targeted screening services to the individuals who are endangered and prone to acquiring and transmitting TB disease.

 

References

Fauci, A. S. (2018). Addressing the tuberculosis epidemic: 21st century research for an ancient disease. Jama, 320(13), 1315-1316.

Getahun, H., Matteelli, A., Chaisson, R. E., & Raviglione, M. (2015). Latent Mycobacterium tuberculosis infection. New England Journal of Medicine, 372(22), 2127-2135.

Hatherell, H. A., Colijn, C., Stagg, H. R., Jackson, C., Winter, J. R., & Abubakar, I. (2016). Interpreting whole genome sequencing for investigating tuberculosis transmission: a systematic review. BMC medicine, 14(1), 21.

Horsburgh Jr, C. R., Barry III, C. E., & Lange, C. (2015). Treatment of tuberculosis. New England Journal of Medicine, 373(22), 2149-2160.

Houben, R. M., & Dodd, P. J. (2016). The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling. PLoS medicine, 13(10), e1002152.

Hutton, S. (2018). Latent Tuberculosis Infection Treatment Completion and Predictors of Noncompletion among Visa Holders in the Rural Setting.

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. (2015). Role of the registered nurse in primary health care: meeting health care needs in the 21st century. Nursing Outlook, 63(2), 130-136.

Uplekar, M., Weil, D., Lonnroth, K., Jaramillo, E., Lienhardt, C., Dias, H. M., ... & Gilpin, C. (2015). WHO's new end TB strategy. The Lancet, 385(9979), 1799-1801.