Investigation of Tuberculosis and Cystic Fibrosis - Essay Example

INVESTIGATING DISEASE - TUBERCULOSIS AND CYSTIC FIBROSIS Disease and Comparison Tuberculosis (TB) is a chronic, infectious disease that usually attacks the lungs but which is capable of attacking other parts of the body as well. It has long been considered a killer but it ceased to be a threat once antibiotics to control the disease were discovered. However the disease has reappeared in all parts of the world and to make a serious matter worse, it has developed resistance to the drugs used to treat it making the prognosis unfavourable. This alarming resurgence may be attributed to a misplaced sense of security and complacence. This global resurgence of TB, according to Volmink and Murphy (2005) can be attributed to, " neglect of tuberculosis control programmes, HIV infection and immigration from high-prevalence countries" (p. 321). In 1993, the World Health Organization (WHO) declared TB a global emergency. It was the scientist Robert Koch who isolated Mycobacterium tuberculosis, a species of bacteria as the causal factor. The disease may be latent or active. In the former stage individuals are infected with the bacterium, but the immune system fights off the bacteria, preventing the manifestation of symptoms. Here the individual is usually not contagious. In the active stage, individuals show symptoms and are contagious. A deficient immune system exacerbates the condition; therefore organs besides the lungs are susceptible to infection. According to Heinsohn (2004), "Extrapulmonary TB may affect any organ or tissue but is much less common than pulmonary TB" (p. 7). Pulmonary tuberculosis is contagious with increased risk of infection. With the discovery of streptomycin by Selman Waksman, antibiotics have repeatedly proved their efficacy in the treatment of TB. However the US Congress, Office of Technology Assessment warns that "When a patient takes TB medication erratically or when an inadequate combination of drugs is prescribed, active, infectious TB can recur in a form resistant to one or more of the drugs used in the original treatment" (The Continuing Challenge of Tuberculosis, 1993,p. 6). Thus Multidrug- Resistant tuberculosis poses a threat in controlling and preventing the spread of the disease. Cystic fibrosis (CF) is a hereditary, genetic disorder that results in the secretion of abnormally thick mucous that damages organs, leading to respiratory and digestive problems that ultimately cause death. While primarily associated with the lungs, this disease also attacks the pancreas, small intestine, and all glands where cystic fibrosis transmembrane conductance regulator (CFTR) plays a vital role in efficient functioning. Thus Kolbe (2005), calls it " a multisystem disease affecting children and increasingly so, adults" (p. 361). It is an incurable and fatal disorder. Branscomb (1994) found that, "In spite of treatment, most patients die during infancy or childhood. Rarely, patients survive past the age of 20" (p. 318). However with improved diagnosis and treatment measures, more patients are surviving to reach adulthood. Tuberculosis and cystic fibrosis are usually seen as diseases of the lungs or pulmonary disorders, as it is here that they do the most damage. But both have debilitating effects on other organs as well. TB is a contagious disease as inhaling infectious particles can transmit it. Contact with infectious droplets may occur via coughing, sneezing or laughing. Preventive strategies play an important role in curbing the disease. Meanwhile CF is a genetic disorder that is brought about by defective genes. Therefore treatment is difficult as these disorders are very complex and scientists and researchers have a long way to go in cracking the genetic code, pertaining to these disorders. Both diseases call for early diagnosis and treatment to stem the damage that is sure to result otherwise. Counselling for the individual and family is imperative in both cases, as it helps people come to terms with the devastating impact of the disease while promoting social adjustment. Biological Basis of the Disease and Related Symptoms Once TB infection occurs, the body's immune system swings into action in order to identify and destroy the dangerous bacteria or at least inhibit its action. According to Heinsohn (2004), "Infection causes lesions in the lungs which usually heal and seldom leave any residual changes" (p. 7). This can be spotted in X-rays and it helps in diagnosis. In this stage the symptoms are barely perceptible and are usually attributed to common cold or fever. Heinsohn (2004) states, "Approximately 95% of those infected enter a latent phase from which there is a lifetime risk of reactivation" (p.7). As long as the immune system remains strong, the odds are favourable that the bacterial cells will stay passive. Padilla (2003) says, "If the bacteria are inhibited, rather than destroyed, the immune cells and the bacteria form a mass known as a granuloma or tubercle". As long as the bacteria remain safely ensconced within the tubercle, there is less risk of renewed infection. If the immune system has been weakened as a result of Acquired Immune Deficiency Syndrome (AIDS) or by other means the cells continue to multiply, break free from the tubercle and soon the infection takes firm root in the body and the individual shows active signs of TB. The bacterial cells carried in the bloodstream also infect other organs. In this stage symptoms become more acute and include severe coughing, loss of appetite, weight loss, night sweats, and sometimes the individual coughs up blood. Ruptured blood vessels account for the bloody sputum. It must be mentioned that none of these symptoms are exclusive of tuberculosis. They merely point to TB as a potential cause, therefore careful diagnosis and a thorough analysis is called for in determining tuberculosis and charting an effective course of treatment. The other forms of TB include Military, Meningitis TB or that which afflicts the lymph nodes, kidneys, bones, intestines and other organs. Diagnosis involves skin testing and identification of the bacteria present in sputum. In this manner the most appropriate method of treatment can be determined. According to Kolbe (2005), "Cystic fibrosis is an autosomal-recessive disease due to mutations of the CF gene, which resides on the long arm of chromosome 7" (p. 361). This gene is responsible for manufacturing the aforementioned CFTR; a protein that governs the flow of chloride ions in particular parts of the body, mainly the lungs and " in the paranasal sinuses, salivary glands, apocrine sweat glands, small intestine, pancreas, biliary system, uterine cervix and Wolffian duct structures" (Kolbe, 2005, p.361). Mutations of the gene that hinders proper functioning of the CPTR results in the production of abnormally thick mucous that interferes with normal bodily function. "In the lungs, this mucous blocks airways and impedes natural infection - fighting mechanisms, eventually turning the body's immune system against its own lung tissue" (Cystic Fibrosis, 2003). In a similar manner, other organs are also afflicted and damaged. The disease thus embarks on a complicated, unpleasant and varying course of bodily destruction, leading to eventual death as the respiratory or digestive system breaks down. The symptoms may appear soon after birth or they may remain elusive. Parents who have undergone genetic testing and are therefore forewarned are more alert and are likely to spot telltale symptoms. The severity of the condition also plays a role in the appearance of symptoms. "In nearly 20 percent of all cases, the first symptom is meconium ileus, in newborns" (Cystic Fibrosis, 2003). Mild respiratory disorders or chest infection is common in newborns with cystic fibrosis. Lee (2004) asserts, "One of the symptoms of babies with CF is jaundiced, or yellowish, skin" (p. 20). Other symptoms in babies are bulky stool and retarded growth. Slow development is a characteristic of the child as it grows. Stunted growth and delay in attaining puberty is evinced. Another characteristic feature according to Lee (2004) is "Eighty - five percent of people with CF also have digestive troubles and may eat a ton of food but never seem to gain weight" (p. 20). Finally the most telling feature is higher concentration of salt in the sweat of these individuals. Therefore the "sweat test" is used as a diagnostic tool in distinguishing between CF and other respiratory tract disorders that produce similar symptoms. Epidemiology Information Tuberculosis claims many lives in the UK, regardless of age, gender or ethnic group. It is a contagious disease, which spreads when individuals come into contact with infected droplets. According to Story and Citron (2003), "The determinants of TB in the UK today are multifactorial: increasing wealth inequality and social deprivation, homelessness, co-infection with the HIV virus, migration, the neglect and consequent failure of public prevention and control services" (p. 147). Poverty is a major factor in the distribution of TB in the UK. Poverty-stricken people are more susceptible to the infection as they usually live in unhygienic, overcrowded places with poor ventilation. They may not be able to buy the prescribed antibiotics, thereby putting themselves at risk to acquiring Multidrug - Resistant tuberculosis. " data show that there has been an increase in the notification rate of TB since 1988 in the poorest 30 percent of the population of England and Wales but no increase in the remainder" (Story & Citron, 2003, p.149). Co-infection with HIV virus is responsible for the changing epidemiology of Tuberculosis. It is, according to Styblo and Enarson (1991), " the strongest risk factor for tuberculosis disease observed in the last hundred years in subjects infected with tubercle bacilli" (as cited in Smith & Moss, 1994, p. 53). The weakening immune system is responsible foe aggravating symptoms. Immigration is another factor in the distribution of TB. It is believed that people from countries where there is high prevalence of tuberculosis are responsible for bringing it in. Though screening for TB before allowing people into the country is a wise precaution, too much emphasis must not be placed on this point, as it will need to negative stereotyping of ethnic groups. This is because a study conducted in an Asian community in London revealed, " almost half of TB cases had been infected by contacts in the UK, compared to only one in three who had been infected abroad" (Story & Citron, 2003, p. 151). In the words of Holland and Stewart (2005), "The prevalence of cystic fibrosis in the UK is about 1 per 2500 live births" (p. 57). Initially it was believed that the disease was relegated to childhood, however the adolescent and adult population with cystic fibrosis is on the rise. Early diagnosis may be credited for this state of affairs, however according to Kolbe (2005), " there is a consensus that improved management has also contributed to better survival" (p. 362). As mentioned earlier CF afflicts and disrupts the functioning of various organs in the body, but it is the extent of impairment of lungs that is a key factor in determining survival. In the words of Kolbe (2005), "Although CF is a multisystem disease, respiratory complications are the major cause of morbidity and mortality" (p. 362). And finally it appears that some individuals are better equipped to deal with the implications of cystic fibrosis in terms of adjusting to the limitations imposed on them. This is evidenced in individuals who manage to complete their education and lead relatively independent lives. Kolbe (2005) reiterates this point by stating, "Survival benefits in CF need to be matched by reasonable levels of psychosocial adjustment and quality of life" (p. 362). Strategies for the Prevention of Disease It is imperative that preventive strategies be implemented in controlling the spread of tuberculosis. Infection control is one such strategy, it includes "limiting exposure to the source of infection, implementing environmental measures, and using individual protective devices" (The Continuing Challenge of Tuberculosis, 1993, p. 6). This method is rather difficult to implement in terms of isolation of infectious patients, prompt diagnosis and treatment and in providing appropriate ventilation, as there are too many uncontrolled variables to be taken into account. Preventive treatment can be undertaken in high-risk populations. The use of isoniazid (INH) is, " as much as 90% effective in eliminating the bacilli from the body and preventing subsequently the development of active disease" (The Continuing Challenge of Tuberculosis, 1993, p. 7). However side effects such as liver inflammation prevent the use of this method for maximum effects. Bacillus Calmette Guerin (BCG) vaccine may also be used as a preventive measure and it has proved to be particularly effective for children. However there are certain drawbacks in using BCG, complications have been reported in patients suffering from AIDS. Moreover its usage causes "skin tests to show up as positive for 3 to 5 years, thereby complicating public health efforts to detect actual infections and offer preventive treatment" (The Continuing Challenge of Tuberculosis, 1993, p. 8). Neonatal or antenatal screening may be used as a preventive strategy for cystic fibrosis. The Cochrane Review (2004) of newborn screening for CF, " concluded that nutritional benefits are apparent and that screening does provide a potential opportunity for better pulmonary outcomes" (Holland & Stewart, 2005, p. 58). However not all results are so encouraging. A number of concerns have been expressed regarding screening, its implementation and subsequent treatment strategies. Mostly concerns abound related to the "positive harm caused by aggressive treatment with antibiotics and chest physiotherapy" (Holland & Stewart, 2005, p. 58). Concerns about psychosocial harm have also been expressed and counselling services rendered by competent staff may offset it. But procuring the right staff is usually a Herculean task and is therefore difficult to implement. Diagnosis and Treatment Skin testing by injecting a purified protein derivative into the skin and examining it for a raised surface is the primary diagnostic tool. According to Padilla (2003), "Skin tests are not 100 percent accurate and they do not always indicate the presence of active disease". The sputum also needs to be inspected. A number of factors must be examined in detail before deciding a treatment approach. Antibiotics are mainly used in the treatment of TB. A combination of drugs like isoniazid, rifampin, streptomycin, pyrazinamide, and ethambutol are used for a prescribed length of time. Failure to adhere to the course of treatment can have dangerous results. A practice known as Directly Observed Therapy (DOT) is recommended to monitor the patient's progress. But since this depends entirely on the patient it hinders effective treatment. Economic status and psychological makeup of the patient also determine the outcome. In cystic fibrosis neonatal tests as well as the aforementioned sweat test serve as diagnostic tools. Unfortunately a complete cure is not available for this disorder. It is possible to merely alleviate the symptoms and provide temporary relief. Surgical procedures may be used when intestinal blockage is a symptom. It is possible to transplant severely damaged lung tissue. However surgery is complicated and does not guarantee results. "Using a procedure called chest physical therapy or postural drainage, caregivers of people with cystic fibrosis repeatedly and vigorously pound on the patient's back and chest to dislodge mucous obstructing the airways" (Cystic Fibrosis, 2003). Researchers have a long way to go in finding a cure for this disorder. Gene therapy appears promising but currently, there is too little research on the subject. Reference list Branscomb, V.B. (1994). Pulmonary dysfunction. In C.Stalow & M.R. Clowers (Eds.), Handbook of severe disability: A text for rehabilitation counsellors, other vocational practitioners, and allied health professionals (pp. 309 - 320). Washington DC: Diane Publishing. Cystic fibrosis. (2003). Microsoft Encarta reference library. USA. Heinsohn, P. (2004). Tuberculosis resource guide. New York: Diane Publishing. Holland, W.W., & Stewart, S. (2005). Screening in disease prevention: What works Oxford: Radcliffe Publishing. Kolbe, J. (2005). Adult cystic fibrosis. In P.Gibson (Ed.), Evidence - Based respiratory medicine (pp. 361 - 388). Oxford: Blackwell Publishing. Lee, J. (2001). Everything you need to know about cystic fibrosis. New York: The Rosen Publishing Group. Padilla, M.L. (2003). Tuberculosis. Microsoft Encarta reference library. USA. Smith, P.G., & Moss, A.R. (1994). Epidemiology of tuberculosis. In B.R. Bloom (Ed.), Tuberculosis: Pathogenesis, protection, and control (pp. 47 - 60). Washington DC: ASM Press. Story, A., & Citron, K. (2003). Private wealth and public squalor: The resurgence of tuberculosis in London. In M.Gandy & A. Zumla (Eds.), The return of the white plague: Global poverty and the new tuberculosis (pp. 147 - 162). London: Bath Press. U.S. Congress, Office of Technology Assessment. (1993). The continuing challenge of tuberculosis. Washington DC: U.S. Government Printing Office. Volmink, J., & Murphy, C. (2005). Pulmonary tuberculosis. In P.Gibson (Ed.), Evidence - Based respiratory medicine (321 - 334). Oxford: Blackwell Publishing. Read More