Infectious Disease: Tuberculosis
Every year on the 24th of March, the global community observes World Tuberculosis Day. The recognition of this day by the World Health Organization (WHO) is symbolic as it recognized Dr. Robert Koch’s Nobel Prize-winning discovery of Mycobacterium tuberculosis: the causative agent for tuberculosis (TB). Most importantly, this day recognizes TB as one of the leading causes of deaths globally. The WHO estimates that out of the 10 million TB cases reported in 2017, 1.6 million were fatal (WHO, 2018). Therefore, World TB Day is a themed commemoration day which brings the global communities together to create TB awareness while also assessing the various strategies aimed at eradicating the pandemic.
Analysis of Tuberculosis
Dr. Koch’s discovery of Mycobacterium tuberculosis in 1882 as the causative agent for tuberculosis was revolutionary. It opened the door to discoveries of different strains of pathogenic bacteria within the Mycobacterium tuberculosis complex that also cause TB and other TB-related respiratory conditions. In addition to the Gram-positive and negative aerobic M. tuberculosis, TB is also caused by M. microti, M. leprae, M. canetti, M. kansasii, M. bovis, M. avium, and M. africanum. Genetically diverse, these strains of mycobacteria are less prevalent and sometimes confined to different regions (Niobe-Eyangoh et al., 2003). The pathogenic mycobacteria primarily invade the human respiratory system, especially the lungs where they successfully evade phagocytosis pathways of the macrophages in the alveoli through a wide range of defensive mechanisms, including neutralization (Knechel, 2009).
While the majority of TB infections are latent and asymptomatic, active TB is symptomatic due to tissue damage, necrosis, and blockage of the bronchi of the lungs. The resulting necrotic material liquefies to become semiliquid, which blocks bronchi and blood vessels. Tissue damage is not confined to the lungs and may spread to other body tissues, especially if the mycobacteria enter the bloodstream Crowley, 2010). Clinical manifestations of active TB include chest pain, fever, and coughing that last for at least three weeks. Patients suffering from TB also experience unexplained night sweats, weight loss, fatigue, and loss of appetite. Additionally, they also show blood or sputum-stained coughs (Knechel, 2009; (CDC, 2019).
- Mode of Transmission
Person-to-person transmission of tuberculosis through via airborne infectious droplets which contain the pathogenic tuberculosis-causing bacteria strain. These aerosol infectious droplets are expelled by individuals suffering from untreated active TB, especially in the case of TB affecting the pulmonary and larynx. Expectoration of the bacteria occurs through singing, spitting, sneezing, talking, and coughing. The mycobacteria enter the body through the lungs, where it can spread to the rest of the body (Knechel, 2009).
- Complications and Treatment
One of the major complications associated with tuberculosis is drug-resistance. For several decades, medical practitioners have used antibiotics to treat TB. However, failure of these drugs to kill all infectious mycobacteria can lead to the emergence of bacteria strains that are resistant to common and less common antibiotics. Such resistance is passed is inherited by new generations of bacteria through the genes (Zumla et al., 2013). Drug-resistant strains of bacteria are difficult to treat, highly virulent, and lead to numerous TB-related fatalities (CDC, 2019; Knechel, 2009).
Additionally, TB-causing mycobacteria may also affect other organs besides the pulmonary system, leading to serious health complications. Highly fatal conditions such as meningitis and multi-organ failure may result from the nervous system and bloodstream TB infection, respectively. TB may also lead to the formation fibrous and necrotic materials within the lymphatic system and bones (Knechel, 2009).
- TB Health Determinants and Epidemiological Triad
Working condition is one of the leading health determinants for the contraction of TB. Healthcare workers are at a greater risk of suffering from the condition (CDC, 2019). Additionally, low-income individuals living in poor conditions are at a greater risk of suffering from TB. The physical environment is also a health determinant. The risk of contracting TB is high among people living in areas with high TB prevalence (CDC, 2019). People with HIV/AIDS have increased chances of contracting the disease due to immunosuppression: a condition known as HIV coninfection (Zumla et al., 2013).
Immunosuppression and poor ventilation are the critical host and environmental factors, respectively, which determine the spread and severity of TB. A suppressed immune system is associated with most cases of active TB (Zumla et al., 2013). Poor ventilation provides a conducive environment for the multiplication of the infectious mycobacteria. Virulence and drug-resistance are important agent factors for the disease (Knechel, 2009). High virulence and drug-resistance increase the infectiousness of the mycobacteria.
Role of Primary Care Nurse Practitioner in Managing TB
Primary care nurse practitioners play a vital role in the management of tuberculosis. According to the WHO, TB care, control, and prevention require evidence-based practices, including policies, standards, and strategies (WHO, 2018). Clinical nurses make significant contributions to TB prevention by identifying clinical symptoms, diagnosing, and subsequently isolating patients to prevent further spread of the disease. Nurses collect, and report TB-related data for physicians and hospital management board to facilitate decision-making by both the hospital and local and federal governments. Data collected vary from TB incidence reports to prevalence and key populations affected. Nurses provide primary care to isolated patients, including overseeing ventilation of the room, cleaning suction catheters, and preventing catheter-related pneumonia.
In addition to overseeing nutrition adherence and guidance, nurses also educate the masses through TB awareness campaigns concerning the proper management, prevention, and treatment of the disease. According to International Council of Nurses (ICN) and American Association of Critical-Care Nurses (AACN), nurses supervise good adherence to TB drugs through monitoring patients and providing moral and emotional support to both the patients and their loved ones (ICN, 2019; Knechel, 2009). Nursing research also contributes significantly to the body of literature that shapes the policies, standards, strategies, and protocols used in TB prevention, treatment, and management.
CDC. (2019 Jan. 24). Tuberculosis (TB) disease: symptoms and risk factors. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/features/tbsymptoms/index.html
Crowley, L. V., (2010). An introduction to human disease: Pathology and pathophysiology correlations (8th ed.). Sudbury, MA: Jones and Bartlett.
ICN. (2019 Mar. 22). It’s time to end TB. International Council of Nurses. Retrieved from https://www.icn.ch/news/its-time-end-tb
Knechel, N. A., (2009). Tuberculosis: Pathophysiology, clinical features, and diagnosis. Critical Care Nurse, 29(2), pp. 34 – 43.
Niobe-Eyangoh, S. N. et al. (2003). Genetic biodiversity of Mycobacterium tuberculosis complex strains from patients with pulmonary tuberculosis in Cameroon. Journal of Clinical Microbiology, 41(6), pp. 2547 – 53.
WHO. (2018 Sept. 18). Tuberculosis. World Health Organization. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tuberculosis
Zumla, A. et al. (2013). Current concepts: Tuberculosis. N Engl J Med., 368, pp. 745 – 55.