Essay on Tuberculosis

Tuberculosis is an acute health problem, particularly in the developing countries of Latin America, Africa, and Asia. Tuberculosis has existed for many centuries. Specifically from 2000 B.C. tubercles have been found in mummified bodies. Reference to this disease has been found in written scriptures of Babylonia, Egypt, and China (Haas, 2000, p. 88). Most new cases of clinical tuberculosis arise in individuals who have been previously infected. The eradication of tuberculosis and its prevention depend upon the detection and prophylactic treatment of infected individuals so that clinical disease does not occur, and effective treatment of those with symptomatic clinical disease so that transmission of tuberculosis to others is prevented.

Help with Essay on Tuberculosis
Help with essay on Tuberculosis

The resurgence in tuberculosis between 1985 and 1993 was mainly the result of its occurrence in persons infected with human immuno-deficiency virus (HIV) and with acquired immune deficiency syndrome (AIDS) (Haas, 2000, p. 81). In addition to individuals infected with HIV, there are other groups with a higher incidence of tuberculosis, including those having close contacts with infectious individuals. Others with higher incidence include intravenous drug users and alcoholics and those in long-term care facilities, such as prisons and nursing homes, and people with medical conditions such as silicosis, diabetes, end-stage renal disease, hematologic disease, and immunosuppressive therapy (Brudney and Dobkin, 1992, p. 748).

TB spreads when a person infected with the active form of the disease coughs droplets carrying the TB organism into the air, which are then inhaled by other people. The disease is not spread through a single exposure to infected droplets, but from extended contact with an infected person (Dolin, Ravaglione, Kochi, 1994, p. 215). Once inhaled, the TB organism usually remains in the lung. The disease may also be acquired by drinking unpasteurized animal milk (Brudney and Dobkin, 1992, p. 749).

In the vast majority of cases the infection is localized and symptomless. Most individuals who are infected with the TB organism do not develop active disease because their immune systems encapsulate and sequester the organism in the lungs, forming what is known as a granuloma (Ellner, Hinman, Dooley, Fischl, Sepkowitz, Goldberger, 1993, p. 538). In this state, the organism can remain latent for years, however it may become active and progress to chronic pulmonary tuberculosis if left untreated. The test for TB infection involves injecting the skin with purified protein derivative (PPD) of the TB organism (Ellner et al, 1993, p. 548). Swelling at the site of injection indicates the presence of infection.

Typical symptoms of active TB infection include fatigue, loss of weight and appetite, night sweats and fever, and persistent cough (Kochi, 1991, p. 3). Sputum is often streaked with blood and massive hemorrhage can occur (Kochi, 1991, p. 5). Untreated, the disease leads to gradual deterioration and weight loss and sometimes death. TB may sometimes spread from the lungs via the bloodstream to any organ in the body such as the brain, lymph nodes, bones, joints, kidneys, skin, and genital organs. Miliary TB, a rapidly progressive multiorgan form of the infection, is rare in the United States (Ellner et al, 1993, p. 543). Why some individuals develop active TB and while others do not is not entirely understood. Underlying chronic diseases such as malnutrition, AIDS, cancer, and diabetes make development of active diseases more likely (Ravaglione, Snider, Kochi, 1995, p. 223).

Pulmonary tuberculosis is one of the major cases of blood in sputum; however, it is uncommon (Ravaglione et al, 1995, p. 224). Other chest complaints, such as shortness of breath or pain, are unusual. On examination, listening to the lungs may disclose rales or crackles and signs of pleural effusion (the escape of fluid into the lungs).

Many preventive methods are used in order to control the epidemic outbreak of TB. Proper ventilation lesson the chance of infection as the bacteria is dispersed round the atmosphere (Kochi, 1991, p. 2). Ultraviolet can also reduce the spread of the disease but it does not eliminate the disease. Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine, prepared from bacteria that have been weakened, are another preventive measure (Ravaglione et al, 1995, p. 221). The BCG vaccine is most effective in preventing childhood occurrences of TB as their immune systems are weak during this time (Toossi and Ellner, 1998, p. 80). For infected individuals antibiotic therapies have been a success around the world. Single-drug treatment often causes bacterial resistance to drugs. Therefore, all recommended therapies include multiple drugs given for at least 6 months, mostly for as long as 9 to 12 months (Toossi et al, 1998, p. 98). Adjustments to the treatments are made based on susceptibility of the bacterial strain. A combination of antibiotics, including isoniazid, rifampin, streptomycin, pyrazinamide, and ethambutol, is usually prescribed (Toossi et al, 1998, p. 108).

If a doctor decides a person should have preventive therapy, the usual prescription is a daily dose of isoniazid (also called “INH”), an inexpensive TB medicine (Toossi et al, 1998, p. 118). The patient takes INH for six to nine months (up to a year for some patients), with periodic checkups to make sure the medicine is being taken as prescribed. If a person already has the TB disease, then treatment is needed.

The patient usually gets a combination of several drugs (most frequently INH plus two to three others). The patient will probably begin to feel better only a few weeks after starting to take the drugs. It is very important that the patient continue to take the medicine correctly for the full length of treatment. If the medicine is taken incorrectly or stopped the patient may become sick again and will be able to infect others with TB (Kochi, 1991, p. 5). As a result many public health authorities recommend Directly Observed Therapy (DOT), in which a health care worker insures that the patient takes his or her medicine (Kochi, 1991, p. 2).

Infectious diseases, in general, are on the rise. One of the explanations for the rise in infectious diseases is that global tourism and migration are on the rise and that spreads infectious disease into new populations (Ellner et al, 1993, p. 540). Some researchers state that over one million people cross an international border every day (Ellner et al, 1993, p. 543). That statistic makes it easy to see that the spread of disease can be related to global tourism. Also, scholars see a link between poverty and illness (Haas, 2000, p. 77). They state that illness causes poverty because when people become ill or disabled, their ability to earn a living declines and they fall to a lower social status. This can be an explanation of why tuberculosis effects minorities and lower social class. In 2000, minorities comprised only 28% of the U.S. population, but accounted for 79% of all TB cases (Haas, 2000, p. 121). The rate of TB per 100,000 is nineteen times greater in Asians/Pacific Islanders, almost eight times greater in non-Hispanic blacks, six times greater in Hispanics, and almost six times greater in American Indians/Alaskan Natives than for non-Hispanic whites (Haas, 2000, p. 83). The number of deaths classified as TB has decreased by 15 percent. In 2000, there were 776 deaths attributed to TB, a death rate of 0.3 per 100,000 people (Haas, 2000, p. 78).

Thus, the current tuberculosis epidemic reflect the increase in AIDS, homelessness, poverty, and substance abuse, persons lacking in health care and drug resistant strains of the disease (Haas, 2000, p. 93). With the increase in AIDS, homelessness, poverty, and substance abuse, the immune systems of Americans are weaker and people become more susceptible to disease, such as tuberculosis. Also, people without health insurance who have tuberculosis do not get the proper medical care and their body suffers even more because they are unable to provide care for themselves. Sometimes people are able to provide care for themselves, however, if the treatment can not be finished due to health insurance restrictions, then the bacteria is not killed and the tuberculosis remains in the person’s body. Therefore, medical centers should be committed to reaching those at highest risk for TB and identifying innovative strategies to improve testing and treatment among high-risk populations.

References

Brudney K, Dobkin J. (1992) Resurgent tuberculosis in New York City: Human immunodeficiency virus, homelessness and the decline of tuberculosis control programs. Am Rev Respir Dis 144: 745-749.

Dolin PJ, Ravaglione MC, Kochi A. (1994) Global tuberculosis incidence and mortality during 1990-2000. Bull World Health Org 172: 213-216.

Ellner JJ, Hinman Ar, Dooley SW, Fischl MA, Sepkowitz KA, Goldberger MJ. (1993) Tuberculosis–emerging problems and promise. J Infect Dis 168:537-551.

Haas DW. (2000) Mycobacterial diseases–Mycobacterium tuberculosis. In: Mandell GL, Douglas JE, Dolin R, eds. Principles and Practice of Infectious Diseases, Vol. 2. Philadelphia: Churchill Livingstone.

Kochi A. (1991) The global tuberculosis situation and the new control strategy of the World Health Organization. Tubercle 72:1-6.

Ravaglione MC, Snider DE, Kochi A. (1995) Global epidemiology of tuberculosis. Morbidity and mortality of a world wide epidemic. JAMA 273: 220-225.

Toossi Z, Ellner JJ. (1998) Tuberculosis and Leprosy. Philadelphia: WB Saunders.

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