This document provides information about tuberculosis, a communicable disease caused by Mycobacterium tuberculosis. It discusses the transmission, symptoms, diagnosis, treatment, and complications of tuberculosis.
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Running head: TUBERCULOSIS1 COMMUNICABLE DISEASE- TUBERCULOSIS Name of Student Institution Affiliation
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TUBERCULOSIS2 COMMUNICABLE DISEASE- TUBERCULOSIS A communicable disease is a disease caused by biological agents such as bacteria, viruses, parasites, and fungi. In addition, or its products and transmitted by the agent or its products from the host/reservoir to a susceptible host. The transmission can be either directly or indirectly from man to man, animal to man or environment (air, water or food) to man. A chain of infection is a model that explains a communicable disease process requires that all the links involved in a communicable disease must all be present for the infection to occur. These links include; infectious agent, the portal of exit, reservoir, host that is susceptible, the route of entry, transmission mode (Mass, 2013). My discussion will talk on tuberculosis as one of the diseases that are communicable. Tuberculosis is of the communicable diseases that it is passed via the bacteria Mycobacterium tuberculosis and spreads from human to human by particles that are airborne and contain Mycobacterium tuberculosis called droplet nuclei. The transfer of these bacteria takes place when an infected host sneezes, coughs, sings or laughs and there is a need for prolonged contact for transmission to take place (Day and Brunner, 2010). Under the model chain of infection, tuberculosis is spread by Mycobacterium tuberculosis from its host to another susceptible host. Man serves as the reservoir for the bacteria that resides in the lungs in 85% of the cases, and there are other sites known as extra pulmonary tuberculosis sites such as urinary tuberculosis, tuberculous meningitis, genital tract tuberculosis, ocular tuberculosis, and tuberculosis pericarditis. The portal of exit from man which is the route used by the pathogen to escape from the reservoir is the respiratory route by way of droplets. The route of transmission explains how the pathogen Mycobacterium tuberculosis is spread from the reservoir to its new host is through the respiratory droplets. The portal of entry to its new host is the respiratory route
TUBERCULOSIS2 by inhalation. A host that is susceptible means a person who is at risk of getting the disease when exposed to the disease-causing pathogen and in this case mycobacterium tuberculosis (Gilligan, Smiley and Shapiro 2014). The probability of transmission of the bacteria depends on the following, the infectiousness of the pathogen which is directly related to the number of droplet nuclei carrying mycobacterium tuberculosis that are expelled into the air, the environment and the length of exposure to the pathogen. The percentage of infected people that will develop tuberculosis at some point in their lives is ten percent with 5% being within one to two years after infection, and the other 5% will develop the disease at some point later in their lives. Persons at risk of developing the disease fall under two categories namely; people with recent infections and those at risk of progressing from latent tuberculosis infection to tuberculosis disease due to their current clinical conditions. The symptoms of tuberculosis are only noticeable in a person who already has tuberculosis disease, and not seen in a person with tuberculosis infection. The symptoms include prolonged productive cough, chest pain, hemoptysis, fatigue, chills, fever, night sweats, loss of appetite and weight loss. These symptoms are mainly seen in the case of pulmonary tuberculosis. The diagnosis of tuberculosis requires sputum collection as sputum specimens are essential in the confirmation of the disease and the specimen should be directly from lung secretion and not saliva. The specimens should be collected from three different days and the morning spontaneous is more desirable than induced sputum. The sputum should be collected before any treatment is initiated. Chest x-ray as a test in the diagnosis of tuberculosis is obtained from patients with a positive tuberculin skin test or with symptoms suggestive of tuberculosis (McCance and Huether 2010). Abnormal x-ray by its self cannot be used to confirm the diagnosis but has to be used in conjunction with other diagnostic tests. Smear examination is another diagnostic tool for
TUBERCULOSIS2 tuberculosis in which patients with smears containing acid-fast bacilli tuberculosis is strongly considered. Subsequent smears are used to assess patients' infectiousness and their response to treatment. Culture of specimens is the gold standard in tuberculosis diagnosis and requires incubation for six to eight weeks before declaring the patient tuberculosis negative. Treatment of tuberculosis is different for latent tuberculosis infection and tuberculosis disease. Daily isoniazid therapy for nine months is used for latent tuberculosis infection: monitoring of patients for signs and symptoms of peripheral neuropathy and hepatitis should be done during the period of this treatment. An alternative regimen is rifampin, which can be used for four months. In the treatment of tuberculosis disease the first line drugs used are pyrazinamide, isoniazid, ethambutol, rifampicin/rifabutin, and streptomycin. The second line drugs used are para-amino salicylic acid, kanamycin, cycloserine, quinolones (ofloxacin/ciprofloxacin/levofloxacin), amikacin, capreomycin and ethionamide (Global Tuberculosis Programme and World Health Organization,2015). The drug regimens should be adjusted if there is any case of drug susceptibility or if the patients have difficulty with any of the medications. There are strains of tuberculosis that are resistant to drugs making it a major killer disease. Tuberculosis strains that resist many drugs are resistant to at least rifampicin and isoniazid. Extensively drug-resistant strains of tuberculosis are resistant to rifampin, and isoniazid, plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (kanamycin, amikacin, or capreomycin as examples). Complications can arise if tuberculosis is not treated and can be life-threatening. Active tuberculosis disease that is not treated affects the lungs but can be spread through the bloodstream to the rest of the body parts. Examples of this complications include joint damage caused by tuberculosis arthritis affecting the hips and knees, spinal stiffness pain and, meningitis
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TUBERCULOSIS2 causing intermittent or lasting headaches, kidney and liver function impairment and cardiac tamponade in the heart. Incidence in epidemiology is used as a measure of new disease cases in a population that develop in a period of time that is specified such as two year incidence. It is used as a probability to measure that people not affected will acquire the disease. It is used when examining an outbreak of a health problem. The incidence of tuberculosis in 2017 was 134 per 100,000 people worldwide. Prevalence, as used in epidemiology, is the proportion of actual cases in a population at a given time and used as an indicator of how a disease is spreading. The percentage number of individuals having a condition or disease within a population within a given point in time is known as prevalence (example tuberculosis prevalence). It explains the severity of a problem through measurement of theoverall extent and this helps in planning for health services. This can include acute illness or chronic illness such as tuberculosis. Mortality is the condition of being dead. Tuberculosis described in terms of morbidity and mortality according to world health organization (WHO) in 2017, ten million people fell ill with tuberculosis and of those 1.6 million died from the disease. The morbidity was 10 million, and mortality from the disease was 1.6 million (World Health Organization, 2015) Health determinants are factors that have an effect on the outcome of health status and they include, personal, social, environmental and economic factors. Another query emphasized is how a society where everyone has a chance to live a long life that is healthy can be created. Health explores these questions by the development of objectives that address individual behavior, the relationship between health status and biology, health services, social factors, and policies. They put emphasizes on an ecological approach to health promotion and disease prevention with the ecological approach focusing on population-level determinants of health and
TUBERCULOSIS2 interventions and at the individual level. The determinants fall under several broad categories, which include social factors, policymaking, health services, biology and genetics, and individual behavior. The relationship between these factors determines population health and individual health. Solutions that target several health determinants are the most effective in many cases. Social determinants of health also known as social and physical determinants of health reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Poverty is major cause of tuberculosis. Working environments that are poorly ventilated and crowded are commonly associated with poverty and key factors in the spread of tuberculosis. Inadequate general health knowledge and empowerment to act on health knowledge are associated with poverty and expose people to many tuberculosis risk factors, such as human immune deficiency virus, abuse of alcohol and smoking. Diminishing poverty minimizes the risk of infection to disease progression in tuberculosis and improves access to health services. Economic, public health and social policies that are needed involve those improving both working and living conditions, pursue expanding social protection and overarching poverty reduction strategies, and promote lifestyles and healthy diets, including reducing harmful alcohol use that is harmful, smoking and other drugs (Woolf et al. 2013). Under the epidemiological triad that is used in the studying of problems in health has three factors that include the disease causing agent, the disease harboring organism and factors that facilitate the disease being transmitted including environmental or external factors. The agent that is involved in the transmission of tuberculosis is the bacteria Mycobacterium tuberculosis. Man is the reservoir for the disease and the environment for disease transmission is a poorly ventilated environment.
TUBERCULOSIS2 The role of public health nursing as related to tuberculosis is to apply key knowledge and critical skills related to public health and nursing sciences including; nursing knowledge of the clinical aspects of tuberculosis infection, disease, and management. Health status inequities and determinants of health population are more likely impacted by tuberculosis. A public health nurse is supposed to assess and analyze information regarding the health and functional status of populations, communities, groups, and individuals that are more likely impacted by tuberculosis infection and disease. This is achieved by collecting, storing and using accurate, appropriate information in available surveillance databases such as tuberculosis registry. They are involved in determining the risk of transmission and period of infectivity of patients diagnosed with active tuberculosis disease. They conduct tuberculosis contact investigations for people identified with infectious tuberculosis disease. The goal is to promptly identify contacts that may have active tuberculosis disease or latent tuberculosis infection (Kaplan, Spittel and David 2015). Public health nurses facilitate diagnostic testing such as tuberculin skin testing, sputum for acid-fast bacilli and chest x-rays. Depending on the outcome of testing, they are facilitating referrals to specialized health care providers for tuberculosis follow-up assessment and care. Other public health nursing roles regarding tuberculosis include planning, implementation, and evaluation of the tuberculosis teams' strategic plan service delivery standards and guidelines. They implement care while taking into account relevant evidence, policies, procedures, regulations, and legislation such as public health act.
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TUBERCULOSIS2 References. Merrill, R. M. (2013).Introduction to epidemiology. Burlington, Mass: Jones & Bartlett Learning Day, R. A., Brunner, L. S., & Day, R. A. (2010).Brunner &Suddarth's Textbook of Canadian medical-surgical nursing. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Gilligan, P. H., Smiley, M. L., & Shapiro, D. S. (2014).Cases in medical microbiology and infectious diseases Global Tuberculosis Programme,,& World Health Organization,. (2015).Guidelines on the management of latent tuberculosis infection. World Health Organization,. (2015).Global tuberculosis report 2015. Geneva, Switzerland: World Health Organization. Woolf, S. H., Aron, L. Y., National Academies (U.S.).,& Institute of Medicine (U.S.). (2013).U.S. health in international perspective: Shorter lives, poorer health. Washington, D.C: The National Academies Press. Kaplan, R. M., Spittel, M. L., David, D. H., &OverDrive, Inc. (2015).Population Health. Place of publication not identified: U.S. Dept. of Health and Human Services