Benchmark Assessment: Epidemiology of Tuberculosis

Mycobacterium tuberculosis is the bacteria that is responsible for the communicable disease known as Tuberculosis, and it is contagious, spread from one person to another through tiny droplet released in the air via cough or sneezing. It is hypothesized as originating more than 150 million years ago. TB has “surged in great epidemics and then receded” (Daniel, 2006, p. 1862). TB disease mostly attack the lungs, but studies has proved also it can attack other systems in the body, such as the brain, kidney, and the spine.

According to research from, “one third of the world’s population is infected with TB” (Centers for Disease Control and Prevention [CDC], 2016). TB is one of the disease that can be related to two conditions namely the latent stage and the TB disease itself. TB is one of the leading cause of many additional disease especially people infected with HIV infection. Tuberculosis epidemic had been very fatal during the 18th, and 19th century it was called the “Captain Among these Men of Death” (Daniel, 2006, p.1862) because of the effectiveness of the disease, Theophile Laennec began his work on understanding the pathogenesis of TB.

Further work was developed by Jean-Antoine Villemin, in 1865, further more Robert Koch was able to identify the root causes (agents) in 1882 known as Tubercle bacillus. The Tuberculin skin test was created in 1907, and later used to show (LTBI) by Climents VON Pirquet. Latent TB infection and the TB disease are associate but have different outputs.

In the latent stage the bacteria stayed in the body without causes any havoc, or sickness, because the body has antibodies that fight the bacteria, and stop it from growing to the point it will be harmless to the society, People at this stage don’t get sick, and can also not even spread the bacteria to others if the inhale it. The most common used diagnosis tool for TB is simple skin test, a small amount of substance called PPD tuberculin is injected in your fore arm and the result will be read within 48 to 72 hours , if there is swelling at the injection site the result is positive, but if there is no swelling the result is negative.

However a false positive to skin test (PPD) may happen if you have been vaccinated with ( BCG ) vaccine, but then an ordered for chest x-ray will be schedule to confirm whether the patient has it or not. A radiologist will do the chest x-ray, and the result will be sent to the doctor for review, if the result is negative, the will have order for treatment of latent tuberculosis infection, but unfortunately patient can obtain the disease if they don’t receive treatment as ordered.

Fortunately people who received the treatment as recommended for the latent TBI will not develop the disease, because the bacteria will become inactive, but unfortunately people who have weak immune system are at risk for allowing the bacteria to become active again. On the other hand active TB disease is related to the body immune system if not strong enough to fight the bacteria, or stop the growth of the bacteria that can lead to sickness in a person who have it.

Symptoms of the disease include pain in the chest, it occur while breathing can be chronic, cough with blood sputum, fever, malaise, lost appetite, shortness of breath, or swollen lymph nodes. Once the bacteria become active in the host it will attack the lungs, kidney, and spine. It is an airborne disease, it will spread through coughing, sneezing, and exposure to respiratory secretion. The most effective treatment for the latent TB, and Active TB is antibiotic. People with active TB need minimum of six months antibiotic therapy.

Patients are not encourage to stop treatment even if the feel better, or symptom subside. It is very important not to skip doses. TB bacteria have a chance to develop mutation that allow them to survive the most potent TB drugs. The result in to drugs resistant strains, and are much more deadly and difficult to treat. Latent TB may be treated with one ABT, while Active TB most be treated with multiple antibiotic such as isoniazid, rifampin, ethabutol, and pyrazinamide etc.

To prevent the bacteria from getting resistance to the medications. However because of the implication of the disease, TB require aggressive treatment. Side effect of medications regiment include nausea and vomiting, dark urine, fever that last for days and has no obvious cause, and jaundice. Mostly the treatment is prefer in hospital or rehab setting to prevent the spread of the bacteria, and at the same time treatment must be carry on as ordered by the physicians.

Patient with TB not in hospital setting tend to miss medications administration as ordered, and that will give the bacteria the opportunity to start developing resistance to the drugs, and if that happen it become very difficult for the medication to be effective. Treatment is the key to TB. Therefore as a nurse it is very important to educate our resident about medications regiment when caring for patient with TB. Complication related to the bacteria can be fatal. It is very important to seek medical attention when the need arise.

As a nurse when you noted a patient start having symptoms related to TB disease it is very wise to isolate him/her from people close to his/her, because it is contagious, and take all necessary precautions as possible to make that happens. Primary prevention for avoiding TB disease is seeking vaccination. Bacillus Calmette Guerin (BCG) vaccine is the recommended vaccine to help prevent the disease process, it is mostly administered to people who are in countries were Active TB is common.

It is given to small children and young adult to minimize the outcome of the disease. This vaccine is not commonly used in US. (CDC, 2016). Because it is not very effective in adult. Dozens of new vaccines are in various stages of developing and testing. Tuberculosis affects one third of the world’s population. It is “one of the world’s deadliest diseases” (CDC, 2016). Therefore it is very important to combat the outbreak and to minimize it sustainability in our community.

Anyone can get tuberculosis, but there are certain factors that increase the risk of having the disease, such as weak immune system, because it make it difficult for the body to mount any effective defense if there resistance is low. There are also certain medications, and diseases that can impact and as well weaken the immune system, it include: HIV/AIDs, cancer, chemotherapy for cancers, severe kidney disease, malnutrition, some drugs used to treat rheumatoid arthritis, crohn’s disease, and psoriasis, and also the very young, and old age.

Travelling to certain countries also increase the risk of the bacteria, places like Africa, Eastern Europe, Asia, and Russia. A healthy immune system have better chance of fighting the disease. Nurses also have a greater risk of catching the disease, especially when having contact with people who are ill increase the chances of exposure to TB bacteria. Therefore as a nurse it is encouraging to maintain airborne precaution by frequent hand washing, and wearing mask reduce the risk.

As I mentioned earlier on the bacteria, without proper treatment it can be deadly, and can spread to other part of the body through the bloodstream, that will lead to spinal pain causing back pain and stiffness, joint damage usually affects the hips and the knee, heart disorder rarely can affect the tissues that surround the heart causing inflammation, and the fluid collection that may interfere with the heart ability to pump effectively. This condition is called cardiac tamponade, can be fatal. For those affected with HIV, it is a deadly combination.

According to the CDC “In 2014, 9. 6 million people around the world became sick with TB. There were 1. 5 million TB-related deaths worldwide”. The CDC also indicates that there has been a 47% decline in mortality between 1990 and 2015. According to the World Health Organization (WHO), “poverty is a powerful determinant of Tuberculosis” (WHO, 2016). Working and living conditions that are over crowed, and with poor ventilation, as well as living in poverty are risk factors for the transmission of tuberculosis.

Another risk factor that contributes to the development of active TB disease is undernutrition. (“Social determinants,” 2016). Essentially, when people live in poor housing, over populated communities, or work in areas that have poor ventilation, the prevalence of the transmission of TB are increased substantially. There are other external factors that contribute to the spread of TB. These factors include homelessness, poverty, ethnicity and racial minorities, prison systems and immigrants.

There is also the density of the agent (bacterium) to consider, as it can influence the risk for developing tuberculosis. The role of the community health nurse is to work collectively with healthcare providers and the community. This is done by tracking the prevalence and spread of TB and help monitor the disease. The community health nurse must also provide education to the individuals that are affected and to the community itself. The collection of data, analysis of the data and appropriate follow up with providers is essential in the control and cure of Tuberculosis.

Tuberculosis can be treated and cured, and with the guidance of the community health nurse, this can be accomplished. Tuberculosis has been around for essentially millions of years, and has taken many lives along the way. With the progression of knowledge gained over the last few centuries, starting with the understanding of the pathogenesis of the disease, to learning the mode of transmission, to the discovery of the first TB skin test, great strides have been made to treat and cure this disease. Providing treatment to those infected has been monumental over the past many decades.

In today’s society, it is vital to educate the individual as well as the public on the prevalence of this disease, the course of treatment, and the risks that can cause this disease to spread. Education would also include on what will not cause the disease to spread. With such a large population worldwide that are infected, the task that lies ahead continues to be an enormous one. As the world strives for healthier communities, it is the hope that the prevalence of tuberculosis will continue to decrease as it has, and at some point, become eradicated.

The Centers for Disease Control and Prevention (CDC) is a national agency that addresses communicable diseases. The CDC has a website specifically for Tuberculosis. This site has everything from TB Basics, treatment, prevention and control, research, guidelines and so much more. There is also a phone number on the site should you want to call the CDC for information, questions, and reporting. The CDC is always on the task of control and prevention of communicable diseases such as Tuberculosis.

References

Addressing the social determinants of TB. (2016). Retrieved from http://www.who.int/tb/areas-of-work/treatment/social-determinants/en/
Centers for Disease Control and Prevention. (2016). Tuberculosis. Retrieved from http://www.cdc.gov/
Daniel, T. M. (2006). The History of tuberculosis. Respiratory Medicine, 100, 1968-1870. http://dx.doi.org/http://dx.doi.org/10.1016/j.rmed.2006.08.006
Treating Tuberculosis. (2016). Retrieve
https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-causes/syc-20351250
https://www.nationaljewish.org/healthinfo/conditions/tb/treatment.aspx