Tuberculosis is a serious bacterial infection that is usually spread from one individual to the other by inhalation of very small droplets originating from the sneezes or coughs of an infected person. The bacteria that causes TB is known as Mycobacterium tuberculosis (Kelly, Wilker, & Ambrose, 2011, p. 14). The main organ affected by the disease is the lungs (also called pulmonary tuberculosis) but it can also affect bones, the nervous system, and the glands. Each droplet of sneeze may contain between 1 to 400 bacilli each. Because the disease is airborne, the bacterium can also be transmitted to a new host via singing, laughing or even talking to each other. On getting inhaled, the microbes are trapped in the airways and alveoli where they get ingested by macrophages and multiply within these cells. After about two weeks, they are transported to secondary sites through the lymphatic system.
Immune response and delayed hypersensitivity reactions lead to the formation of granuloma, which a corresponding decreases in the number of the bacilli. The bacilli can remain dormant for a long time, usually many years- the dormant stage is called latent TB infection and is asymptomatic and even undetectable in humans. Positive tuberculin tests, which signify the presence of LTBI, do not show the presence of the active disease. Once the infection has occurred, 3% to 5% of patients develop the active symptoms of the disease in two years’ time while another 3% to 5% develop the disease later in their lifetimes. It is, therefore, important to treat any positive test of the tuberculin to prevent the occurrence of the disease later on in life. Reactivation of the dormant cells is estimated at 20% of most people who have a purified protein derivative induration of 10mm or more and also evidence of HIV infection or healed TB.
Recent studies using DNA fingerprinting have shown that current transmission or exogenous reinfection more especially in HIV-positive patients can account for 40% of the new cases of the disease. This is in contrast with earlier studies which indicated that approximately 90% of new cases of the disease were the result of endogenous reactivation. Patients who are infected with HIV are at the greatest risk of progression of TB to the active stage, especially in adults. Other factors include renal failure, malnutrition, co-existing malignancies, diabetes mellitus, and silicosis.
Symptoms of TB- the main symptoms to look out for in order to arrest the disease include shortage of breath (Roberts & Buikstra, 2003, p. 214), continuous persistent coughs that may last for over three weeks which usually bring up bloody phlegm, drastic loss of weight, feeling of fatigue and generally tired, swellings that do disappear after a few weeks, sweating at night, loss of appetite, fevers, among others that may be minor. The major symptom that should raise an immediate alarm is the continuous coughing that goes beyond two weeks without showing signs of receding. For the type of disease developing outside the lungs, otherwise called extra-pulmonary TB, is characterized by confusion, seizures, persistent headaches, hardship in moving some joints because they are painful, abdominal pain and swollen glands that also don’t recover in good time.
A recent outbreak of the disease was reported in the State of Alabama, the United States in the town of Marion. This town is the poorest locality in the state and about 47% of their populace lives below the poverty line and the annual per capita income is 13,000 US Dollars. Two people were reported to have died of the disease last year, which made public health officials to lead campaigns to have the people tested but the officials were ignored by the majority of the citizens. A few people had tested positive for the disease in 2014 but when health officials tried to trace their contacts, they were turned away by people unwilling to report their neighbors. Pam Barrett, the director of Alabama Department of Public Health, division of TB control reported of the poor turnout and of some people throwing beer bottles at them during the screening exercise.
The TB outbreak was spoken of as being worse than in many countries in the developing world. Because of the poor turnout and negativity received from the people, the Centres for Disease Control and Prevention devised an incentive plan to urge more people to come out and get tested in the poor countryside town of Marion. This yielded fruits as more than 1,000 individuals turned up for the tests. Shocking results were discovered: an outbreak whose big magnitude had not been seen in recent years. It was discovered that 20 individuals had had the disease from 2014 while 47 others had latent infections. This infection rate was higher than state and national rates, as it stood at 2.96 cases per 100,000 people in 2014. All of them have undergone treatment to minimize the risk of spreading the causative agent to other parts of the state or the country. This spread was linked particularly to the tendency of the people in the state to lead secret lives and wanting to keep their issues private. They were also reported to have feared stigmatization that may come with being labeled a TB patient hence shied away from the tests.
While undergoing the screening and treatment, the locals of Marion were educated about the causes of the disease and its possible pathways of spread to everyone if it remained unchecked. Management of TB generally involves treatment, monitoring, and evaluation of the response to treatment. Treatment ensures that the patient is cured of the disease, the risk of death or disability is minimized, and the transmission of the bacteria to other people in minimized. It is usually treated for at least six months to ensure destruction of more resistant bacteria that may stay on when most of them die in the first 8 weeks of treatment. Multiple drugs are used during treatment to ensure there is no development of a bacterial population resistant to any given drug. A four-drug therapy is mostly recommended.
Any patient is required to follow the course of treatment to the latter and non-adherence is common after they start to feel free from the symptoms. This is a major problem in the management of the disease and can cause failure of the treatment, continued transmission to new hosts, and development of drug resistance. Patients are also educated on what drugs to take, possible side effects, consequences of non-adherence, and infection control measures plus the potential need for isolation to prevent the spread of the disease. HIV testing is also highly recommended for all TB patients (World Health Organization, 2013, p. 71). Evaluating response to treatment is key to ascertain treatment efficiency, point out any adverse side effects of the medications, and assess adherence to the treatment calendar. Evaluation is mostly done via clinical examination, chest radiography or bacteriological examination.
As it stands, tuberculosis is not well placed in the Healthy People 2020 objectives which state that people should not suffer from diseases that are preventable through vaccination. It remains among the leading causes of illness and death in the United Sates accounting for a huge spending on the effects of the disease to the citizens. It keeps on re-emerging at the time when people think it has been fully eradicated from the country; it is no wonder that new cases are always associated with immigrants into the United States. Other defenses put in place to ensure its complete eradication include proper utilization of vaccines, screening and testing procedures and guidelines, provision of antibiotics to treat the disease and scientific advancements in the diagnosis of the disease and its related health concerns
There are still many cases of unvaccinated or under-vaccinated populations, like the case may have been for Marion, which increases the risk of the disease outbreak every now and then. It is, therefore, important that these people and any other population suspected of under-vaccination especially rural areas are enlightened on the need to ensure everyone is vaccinated to see t it that no one suffers from the disease. TB prevention and interception should be prioritized to the reactive measures of rushing to screen a population only after an outbreak has been reported. Ideally, every citizen should be screen and those found to be having TB or LTBI treated and let free of this ticking time bomb.
References
Kelly, E. B., Wilker, I., & Ambrose, M. (2011). Investigating tuberculosis and superbugs: Real facts for real lives. Berkeley Heights, NJ: Enslow Publishers.
Roberts, C. A., & Buikstra, J. E. (2003). The bioarchaeology of tuberculosis: A global view on a reemerging disease. Gainesville: University Press of Florida.
World Health Organization. (2013). Global tuberculosis report 2013. Geneva, Switzerland: Author.
