Free «Tuberculosis» Essay Sample

There are many serious diseases around the world. Some illnesses are more dangerous than others are; some are more widespread. This paper discusses cases of tuberculosis, which is not very common disease in the United States, but still it is present. This dangerous disease is more common in Asia or Africa, but it occurs in the USA as well.

What Is Tuberculosis and How Does It Spread?

Tuberculosis is a contagious disease that can be quickly spread from person to person. Mycobacterium tuberculosis discovered by Robert Koch in 1882 causes the disease. It is transmitted between people through the air, usually affecting the lungs. When infected person coughs, sneezes, or even speaks, he spreads the bacteria into the air and another person may breathe them in and become infected too. Although the disease spreads through the air, you have to spend much time with a sick person to become infected. It is quite impossible to get tuberculosis in a bus, train, or any other kind of a public transport. It is also important to note that not everyone infected with tuberculosis can spread the disease. A person with tuberculosis is not infectious as long as he takes his medication. Moreover, if a person is infectious and he starts to take medication, he will stop being contagious in no longer than three weeks.

Tuberculosis is a disease that anyone can catch, but there are certain groups of people that are more likely to be infected. These are:

• people who have lived with someone infected with tuberculosis or have had a long contact with such people;
• homeless people, because their living conditions are very unhealthy;
• people who have spent a long time in the places with a high rate of tuberculosis, including southeast Asia, sub-Saharan Africa and some East-European countries;
• people who have problems with drugs or alcohol;
• imprisoned people;
• people who eat too little and, therefore, are not able to stay healthy;
• people with weak immune system.

Pathogenesis of LTBI and TB Disease

Pathogenesis of tuberculosis describes how bacteria causing the disease infect a person and how they grow in the organism.

A person is infected when he breathes the bacteria in. After that, a primary infection either develops immediately or the disease becomes hidden in the body.

When the bacteria enter the body, they travel to the lungs and reach the alveoli. As Babalola notes in his article, “only a few droplets containing the tubercle bacilli is sufficient for the pathogen to infect the lungs”. Those bacilli multiply in the alveoli. At the same time, a few of them pass into the blood and can travel to any other organ, such as kidney, spine, lung, brain etc. After that, macrophages are formed. These are immune cells that create a special barrier called granuloma that surrounds tuberculosis bacilli and keeps them under control. This process usually happens within two to eight weeks. This is the depiction of what happens when a person develops LTBI, which stands for latent tuberculosis infection.

Tuberculosis disease develops in a different way. It progresses if the immune system is not able to control the bacilli and they continue to grow rapidly. This process can happen in any organ, such as brain, kidney, or bone.

People with latent tuberculosis infection (LTBI) have tuberculosis bacilli in their organism, but they do not have tuberculosis disease and they are not infectious. There are also no symptoms or signs of the disease in case of latent tuberculosis infection. In order to detect LTBI, tuberculin skin test is performed. It usually takes from two to eight weeks after the infection to detect the disease using this method. A person with latent tuberculosis infection is not considered to have tuberculosis disease.

In cases when tuberculosis bacilli are stronger than the immune system, tuberculosis disease develops. People with tuberculosis disease are contagious and can spread it to other people. A person can develop tuberculosis disease from latent tuberculosis infection. This can happen at any time, and the disease may develop within hours or within years.

Symptoms and Signs of Tuberculosis

As it has been mentioned earlier, tuberculosis bacilli usually affect lungs. It is referred to as pulmonary tuberculosis. When the disease affects other organs, it is known as extrapulmonary tuberculosis.

The symptoms of tuberculosis may not be noticed for weeks or even months. According to World Heath Organization (2015), during that period of time, a person with infectious tuberculosis can infect from ten to fifteen people.

Some symptoms of pulmonary tuberculosis include:

• a cough (especially one lasting for more than three weeks);
• coughing up blood or sputum;
• pain in the chest during breathing;
• weight loss;
• loss of appetite;
• fatigue;
• fever;
• chills;
• sweating at night.

Symptoms of extrapulmonary tuberculosis differ, depending on the body organ that is affected by the disease. They may include:

• blood in urine (in case of kidney tuberculosis);
• headaches, migraines, or confusion (if tuberculosis affects the brain);
• back pain (tuberculosis of the spine);
• loss of appetite;
• weight loss;
• fatigue;
• fever;
• night sweats.

It is important to note that these symptoms do not necessarily have to be caused by tuberculosis; they may be caused by a number of other diseases as well. However, in case of any of these symptoms, a person should consider performing tests for tuberculosis.

How Is Tuberculosis Diagnosed?

Nowadays, tuberculosis is not as widespread as it used to be; thus, doctors do not tend to consider tuberculosis as a possible diagnosis. As a result, the diagnosis of the disease may be delayed or overlooked, which gives time for it to develop.

A complete medical evaluation for tuberculosis requires the following steps:

1. Medical history
2. Physical examination
3. Testing for tuberculosis
4. Chest radiography
5. Bacteriologic examination

While checking the medical history of the patient, the doctor should ask him if he has any symptoms of tuberculosis. If the answer is yes, then it is necessary to establish how long these symptoms lasted and if the patient closely interacted with the person who has the disease. It is also important to understand whether the patient was diagnosed with latent tuberculosis infection or tuberculosis disease earlier. In such case, the clinician should find out how many pills were prescribed because tuberculosis may return and, this time, it could be drug-resistant. Demographic factors that put a person at risk group should also be considered, including country of origin, racial group, ethnicity, and occupation.

Although physical examination cannot confirm or exclude that the patient has tuberculosis, it is still an important part of the evaluation process. This step helps to define the overall condition of the patient and may be helpful if the diagnosis is confirmed.

Nowadays, there are two most commonly used tests for diagnosing tuberculosis. These tests are:

• Mantoux tuberculin skin test (TST)
• Interferon-gamma release assays (IGRAs)

These tests are used to separate those who are infected from the uninfected ones. Nevertheless, a negative reaction to any of these tests does not necessarily mean that a patient is not ill. Even if the results are positive, the diagnosis of tuberculosis cannot be confirmed unless other tests, such as chest radiography and bacteriologic examination, are carried out. One more important thing to note is that these tests cannot differentiate latent tuberculosis infection from tuberculosis disease.

The most commonly diagnosed type of tuberculosis is pulmonary tuberculosis. Therefore, chest radiography is one of the most helpful tools used to help in further diagnosis of the disease. If there are any abnormalities in the chest, it may suggest that the person has tuberculosis, but they are not determinative in diagnosing tuberculosis disease.

Probably, the most important step in diagnosing tuberculosis is a bacteriological examination. Different specimen should be collected, depending on the suspected type of the tuberculosis. In case of pulmonary tuberculosis, sputum is taken for examination. If extrapulmonary tuberculosis is suspected, then urine, blood, biopsy specimen, cerebrospinal fluid, or pus are needed for the examination. Initial positive results should be informed within twenty-four hours to health provider.

Treatment Options

Tuberculosis is the disease that can be treated successfully. The main purposes of the treatment are to cure the patient, to prevent the disease from spreading, and keep it from returning in a drug-resistance form. Treatment of tuberculosis is not only important for the sake of patients, but it is also done for public health. It is essential to prevent the spread of tuberculosis among people because it is very contagious and is easily transmitted through the air. Treatment of tuberculosis usually takes six months or longer. It depends on a severity of particular situation. Typically, most bacteria are killed during the first eight weeks of the treatment. If the patient stops the therapy at this stage, there is a high possibility that bacteria that have survived may cause the return of the disease, which may be drug-resistant tuberculosis. There are different options for treating the disease. They include daily therapy or treatment in intervals. However, the main goal is to provide the patient with fast and effective therapy.

A fundamental aspect in curing tuberculosis is obviously medication. Patients should take prescribed medicines for a certain period of time, from six to nine months. The main medications for tuberculosis treatment, recommended by Centers for Disease Control and Prevention (2003), include isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin. These drugs are usually taken for the first two months of the treatment program. There are other different options to choose from for the rest four to seven months of treatment. According to Centers for Disease Control and Prevention (2003), the six-month program is usually enough to cure tuberculosis. The nine-month program is required in the following cases:

• patients with pulmonary tuberculosis whose sputum samples are still positive after the two-month treatment program;
• patients who were not taking pyrazinamide during their first phase of treatment;
• patients that were treated with isoniazid and with rifampicin once a week and whose sputum is still positive after the two-month treatment program.

In case of drug-resistant tuberculosis, the disease cannot be cured with at least one of the five main drugs. More than one of the above drugs, including isoniazid and rifampicin, do not help to cure multi-drug resistant tuberculosis. This makes treatment of drug-resistant tuberculosis very difficult. Tests need to be done to elucidate which drugs the disease is resistant to. However, it is important to start the treatment program as soon as drug-resistant tuberculosis is suspected because such testing may last for weeks. When the results of the tests become known, the treatment program is adjusted according to them.

It is also important to note that all patients infected with tuberculosis have the same treatment regimen. This is done in order to reduce mistakes in prescriptions; therefore, the possibility of drug-resistant tuberculosis is reduced. In addition to that, it makes medication easier to distribute and control its consumption.

Side Effects of Medication

Drugs that are used to treat tuberculosis can make some patients experience negative effects. They are not very common, but they do occur in some of the patients. Particular side effects are very serious. They include hair loss, appetite loss, nausea, vomiting, fever lasting for a couple of days when there is no obvious cause for it, yellow skin or eyes, nosebleed, dark urine, skin rashes, gum bleeding, and dizziness. In case if any of the symptoms occur, the patient should immediately contact his doctor in order to prevent any negative impact on his health.

It is also necessary to check the liver before starting the treatment course because the drugs are extremely harmful to this organ. In case any problems are detected, additional monitoring during the treatment process will be required.

Nursing Interventions for Patients with Tuberculosis

A person with tuberculosis disease should be under control of the nurse. It is needed in order to make sure that the patient follows the prescribed treatment program. The nurse also is able to indicate any side effects of the treatment and see any improvement of the patient’s condition.

Nurses need to be able to work effectively with  patients in order to do their work successfully. Therefore, it is a good idea to get acquainted with the patient from the beginning. The nurse should be familiar with the patient’s health history to educate him about the disease. It is important to use simple language and avoid using complicated medical terms.

The next step is to establish good relations with the patient. Those relations should be built on trust, and it takes some time to achieve it. However, the foundation of those relations is laid during the very first visit. The nurse should respect the patient, listen to him carefully, be honest and open in order to make the first visit successful. It is vital not criticize the patient.

The best way to control treatment progress and help patients is home visits. The nurse specialist should remember that his duty is to control how the treatment program is followed and if there are any medication side effects. However, he also has to help the patient to deal with any other problems that may occur due to the treatment, such as difficulties with accommodation or immigration, visits to social services, etc.

It may be difficult for patients to start treatment program right because they have to take many medications and it is possible that they will have to deal with a variety of side effects. Unfortunately, there is a possibility that the treatment may not bring the desired effect. Therefore, the patient may feel depressed and not sure whether to continue the treatment program. In such situation, the nurse should explain to the patient that it is important to finish the program in order to defeat the disease.

There are many other things that the nurse specialist can do to make the treatment program easier for the patient. These include helping to manage medication side effects, organizing hospital visits, taking blood samples, checking if there is blood in sputum, controlling if the patient receives enough food and rest, as well as supervising medication use.

The nurse specialist plays a crucial role in controlling tuberculosis treatment program and finishing the curing process successfully.

How to Prevent Tuberculosis

Despite being a rare and curable disease, it is still a good idea to take measures to prevent tuberculosis.

1. Avoid spending much time with a person who has infectious tuberculosis or take some protection measures while communicating with them, for instance, put on a respirator.
2. Follow a healthy lifestyle. Eat healthy food, have enough rest, and exercise at least three times per week, get rid of bad habits, such as smoking or drinking alcohol.
3. Be vaccinated against tuberculosis. The vaccination against tuberculosis is not very popular in the USA. However, if there are any fears, you can get it and prevent the disease.

These easy steps will help you prevent the disease and may save your health or even life.

Conclusion

Tuberculosis is a very serious and contagious disease spread through the air. It is important to differentiate between latent tuberculosis infection (LDBI) and tuberculosis disease. LTBI occurs when a person is infected with tuberculosis bacilli. However, such individual is usually not infectious and does not have any symptoms of the disease. Tuberculosis disease occurs when a person is contagious and shows obvious symptoms. Tuberculosis can be pulmonary and extrapulmonary. Pulmonary tuberculosis, which refers to lung tuberculosis, is the most common. Extrapulmonary tuberculosis occurs when the disease affects other body organs.

The symptoms typical of tuberculosis, which may not be visible for weeks or even months, can be also sings of many other diseases. Therefore, if a person has such symptoms as a cough lasting for more than three weeks, sputum or blood during coughing, weight loss, and pain in the chest during breathing, he should see the doctor. It is important to insist on performing tests for tuberculosis infection.

Diagnosing tuberculosis is a complex and long process, which means it is essential not to waste time. After the diagnosis confirmed tuberculosis, it is crucial to create a proper treatment plan. Tuberculosis is a disease that can be treated using antibiotics. It usually takes up to six months to cure the disease, while in some cases, nine months are needed. It is important to remember that if the patient follows all instructions of the doctor and takes his medication, he will be cured without any serious health consequences.