Epidemiology of Tuberculosis - Assignment Example

Epidemiology of tuberculosis Introduction Tuberculosis (TB) is a life-threatening communicable infection that affects mainly the lungs (pulmonary TB) but may in certain instances affect structures and organs of the body other than the lungs (extra-pulmonary TB). Several strains of mycobacteria cause TB, but common to the strains is the Mycobacterium tuberculosis. Mycobacterium tuberculosis is a tiny non-motile aerobic bacillus that is high in lipid content and accounts for the signs of the disease. The disease is air born and spreads when individuals affected sneezes, cough, speak, spit or can be transmitted through contact with the respiratory droplets of an affected individual and inhaled by another individual (Lawn & Zumla, 2011). A sneeze is capable of releasing up to 40, 000 droplets of tuberculosis microorganisms, and a single droplet is enough to transmit the infection. People with frequent contact with individuals infected with the disease are at a higher risk of contracting the infection with an estimated infection rate of 22%. An untreated person with active TB can infect between 10 and 15 people in a year. The chances of transmission of TB from one person to another is dependent on factors like the amount of infectious droplets expelled by the infected individual during the sneezing episode, the duration of exposure to the droplets and the ineffectiveness of ventilation. Signs and symptoms TB infection in an individual can exist in the form of an active disease or the form of a latent infection. An individual with the latent form of the disease does not feel sick and presents with no signs and symptoms of the infection. Latent form of TB is only diagnosed through a tuberculin skin test or a TB blood test. People with the latent TB are not infectious despite possessing the mycobacterium. Individuals with the active form of TB presents with the signs and symptoms of the infection in addition to the positive tuberculin skin test and the TB blood test (Golden & Vikram, 2005). The most active form of TB is the pulmonary tuberculosis that presents in about 90% of the cases. Pulmonary TB affects the lungs and manifests with chest pain, prolonged coughing and sputum production. In extreme cases of the condition, an individual can cough small amounts of blood a manifestation of the erosion of the pulmonary artery. Extra pulmonary tuberculosis accounts for 15-20% of the active cases of the disease. These are conditions caused by Mycobacterium tuberculin but affect structures out of the lungs. Extra pulmonary tuberculosis is common among the immunosuppressed individuals and young children. The common symptoms of tuberculosis include persistence in cough that lasts for more than two weeks. The cough usually brings up phlegm that may be blood stained. Weight loss is another sign of TB infection especially if the weight is lost in an abnormally higher rate despite maintenance of normal nutritional intake. Night sweats and fever are common among individuals infected by tuberculosis germ accompanied by fatigue and loss of appetite. Complications TB can be fatal in case it is not treated and can spread from the lungs by means of the bloodstream or through the lymphatic system to cause complication to other body structures. Spinal pain resulting in stiffening of the back, which may equally result, to meningitis is a complication of untreated tuberculosis. Joint damage resulting to tuberculosis arthritis is a common complication affecting majorly the knee and the hip joints. Tuberculosis may affect the liver and the kidneys thus leading to inability of the body to manage the waste products and the metabolic products. In rare instances, tuberculosis may affect the heart tissues resulting in an accumulation of fluid in the pericardial cavity. This impairs the functionality of the heart resulting in cardiac temponade (Günther, Heyckendorf, Herzmann, & Lange, 2012). Treatment The treatment of TB takes a longer duration than any other bacterial condition; thus adherence to medication is the cornerstone of achievement of the desired treatment outcome. Treatment of tuberculosis relies on antibiotic therapy for a period of between six and nine months, with the specific drug composition and duration of treatment dependent on age, possibility of drug resistance, the overall health condition, the form of TB (active or latent) and the location of the infection in the body. Cases of latent tuberculosis may require a single kind of TB medication while active tuberculosis is managed through combined therapy. TB is commonly treated with isoniazid, rifampin, ethambutol, and pyrazinamide. In cases of resistant strains, fluoroquinolones can be used for the treatment of the disease for a duration of between 20 and 30 months. However, in the course of treatment, the patients must be notified of the side effects of the medications that may include nausea and vomiting, jaundice, loss of appetite, dark coloration of urine and fever that may last for three or more days (Lawn, 2013). Demographics of TB About a third of the world population has suffered from TB infection with new infections occurring at a rate of 1% annually. According to the world TB statistics of 2012, about 8.6 million people were reported to have a chronic case of the disease. In 2010, approximately 8.8 new cases of TB in the world were diagnosed that contributed to a motility of between 1.25 and 1.45 million people in the year. Epidemiologically, TB is the second most cause of world motility among the infectious conditions after HIV/AIDS. Nevertheless, the prevalence of TB cases has reduced while the incidence has increased since 2002. In the Asian continent, China has achieved significant progress in the fight against TB with a recording of 80% reduction in motility rate from the disease from 1990 and 2010. TB is highest in prevalence among the developing countries especially in the sub-Sahara Africa, Asia, and South America. Nevertheless, in the United States, only 5 to 10% of the population test positive of TB as at 2010 (WHO, 2013). According to WHO statistical data, for TB epidemiology in 2007, Swaziland was ranked the first country with the highest incidence rate of TB 1200 cases of new infection reported per 100,000 people. In America, the natives have a five times higher index of mortality. In the African continent, TB infection mainly attacks the youths and the adolescents while in the developed nations like the US where the there is a decline in the incidence rate, TB infection is major among the older generation. Epidemiologic Triangle of TB The epidemiological triangle has three vertices being the agent, that is the cause of the disease, the host, which is the organism harboring the disease and the environment that is the external factors allowing the transmission of the disease. Epidemiologic Triangle is useful in explaining the spread of an infection in the community. In the case of TB, the agent is Mycobacterium tuberculosis; which is an acid-fast bacterium, hypersensitive to heat and UV light. The host factors in TB infection include weakened resistance, non-immune individuals, and poor nutrition. The environmental factors in the transmission of TB are conditions that promote overcrowding, poor ventilation, and poor sanitation (Daniel, 2006). Role of community health nurse in the control of TB A community health nurse has the responsibility of caring out a Case-finding mission to determine the incidence rate of TB in the community. Case finding can be made efficient through a collaborative approach between the community health nurse, the social workers, and the community leaders thus making it possible to reach households that may be affected by the condition. After case finding missions, the community health nurse conducts a reporting of the TB infection to enable public health officials to conduct a surveillance and seclusion to help in preventing the spread of the disease in the community. Reporting of the cases must be done in a chronological order that enables the preparation of sufficient materials and medicines to contain the infection. Data collection and data analysis are among the key roles of a community health nurse in the management of TB in the community. Working with the public health sector and the social workers, a community health nurse can collect date related to the prevalence, incidence and mortality rate of the disease to identify the disease burden in the community. This data is then analyzed to develop a plan for future actions in responding to the new cases of the disease. A community health nurse must also carry out a follow-up activity on the identified cases of TB infections to ensure adherence to medication. Follow up is crucial to prevent the development of drug-resistant TB that occurs through ineffective adherence (Young, 2009). World health organization is active in combating the TB pandemic. In 2006, the world health organization developed a six-point strategy for control of the infection that included direct observation therapy (DOT) as a strategy to ensure there is maintenance of adherence to TB medication and helps in the prevention of drug-resistant TB. Among the six strategies, WHO purposes to enable and promote research in tuberculosis, empower TB affected individual and engagement of all health care providers in control of TB. Additionally, the control of tuberculosis was to depend on primary health care as well as addressing poor and vulnerable peoples needs (World Health Organization, 2012). References Daniel, T. M. (2006). The history of tuberculosis. Respiratory Medicine, 100, 1862–1870. Golden, M. P., & Vikram, H. R. (2005). Extrapulmonary tuberculosis: An overview. American Family Physician. Günther, G., Heyckendorf, J., Herzmann, C., & Lange, C. (2012). [Tuberculosis]. Deutsche Medizinische Wochenschrift (1946). Lawn, S. D., & Zumla, A. I. (2011). Tuberculosis. Lancet, 378, 57–72. Lawn, S. D., Zumla, A. I., Raviglione, M., Hafner, R., & von Reyn, C. F. (2013). Tuberculosis. Lancet, 378, 57–72. WHO. (2013). Global Tuberculosis Report 2013. World Health Organization (p. 306). World Health Organization. (2012). Global tuberculosis report 2012. WHO (p. 258). Young, D. B., Gideon, H. P., & Wilkinson, R. J. (2009). Eliminating latent tuberculosis. Trends in Microbiology, 17, 183–188. Read More