Infectious Diseases: Tuberculosis
Introduction
Tuberculosis (TB) is a top infectious disease worldwide (World Health Organization, 2015). TB affects primarily the lungs and may spread to other parts of the body. 9.6 million cases of TB were recorded in 2014 and 1.5 million of these ended in death (WHO, 2015). It is one of the oldest known human diseases and is still prevalent in some countries like the Philippines. In the Philippines, this disease ranks number 6 in the leading cause of death (Ong, 2012). The Philippines is at number nine in the top 22 high-burden tuberculosis countries worldwide according to the WHO report (Ong, 2012).
Tuberculosis is caused by the aerobic bacterium Mycobacterium Tuberculosis, classified as acid fast bacilli (Knechel, 2009). Its mode of transmission is through droplet nuclei. Droplet nuclei is defined as <5 μm in size. Microorganisms with droplet nuclei as mode of transmission remain infective in long distances and over time through air currents (Cdc.gov, 2007). A person infected with this Mycobacterium Tuberculosis can transmit the pathogen in the air through coughing, sneezing or talking and can be inhaled by the susceptible individual. If an individual inhales the infected droplets, the bacteria settles in the upper airways wherein an initial physical defense by the goblet cells occur through entrapment in the mucus being produced (Knechel, 2009). In cases where the bacteria are not defeated by the initial host defense, they reach the alveoli and are destroyed by the second line of defense – the alveolar macrophages. The mycobacteria continue to multiply every 25-32 hours. Depending on the immune system of the host, the infection might progress to primary progressive tuberculosis (Knechel, 2009).
Symptoms
TB may occur in the first few weeks of infection or can remain dormant for years. Signs and symptoms of TB in the lungs include cough that lasts 3 weeks or more, cough with phlegm or bloodstained phlegm, fever, weight loss, fatigue, night sweats, loss of appetite (Nlm.nih.gov, 2014).
Risk Factors
The risk factors of Tuberculosis include bacillary load, being in close contact to infectious individuals, immunosuppressive conditions such as HIV, malnutrition, young age, Diabetes, health care workers, socioeconomic and behavioral factors, tobacco smoke, alcohol, indoor air pollution, ethnic factors and health system issues (Narasimhan, Wood, MacIntyre & Mathai, 2013).
Extent of Issue
9.6 million cases of TB were recorded in 2014 and 1.5 million of these ended in death (WHO, 2015). Countries in South-East Asia and Western Pacific Regions account for 58% of new cases worldwide (WHO, 2015).
Among the 196 countries, the Philippines ranks 22 and together with the other 21 countries, contribute to 80 percent of the TB cases globally. Every day, there are 73 Filipinos who die of TB (Ong, 2012).
Prevention and Treatment Options
Tuberculosis is treated with an antiTB regimen consisting of antimicrobial drugs which include Rifampicin, Isoniazid, Pyrazinamide, Ethambutol and Streptomycin. Depending on the TB category, the number of months of treatment may vary. These drugs are to be taken daily during its intensive and maintenance phases. A TB patient in the community, is provided with information, supervised and supported by a health worker. Since the cure of TB depends on proper adherence to the regimen, support and supervision by the family and health worker is of utmost importance.
Current Efforts and Future Outlook
In the Philippines, the detection and treatment of this disease is one of the top priority health programs. Directly Observed Therapy Short Course (DOTS) is a strategy for TB control that is being implemented in the Philippines. Through DOTS, a health worker is responsible for directly observing the TB patient’s intake of antiTB medications. Through this strategy, the TB patient will be able to follow the regimen properly. Its rate of success in the Philippines is at 88% (Ong, 2012).
In a global scale, the World Health Organization has set a goal of ending the TB epidemic by 2035. It aims to reduce incidence by 80% from 2015 to 2030 and reduce death caused by TB by 90% (WHO, 2015). The WHO End TB strategy consists of key principles outlined in the 3 strategic pillars which include government stewardship, strong collaboration with organizations and community, protection of human rights and global collaboration (WHO, 2015). Regarding the treatment and diagnosis of TB, approximately 43 million people were saved from 2000 to 2014 (WHO, 2015).
Conclusion
I honestly was not aware that Tuberculosis is still an epidemic affecting millions of people worldwide and it is our duty as health care providers to help with promotion of health behaviors, prevention of TB and proper treatment of the disease. TB is preventable and curable. Patient-centered care and prevention strategies must be strongly implemented. Policies regarding TB must be strengthened. Extensive research to discover improved TB treatments or detection should also be put in place. As nurses, it is our duty to help end TB once and for all.
References
Cdc.gov,. (2007). CDC - 2007 Isolation Precautions:Part 1 - HICPAC. Retrieved February 2016, from http://www.cdc.gov/hicpac/2007IP/2007ip_part1.html
Knechel, N. (2009). Tuberculosis: Pathophysiology, Clinical Features, and Diagnosis. Critical Care Nurse, 29(2), 34-43. http://dx.doi.org/10.4037/ccn2009968
Narasimhan, P., Wood, J., MacIntyre, C., & Mathai, D. (2013). Risk Factors for Tuberculosis. Pulmonary Medicine, 2013, 1-11. http://dx.doi.org/10.1155/2013/828939
Nlm.nih.gov,. (2014). Tuberculosis: MedlinePlus. Retrieved 1 February 2016, from https://www.nlm.nih.gov/medlineplus/tuberculosis.html
Ong, W. (2012). Tuberculosis in the Philippines: 10 things you should know. The Philippine Star. Retrieved from http://www.philstar.com/health-and-family/763897/tuberculosis-philippines-10-things-you-should-know
Smith, I. (2003). Mycobacterium tuberculosis Pathogenesis and Molecular Determinants of Virulence. Clinical Microbiology Reviews, 16(3), 463-496. http://dx.doi.org/10.1128/cmr.16.3.463-496.2003
World Health Organization,. (2015). Tuberculosis. Retrieved 1 February 2016, from http://www.who.int/mediacentre/factsheets/fs104/en/
