Tuberculosis: Causes, Symptoms, Diagnosis, Treatment and Prevention

This term paper discusses the causes, symptoms, diagnosis, treatment and prevention of tuberculosis. It covers risk factors, etiology, anatomy, pathophysiology and clinical manifestation of the disease. The paper also includes an annotated bibliography of relevant research articles.

Running Head: TUBERCULOSIS
Tuberculosis
Student’s Name
University Affiliation
Date

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Table of Contents
Outline of the term paper..............................................................................................................2
Annotated Bibliography................................................................................................................3
Introduction....................................................................................................................................8
Transmission of Tuberculosis.......................................................................................................9
Risk Factors of tuberculosis..........................................................................................................9
Etiology, Anatomy, Pathophysiology and clinical manifestation............................................10
Diagnosis, treatment and prevention of the disease.................................................................11
Self-Management and Tuberculosis...........................................................................................12
Prognosis and Quality of Life of patients, family and community..........................................12
Conclusion....................................................................................................................................13
References.....................................................................................................................................13

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Topic: Tuberculosis
Outline of the term paper
i. Annotated Bibliography
ii. Introduction of tuberculosis
iii. Transmission of Tuberculosis
iv. Risk factors
v. Etiology, Pathophysiology and clinical manifestation
vi. Diagnosis, Treatment and prevention of tuberculosis
vii. Self-management and Tuberculosis
viii. Prognosis and Quality of Life
ix. Conclusion

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Annotated Bibliography
Makanjuola, T., Taddese, H. B., & Booth, A. (2014). Factors Associated with Adherence to
Treatment with Isoniazid for the Prevention of Tuberculosis amongst People Living with
HIV/AIDS: A Systematic Review of Qualitative Data. PLoS ONE, 9(2), 1–13. Retrieved
from https://doi.org/10.1371/journal.pone.0087166
Summary of the article; the aim of the article is to systematically recognize from qualitative data
found in the documented literature the major barriers to compliance of isoniazid preventing
therapy for the TB in individuals having HIV/AIDS. The method of data collection is through
searching of 10 sources of data entailing EMBASE and MEDLINE for papers published and
documented in journals which have been peer-reviewed from the start via to December, 2011 for
empirical statistics relevant to isoniazid preventive therapy relative to individuals living with
HIV/AIDS. The article concluded by suggesting that the comprehension of the intricate interplay
of various factors more succinctly is vital for decision makers in the healthcare sector to be able
to realize the level of compliance needed to effectively mitigate the health threats from co-
infection with HIV/AIDS and TB in developing nations.
Relevance and significance of the article to my term paper; the paper analyzed the treatment of
TB using isoniazid preventive therapy for individuals living with HIV/AIDS. This is vital for my
term as I will be discussing treatment and preventive measures for TB.
Mukherjee, A., Kaeley, N., Dhar, M., Kumar, S., & Bhushan, B. (2019). Prevalence,
characteristics, and predictors of tuberculosis associated anemia. Journal of Family
Medicine & Primary Care, 8(7), 2445–2449. Retrieved from
https://doi.org/10.4103/jfmpc.jfmpc_311_19

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Summary of the article; the aim of the paper was to find the characteristics and prevalence of
anemia in the pulmonary tuberculosis. Moreover, the secondary aim of the paper is to evaluate
anemia predictors in new incidences of pulmonary tuberculosis. The article discuses tuberculosis
as a communicable disease which is caused by mycobacterium tuberculosis. The article states
that tuberculosis is considered as one of the dangerous diseases as well as a major global burden
on various healthcare systems especially in India. India which is the second populous nation in
the world has been stated as having very high international yearly incidences of tuberculosis. The
article states that numerous hematological changes are usually seen in individuals having
tuberculosis like folate deficiency, iron deficiency anemia, as well as sideroblastic anemia. The
article used retrospective study methodology which was undertaken in a tertiary healthcare
institution of Uttarakhand and entailed all the new incidences of tuberculosis aged at
approximately more than eighteen years attending inpatient and outpatient departments over 1
year period.
Relevance and significance to my study; the article is important to my study since it is discussing
the hematological changes in individuals suffering from tuberculosis such as folate deficiency,
and iron deficiency anemia. This is significant to my study as I will discuss the health impacts of
individuals living with tuberculosis.
Smiljić, S., Stanisavljević, D., Radović, B., Mijović, M., Savić, S., Ristić, S., & Mandić, P.
(2018). The sociodemographic characteristics and risk factors for tuberculosis morbidity
between two decades at the beginning of the 21st century at the north of Kosovo,
Serbia. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of
Serbia, 75(5), 461–467. Retrieved from https://doi.org/10.2298/VSP160323335S

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Summary of the article; the aim of the article is show social and demographic influences and
determinants, risk factors for the clinical features and morbidity of tuberculosis among the
people of northern Kosovo, Serbia between twenty years at the dawn of the 21st century. The
articles states that tuberculosis is one of the major causes of morbidity and death rates globally,
impacting on various nations disproportionately. Appropriate treatment and diagnosis of
tuberculosis saved an approximated 45 million people at the period between 2001 and 2014. The
article used a prospective study which was undertaken at the Pulmonology of the clinical-health
center in Kosovska Mitrovica and entailed people treated during 2-3 year periods between 2012-
2014 and 2000-2002. 135 patients having TB were treated, 92 were diagnosed and treated in the
initial period and 43 were diagnosed and treated in the second phase. The result indicated that
male patients were prone to tuberculosis than their female counterparts. Older age as well as
comorbidities were found to be the most vital risk factors of TB inpatients and thus, such target
group should be given utmost attention during active approach in screening of the disease.
Relevance and significance of the article to my term paper; since I will be critically analyzing the
risk factors of tuberculosis in the society, this paper is relevant and significant to my study since
its aims is to show the social and demographic determinants, risk factors for the clinical
attributes and morbidity of tuberculosis among the people living in northern Kosovo, Serbia
between twenty years at the dawn of the 21st century.
Thee, S., Krüger, R., von Bernuth, H., Meisel, C., Kölsch, U., Kirchberger, V., & Feiterna-
Sperling, C. (2019). Screening and treatment for tuberculosis in a cohort of
unaccompanied minor refugees in Berlin, Germany. PLoS ONE, 14(5), 1–9. Retrieved
from https://doi.org/10.1371/journal.pone.0216234

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Summary of the article; the aim of the paper was evaluate and assess the application of an
interferon-y-release-assay in the first screening and examining of tuberculosis of 971
unaccompanied minor refugees. The paper states that in 2015, about 4063 minor refugees who
are were unaccompanied were registered in Germany particularly in Berlin. The paper concluded
by suggesting that minor refugees entering Germany should be screened for infection of TB
rather than TB disease only.
Relevance and significance to my study; the paper is relevant and significant to my paper as it
establishes the screening as well as treatment for TB which I will also discuss in my term paper.
Vayr, F., Martin-Blondel, G., Savall, F., Soulat, J.-M., Deffontaines, G., & Herin, F. (2018).
Occupational exposure to human Mycobacterium bovis infection: A systematic
review. PLoS Neglected Tropical Diseases, 12(1), 1–14. Retrieved from
https://doi.org/10.1371/journal.pntd.0006208
Summary of the article; the aim of the article was to highlight and pinpoint the occupation or
work setting exposure to bovine tuberculosis because of the mycobacterium bovis. The article
states that Mycobacterium bovis is considered as the major causative agent of bovine zoonotic
tuberculosis. The methodology of the research in the article was secondary data collection in
which a computer based search of literature was done to identify papers documented between
2006 and 2017. The article used science direct, PubMed and Cochrane databases for the
systematic review. The paper entailed articles having or focusing Mycobacterium bovis, and
work setting exposure to bovine tuberculosis. Articles that were reviewed by the paper came
from different continents and nations having distinct socioeconomic conditions, thus, widening
the comprehension of the authors. The paper extrapolated the findings from nations having
higher disease prevalence.

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Relevance and Significance of the article to my term paper; since I will be analyzing the causes
of tuberculosis in different environments and settings especially in the crowded areas, the paper
is vital and significant to my term paper as it points out that there is high level of contracting the
diseases in crowded work environments and settings. The paper is also vital as it reviews articles
from various countries and continent, giving the research great, accurate, diverse and credible
information concerning tuberculosis.

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Introduction
Globally tuberculosis is caused by Mycobacterium africanum and Mycobacterium bovis,
as well as Mycobacterium tuberculosis. This can be explained by the closer relationship between
livestock and people; it should be noted that livestock is also a host for the organism. The
bacteria is transmitted to susceptible human beings from livestock though livestock products like
milk (Mukherjee, Kaeley, Dhar, Kumar, & Bhushan, 2019). The disease usually affects the
respiratory tract and the lungs. Mycobacterium tuberculosis is transmitted from an individual
when someone having the active form of TB emits small, droplets containing bacteria into the air
via laughing, coughing, singing, talking and sneezing. It should be noted that the bacteria can
remain suspended in the atmosphere for many hours; thus, having the potential to infect anyone
who breathes them in.
Transmission of Tuberculosis
M. tuberculosis is spread by minute airborne droplets known as nuclei which are
generated by singing, talking, sneezing, or coughing by an individual having laryngeal or
pulmonary TB. The minute droplets usually can remain airborne for numerous minutes after
expectoration. Moreover, transmission of the M. tuberculosis is influenced and determined by a
host of factors like exposure of the bacilli to the ultraviolet light, the number of the M. bovis in
the droplets, degree of ventilation, bacilli virulence as well as situations of aerosolization of the
bacilli. It should be noted that the introduction of bacilli into the human lungs results in the
respiratory system infection, nevertheless, the M. tuberculosis may spread to other organs like
bones/joints, meninges, pleura, lymphatics, as well as lead to extrapulmonary tuberculosis.

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Risk Factors of tuberculosis
Numerous medical conditions are risk factors for poor tuberculosis treatment results and
for tuberculosis. It is thus, vital to identify the comorbidities in individuals diagnosed with
tuberculosis to make sure early diagnosis as well as enhance co-management. People who are
living with HIV/AIDS are 27-32 times likely to suffer from tuberculosis relative to people
without HIV/AIDS. It should be noted that tuberculosis is one of the major common presenting
illness in individuals living with HIV/AIDS, entailing among those taking ARVs treatment as
well as major cause of deaths linked to HIV/AIDS. People who are having diabetes are three
times more likely to be diagnosed with tuberculosis. It should also be noted that the rates of
tuberculosis are greater in individuals having diabetes that the general population while diabetes
has been stated as a common comorbidity in individuals having tuberculosis. Moreover, it has
been established that malnutrition increases the chances of people having TB while TB can be a
cause of malnutrition. Crowded places, and smoking are also risk factors for TB (Smiljić et al.,
2018).
Etiology, Anatomy, Pathophysiology and clinical manifestation
Once the M. tuberculosis is inhaled, the infectious bacteria settle throughout the
atmosphere. Numerous bacilli are normally trapped in the upper chambers of the airways in
which goblet cells secreting mucus exist. M. tuberculosis organisms are always enclosed but are
hard to wholly eliminate. Individuals having latent tuberculosis usually have no symptoms or
signs of the disease, are not infectious, and do not feel ill. Primary tuberculosis is normally
asymptomatic. Active tuberculosis grows in six and eleven percent of individuals exposed to the
bacteria (Vayr et al., 2018). Symptoms always include progressive malaise, loss of weight,
fatigue, as well as fever along with night sweats and chills. Extensive tuberculosis leads to

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orthopnea or dyspnea since the enhanced interstitial volume results in a reduced capacity of lung
diffusion. It is also associated with extensive coughing having purulent sputum. Wasting and loss
of appetite are also major signs of the disease.
Once inhaled, the communicable droplets settle throughout the respiratory tract.
Numerous bacilli are usually trapped mostly in the upper section of the respiratory tract in which
the goblet cells which secret mucus are found. The mucus which are produced
Diagnosis, treatment and prevention of the disease
For over 100 years, TB has been diagnosed basically by acid-fast bacilli detection in
postmortem assessment as well as the utilization of the intradermal tuberculin diagnosis in live
animals. Several diagnostic tests have been mooted, examined, as well as rejected during the past
100 years, therefore, numerous control efforts are usually dependent on the original tests of
diagnosis. The availability of an effective test for screening is a vital feature for a successful
control and eradication of the disease program like the Bovine TB eradication program.
Conceptually a screening test has to be easy to undertake, comparatively inexpensive, as well as
easily interpretable as negative or positive. Doctors usually check for lymph nodes whether they
are swollen during physical examination and use a stethoscope to understand the lung sounds
while the patient is breathing. Skin test is the commonly used diagnostic tool for the disease even
though blood tests are currently being adopted (Thee et al., 2019). PPD tuberculin is normally
injected into the skin and after 48-72 hours the doctor checks the arm for swelling majorly at the
site of injection. It should be noted that the lump size determines whether the results are vital.
Other tests imaging sputum and blood tests. The standard test for TB detection is the intradermal
tuberculin test which has been applied by the doctors for almost 100 years to detect
Mycobacterium bovis infection. Active TB can be considered as possible diagnosis when the

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results on a chest radiograph of an individual which is being examined for clinical manifestations
are abnormal as it happens in many people with TB. The radiographs can display characteristic
results of infiltrates having cavitation in the middle and upper lobes of the lungs. The most
common TB drugs include Pyrazinamide, Ethambutol, Isoniazid and Rifampin (Makanjuola,
Taddese & Booth, 2014). If the patient is drug-resistant, then a combination of injectable
medications like Capastat and antibiotics like fluoroquinolones are normally used for between 20
and 30 months. Prevention include stopping smoking, eating balanced diet, avoiding crowded
places and regularly seeking for medical screening. The cost for treatment and screening for 3HP
is usually about $48, 997 per QALY relative to 4R which is $25, 207 and 9HP which is $50000
per QALY.
Self-Management and Tuberculosis
Patient self-management enhances wellbeing and health. Tuberculosis is curable and
preventable but its treatment cannot be effective without having individual’s self-management.
Self-management reduces abandonment of treatment, prevents admissions in hospitals, as well as
raises sense and confidence of control. It entails managing regimens of medication, monitoring
indicators in the laboratory, having balanced diet, coping to social and psychological demands,
as well as behavioral regulation.
Prognosis and Quality of Life of patients, family and community
Quality of life is described as the person’s perception of his or her mental and physical
wellbeing/health in his or her day-to-day life that cover economic, social, spiritual, psychological
and physical functioning. It usually mirrors the disease impact as well as linked morbidities on
daily functioning and activities. TB can result in anxiety and depression among the patients and
families leading to worsening of the condition in the patients. The deterioration of health of

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individuals brought by anxiety and depression can further lead to disappointments, frustration
and fear. TB is also associated with stigma among the patients and the family. Therefore, it is
very vital to comprehend the social milieu whereby individuals look for medical services as well
as the adverse effects stigma can have not only on patients but the entire community.
Conclusion
Tuberculosis is one of the deadliest diseases in the globe having various risk factors some
of which can be avoided and eliminated through individual behavioral change and lifestyle
changes. It is vital for individuals to seek medical advice anytime they have the mentioned
clinical signs and symptoms. It is also vital that patients take their drugs under the guidance of
medical doctor.

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References
Makanjuola, T., Taddese, H. B., & Booth, A. (2014). Factors Associated with Adherence to
Treatment with Isoniazid for the Prevention of Tuberculosis amongst People Living with
HIV/AIDS: A Systematic Review of Qualitative Data. PLoS ONE, 9(2), 1–13. Retrieved
from https://doi.org/10.1371/journal.pone.0087166
Mukherjee, A., Kaeley, N., Dhar, M., Kumar, S., & Bhushan, B. (2019). Prevalence,
characteristics, and predictors of tuberculosis associated anemia. Journal of Family
Medicine & Primary Care, 8(7), 2445–2449. Retrieved from
https://doi.org/10.4103/jfmpc.jfmpc_311_19
Smiljić, S., Stanisavljević, D., Radović, B., Mijović, M., Savić, S., Ristić, S., & Mandić, P.
(2018). The sociodemographic characteristics and risk factors for tuberculosis morbidity
between two decades at the beginning of the 21st century at the north of Kosovo,
Serbia. Vojnosanitetski Pregled: Military Medical & Pharmaceutical Journal of
Serbia, 75(5), 461–467. Retrieved from https://doi.org/10.2298/VSP160323335S
Thee, S., Krüger, R., von Bernuth, H., Meisel, C., Kölsch, U., Kirchberger, V., & Feiterna-
Sperling, C. (2019). Screening and treatment for tuberculosis in a cohort of
unaccompanied minor refugees in Berlin, Germany. PLoS ONE, 14(5), 1–9. Retrieved
from https://doi.org/10.1371/journal.pone.0216234
Vayr, F., Martin-Blondel, G., Savall, F., Soulat, J.-M., Deffontaines, G., & Herin, F. (2018).
Occupational exposure to human Mycobacterium bovis infection: A systematic
review. PLoS Neglected Tropical Diseases, 12(1), 1–14. Retrieved from
https://doi.org/10.1371/journal.pntd.0006208

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