Tuberculosis: Causes, Transmission, and Impact on Society

This report provides an overview of tuberculosis (TB), including its definition, causes, transmission, and impact on individuals and society. It discusses the symptoms and treatment options for TB, as well as demographic and epidemiological data related to the disease. The report also highlights the social stigma and challenges faced by TB patients, and the importance of a comprehensive approach to TB control.

Module: Public Health and Illness in
Society (SH5002)
Assignment 2: Report
Tutor name: Dr. Maha Abbas
Due Date: 17.05.2019
Word counts: 3607

Learning Outcome 4 (LO4)
Introduction
In this report, I will start by defining the TB also known as the White Plague is an
infectious disease and I will be describing and explaining about Tuberculosis and the
changing patterns of health and illness in a population. I will also provide a definition
of the disease. I will explain how Tuberculosis is transmitted and what are the
causes of Tuberculosis. In doing this I will discuss the diversity of consequences that
varying states of illness can have for the individual’s sense of self and way of life by
considering the relation between health professionals, patients’ and those around
them. I will also give an account on social relationship and how this will affect the
patients’ conditions.
Definition of Tuberculosis
There are many definitions on the internet regarding Tuberculosis disease but the
one that I understood was the following.
Tuberculosis (TB) remains a major global health problem. It causes ill-health among
millions of people each year and ranks as the second leading cause of death from an
infectious disease worldwide, after the human immunodeficiency virus (HIV).
(Apps.who.int, 2019)
Tuberculosis or TB, as it’s commonly called is a contagious infection that usually
attacks the lungs. It can also spread to other parts of the body, like the brain and
spine. A type of bacteria called Mycobacterium tuberculosis causes it. (Cold et al.,
2019). TB also affect the any other part of the body including kidneys or brain which
is called non pulmonary TB
Although TB can be treated, cured, and can be prevented if persons at risk take
certain drugs, scientists have never come close to wiping it out. Few diseases have
caused so much distressing illness for centuries and claimed so many lives.
(TheFreeDictionary.com, 2019). This disease is chronicle and very highly infectious.
How Tuberculosis is transmitted
When someone is infected with the disease they will coughs, sneezes or spits, the
tuberculosis bacteria are spread into air and will infect those who breathe
When infected individual coughs, sneezes or spits, M. tuberculosis is propelled into
the air and infected those who breathed in the bacteria that existed in droplets of
saliva. Primarily, tuberculosis will affect the lungs, known as pulmonary tuberculosis.
It will also affect other parts of body, for instance lymph nodes, bones, brain and
kidneys.

(Image.slidesharecdn.com, 2019)
The causes of Tuberculosis
When someone who is infected coughs, sneezes or spits the TB bacteria is impelled
in the air and can infect those who breath in the bacteria that is in the saliva. Firstly,
tuberculosis will affect the lungs known as pulmonary tuberculosis but it will also
affect other parts of the body for example lymph nodes, bones, brain and kidneys.
The main cause of TB is the bacteria called Mycobacterium tuberculosis (MTB) it’s a
small aerobic and non-motile bacterium. It usually spread into air when a person who
is infected cough or sneeze or even spits. (Clinaero, 2019)
There is in some cases the immune system can’t kill the bacteria but it will prevent it
from spreading to the other parts of the body. If in any case the immune system fails
to kill the it will get all over the body and a person will get the symptoms between few
weeks. Which they call active TB. It can also be linked to certain risk factors
including alcohol, drugs abuse and homeless. Research has shown that people with
certain risk factors are more likely to develop tuberculosis. A risk factor is anything
that increases a person's chance of developing a disease. (Clinaero, 2019)

(Verywellhealth.com, 2019)
There are two type of TB which are the following active TB and latent TB. Most
health people, the immune system is able to kill the bacteria that can cause
Tuberculosis. But for some people the bacteria will infect the body but they
sometimes don’t cause or show symptoms that is called latent TB and if the infection
causes symptoms within few weeks it’s called active TB. Up to 10% of people with
latent TB eventually develop active TB years after the initial infection. (nhs.uk, 2019)
This usually happens either within the first year or two of infection, or when the
immune system is weakened – for example, if someone is having
chemotherapy treatment for cancer. (nhs.uk, 2019)
About one-third of the world's population is believed to have latent TB. There is a 10
percent chance of latent TB becoming active, but this risk is much higher in people
who have compromised immune systems, i.e., people living with HIV or malnutrition,
or people who smoke. (University of Illinois-Chicago, 2019)

Demographic and epidemiological data
Tuberculosis (TB) is one of the world’s deadliest diseases:
 One fourth of the world’s population, is infected with TB.
 In 2017, 10.0 million people around the world became sick with TB disease.
There were 1.3 million TB-related deaths worldwide.
 TB is a leading killer of people who are HIV infected. (Cdc.gov, 2019)
A total of 9,105 TB cases (a rate of 2.8 cases per 100,000 persons) were reported in
the United States in 2017. This is a decrease from the number of cases reported in
2016 and the lowest case count on record in the United States. (Cdc.gov, 2019). The
case rate of 2.8 per 100,000 persons is a 2.3% decrease from 2016. Ending TB
requires maintaining and strengthening current TB control priorities while increasing
efforts to identify and treat latent TB infection among high-risk populations. (Cdc.gov,
2019)
TB rates are very low nowadays in England, following intensive efforts a long decade
rise in cases that started in the middle of 1980s. However, TB in England have
becomes associated with inequality. In England in 2017: (TB Alert, 2019)
There were 5,102 TB cases – a rate of 9.2 per 100,000 populations (TB Alert, 2019)
The rate of TB among the most deprived 10% of the population is seven times higher
than among the least deprived 10% (TB Alert, 2019)
71% of cases were among people born outside the UK (TB Alert, 2019)
13% of people with TB have at least one social risk factor for the illness
(homelessness, a history of substance misuse, or time spent in prison) (TB Alert,
2019)
The rate of TB among the non UK-born population was almost 20 times the rate in
the UK-born, at 80 per 100,000 but has continued to decline over the last seven
years. In the UK-born population, the incidence of TB has not declined in the past
decade, with rates remaining stable at 4.1/100,000 per year. Within this population,
those most at risk remain individuals from ethnic minority groups, those with social
risk factors and the elderly. (Tidy, 2019)

(A
ssets.publishing.service.gov.uk, 2019)
Data indicate that the transition from environmental organism to an obligate
pathogen happened in Africa, but there is currently no consensus with respect to the
timing of this event.
Around 2 billion people (about one third of the world’s population) are infected with
TB – and are therefore at risk of developing active TB (TB disease) at some time in
their life. (Assets.publishing.service.gov.uk, 2019)
Globally, TB causes about 1.4 million deaths every year. Alongside malaria and HIV,
it is one of the greatest infectious disease challenges in the world today.
(Assets.publishing.service.gov.uk, 2019)
Learning Outcome 5 (LO5)
Signs and Symptoms of TB
Normally a person with TB will have no sign as the bacteria inside the immune
system is inactive.
General signs and symptoms of active TB will and can include fever, chills, night
sweats, loss of appetite, weight loss, and fatigue.
According to the centers for Disease Control and Prevention (CDC), the symptoms
of TB disease can include being sick or weak, loss of appetite and weight loss.

Patients will have chills, fever, night sweats and a cough that last more than 3 weeks
as well as chest pain. (University of Illinois-Chicago, 2019). TB can also affect other
parts of the body. Symptoms will depend on the part it affects. (University of Illinois-
Chicago, 2019). These are the early sign of Tuberculosis.
During the stage of latent, TB has no sign or symptoms. When TB is active, cough
and fever or any other symptoms can start to appear little at the time.
While TB usually affects the lungs, it can also affect other parts of the body, and the
symptoms will vary accordingly.
Without treatment, TB can spread to other parts of the body through the
bloodstream. There may be spinal pain and joint destruction and it can lead to
meningitis which will affect the brain. It can also impair the waste filtration functions
and lead to blood in the urine which can affect the liver and kidneys. The heart will
lose the ability to pump blood which will result in cardiac tamponade, it’s a condition
that can be fatal. (University of Illinois-Chicago, 2019)
How the disease affects on people’s life
TB can have a negative effect on someone life as they have to take medication and
be on their own as it’s a contagious chronic bacterial infection that can be easily
spread in the air.
If someone have TB in their family or anyone close to them have lung TB it can
spread easily before the patient has starts the treatment and few weeks after that.
Those who have been infected with TB don’t quite develop the illness. Those who
have a weak immune system such as small children, young adults and elderly have
a bigger chance to develop the illness.
While on treatment a patient can be in isolation in order to not get the bacteria to
spread. While in treatment, a patient needs a regular check up to help to make sure
that the treatment its working for the patient. They must finish their course which can
be 3 months or 6 months depending on the type of TB a patient has. If they stop the
treatment too soon, the bacteria can be still alive and can become more resistant to
the drugs.
There is big social stigma around and that is attached to TB even in this year, afraid
to contract the disease, many people sidestep those who have TB which will result in
isolating them within the community. Addition to this many people have to travel
outside of their home to get treatment and get checked up. Beyond all this, their
loneliness and the financial strain give them pressure as when someone who has a
full time job has to take leave from work to get treated.
The cost of living with Tuberculosis has physical discomfort and pain. Many patients
have mental health pain due to their isolation and the guilt of not proving financial
help to their family. Health professional has to come up with an improved drug

resistant TB as well as a social program that can be an answered to the social and
psychological problems that a TB patients come across while being on treatment.
There are many test to diagnose TB, depending on the type of TB.
Pulmonary TB, a patient may have a chest x-ray to look for changes that can be
visible in the chest and sample of phlegm can be taken also.
Extra pulmonary TB this is when the doctor suspects that a n individual have TB
outside their lungs. To find out that several test can be used such as a CT scan, MRI
scan or even ultrasound scan to find where is the TB. A patient may also give his or
her sample of blood and urine.
If you don’t have TB but has been exposed to TB which they called latent TB, they
will use Mantoux test which involves injecting an amount of a substance called PPD
tuberculin in the forearm skin. If the skin has a strong reaction to this, the patient will
be offered a chest x-ray.
LO6
Key insights of illness
If a patient has an active TB, they have to take a course of anti-biotic for six months.
In some occasion the TB bacteria may be resistant to one or more of the antibiotic
tablets so which results in taking it for more longer.
If the patients have latent TB, they may be offered a shorter treatment with less
tablets. This will aim to reduce the risk of developing active TB.
The health professional will prescribe Isoniazid which has a side effect causing nerve
damage (peripheral neuropathy). (nhs.uk, 2019)
Vitamin B6 (pyridoxine) supplements given to take alongside it to reduce this risk.
Liver function will be tested before a patient start treatment.
In rare cases, the antibiotics used to treat TB can cause eye damage, which can be
serious. If you're going to be treated with ethambutol, your vision should also be
tested at the beginning of the course of treatment. (nhs.uk, 2019)
Contact your TB treatment team if you develop any worrying symptoms during
treatment, such as being sick or the skin is turning yellow and the whites of your
eyes which is called jaundice. There will be high temperature and some patients may
experiences tingling or numbness in your hands or feet and changes to your vision
such as blurred vision (nhs.uk, 2019)

(Bing.com, 2019)
The other tablets its Rifampicin can reduce the effectiveness of some contraception,
a patient should use an alternative method of contraception, such as condoms, while
taking rifampicin. (nhs.uk, 2019)
Rifampicin can also interact with other medication, so it's important that your TB
team know about all of the medicine you're taking before you start treatment for TB.
(nhs.uk, 2019)
(Bing.com, 2019)
The cultural meaning of illness
Tuberculosis is extremely common in every country even in developed countries but
not in United States. Scientist things that one in three people in the world has got TB.
There is nearly 95% of death caused by TB in developing countries due to the lack of
medical resources. Ever since 1992, the number of TB death is slowly declining
worldwide but in the US its increasingly. Most people who have TB are born in other
countries, where TB is mostly common.
Patients affected by TB are in the position to suffer discrimination it can be in the UK
as well as overseas, this is the result of the stigma that surround the illness and

some cultures thinks that a person with TB is been possess by a witchcraft. Some
countries in Africa consider TB as a curse on a family as they think the illness affects
multiple generation of the family as most people knows that TB is an airborne illness
that is spread to one person to another if you have a close contact with them. TB is
related with many factors that can create stigma around the diseases which are HIV,
poverty drug and alcohol misuse, homeless and a person who was in prison.
People who are discriminated are isolated socially if they live in a small community in
poor countries even the entire family can be affect by this. Women who have TB can
divorce and can be considered unfit for marriage.
The impact of this stigma that surround TB have fear of discrimination of delay
seeking help which will result them to become seriously ill and infects others. This
then perpetuates the myth that it is the TB treatment itself that causes deaths, as
treatment is much less effective if left until the illness is in its advanced stages. (TB
Alert, 2019). It can also make people keen to stick with their treatment as its take
many months for the treatment to finish. In this case a person will become resistance
to drugs as patients are taking their treatment irregularly.
TB is not spread through spitting or sharing crockery or cutlery. You need to be
exposed to TB droplets in the air for a long period of time – typically eight hours or
more – to be at risk of contracting the illness. This means the idea that TB is easily
spread on public transport is also a myth. (TB Alert, 2019)
Experiential dimension of an illness
Each and every one experience towards or because of this illness is different. This
section is about the experience of patient with TB.
Suffering was the main problem for patient with TB because of fear of dead and the
fear of transmitting the illness to others and of being discriminate against. The
suffering was mostly because of the stigma and the ignorance about TB. People
should be educated towards this disease and proper campaign should be put on
place.
Fear of transmitting the disease to their member of the family which led the patient to
be shy away from the society. Some patient has to give their personal space like my
own cup, own plate so that others don’t get the illness and to control the disease.
The suffering experienced by the patient was primarily linked to the idea of contagion
and likelihood of being discriminated against, which made them feel lonely and
stigmatized. In some cases of TB only the family knew so that helped them to finish
their treatment without being judged. Patient are sometimes moved at the back of
their house and food are passed through windows to avoid coming in the patient’s
room in the developed countries.

Most of the patients mentioned that the negative attitudes of others affected the way
they interacted with both family and community members. Patients living with
relatives said they ensured that they had very limited interaction with the family
members. They had to isolate themselves, separate their eating bowls and cups
from the households', sleep outside, or stay somewhere (after the daily medication)
till evening before going home. Socially, some of them had to limit their interaction
with friends and other relatives and lived secluded lives. (Dodor, 2019)
Biomedical dimension of an illness
Tuberculosis (TB) is a chronic granulomatous disease. In humans it is caused by
bacteria of the Mycobacterium tuberculosis complex (which includes M. tuberculosis,
M. bovis and M. africanum). It is most commonly spread by inhalation of infected
droplets (accounts for almost all cases in the UK). Infectious patients cough up huge
numbers of mycobacteria, which can survive in the environment for long periods of
time. (Tidy, 2019)
TB which is diagnosed in the lungs or throat it’s called pulmonary TB are infectious
which mean it can pass from one person to another. Yet, TB can also affect any part
of the body this is called non pulmonary TB and it’s not infectious. Tuberculosis
cases in the UK are still low even though they have increased since 1980s. this
disease can be cured with a treatment of 6 months and in some case over a period
of 3 months.
A patient named Allen has been diagnosed with TB and had to be put under a
course of 18 months’ treatment. During that time, he had to stop working and had to
stay at home. He got to a stage where he goes out of his house only for his
medication and o see the doctor at the hospital. He became so nervous at how TB
made him look as well as he uses scarf to cover his mouth when is out.
The psychological effects of TB on this patient did affect badly, specially when he
found himself stigmatized by other people. He felt so isolated as people did not want
to come near him as they knew he had TB and they were worried about catching the
illness. While staying home, he was struggling with money as he could not go to
work. (The Truth About TB, 2019)
TB treatment takes at least six months. It really important to take all the tablets that
has been prescribed by the doctor. The patient will also be tested for TB and it may
be put on medication too.
Word count:3607

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