Despite being known for rather a long time and thoroughly researched, tuberculosis (TB) remains a considerable danger for a number of people, especially socially vulnerable and unprotected. Unlike many diseases continually present in the history of humanity, TB cannot be viewed as vanquished or easily treated – the eradication of the illness is still a distant objective, partially due to its antimicrobial resistance. Much research and financial support is dedicated to TB, namely in developing countries where its cases seem to be more widespread, and thus the infection is more easily contracted. Some of TB’s characteristics and social determinants render the disease especially grave; without proper treatment, a significant number of cases result in death. Consequently, this paper aims to investigate TB’s core properties, as it still presents a substantial danger for human health with several issues not fully resolved by contemporary researchers, for instance, antimicrobial resistance.
General Characteristics and Treatment
Tuberculosis may be described as a chronic infection caused by the bacteria mycobacterium tuberculosis complex. Respiratory organs are most often affected by TB; in addition, cases of tuberculosis of bones and joints, genitourinary organs, eyes, and peripheral lymph nodes also occur, but less commonly (Raviglione, 2016). Pulmonary tuberculosis is frequently followed by an initially dry cough that worsens at night, and in the morning, this constant cough continues for days, and with the progression of TB, hemoptysis may appear (Raviglione, 2016). The nature of the illness can be chronic, it usually begins gradually (for a long time, it may be asymptomatic). Over time, symptoms of general intoxication appear – hyperthermia, tachycardia, weakness, decreased energy, loss of appetite and weight, and sweating (Raviglione, 2016). Intoxication syndrome may also intensify as TB progresses; major weight loss, changes in the face, and unhealthy blush are additional complications (Raviglione, 2016). Body temperature does not rise above subfebrile levels, but lasts a long time; fever occurs only in the event of a massive lesion (Raviglione, 2016). In this way, due to its many clinical forms, tuberculosis can manifest itself in a wide variety of symptoms.
The primary cause of TB is its bacteria, which appears in the air when a person with the pulmonary type of the disease coughs, sneezes, or talks. The disease has comparatively high mortality and morbidity rates and may lead to severe complications. Pulmonary tuberculosis can be aggravated by a pulmonary hemorrhage, which is a life-threatening condition. According to MacNeil et al. (2017), “worldwide, tuberculosis (TB) is the leading cause of death from a single infectious disease agent” (p. 266). Additionally, the disease is most often transmitted by airborne droplets, less frequently through direct contact. Infected people constitute the disease’s reservoir – a TB patient with a severe cough may infect a large number of individuals (Raviglione, 2016). Apropos of TB incidence in the USA: in 2008, the number of the disease’s cases reported was around nine thousand (MacNeil et al., 2017). Tuberculosis is a reportable disease: TB Control Section has to be informed within one working day of identification of a TB case (Raviglione, 2016). Hence, the disease has the necessary characteristics to occupy its place as one of the most infectious and mortal globally.
Diagnosis of tuberculosis is performed with a tuberculin test, an X-ray examination of the lungs, and an additional instrumental examination of organs affected by tuberculosis. Tuberculosis treatment is aimed at healing the foci of the disease in a patient’s lungs and eliminating symptoms (Raviglione, 2016). The process takes a substantial amount of time and combines methods of pharmaceutical therapy and physiotherapy. Initially, treatment is carried out in a specially designed facility until patients are discharged to continue outpatient treatment (Raviglione, 2016). Regular stays in sanatoriums created to accommodate persons going through TB rehabilitation may also be advisable (Raviglione, 2016). Bed rest is prescribed only to patients with a high degree of lung destruction and severe hemoptysis; in other cases, they benefit from walking, physiotherapy exercises, and various physical activities (Raviglione, 2016). Individuals suffering from tuberculosis are in need of a high‑calorie diet rich in easily assimilated protein, vitamins C and group B. Surgical treatment is indicated in cases where conservative therapy is not sufficient to achieve the desired results (Raviglione, 2016). Hence, tuberculosis treatment is a complex procedure as it includes long‑term systemic surveillance, antibiotic therapy, and, in some cases, surgery.
Social Determinants of TB
Social determinants play a crucial role in the spread and contamination of TB. Socioeconomic status influences the exposure to TB, augments the risk behaviors associated with it, and, generally, hinders access to health care services. Poverty presupposes worse living and work conditions, which facilitate the transmission of the disease. Dangerous behaviors associated with lower socioeconomic statuses, such as smoking and drug abuse, increase the chance of a TB-related death as well as cause more frequent cavitation, bilateral x-ray findings, and a larger bacillary load (Duarte et al., 2018). Alcohol abuse is another poverty-related factor contributing to the increased TB mortality and morbidity. Duarte et al. (2018) state that “17% of TB cases and 15% of deaths due to TB could have been prevented if there had not been heavy alcohol consumption” (p. 118). Homelessness is an additional contributing element, as it is strongly connected with unsanitary living conditions and the outlined risk behaviors – income level is a powerful social determinant, and TB’s peculiarities magnify its significance further.
The disease itself propels inequality, lowering productivity, and socioeconomic status of a patient. TB is recognized as a stigmatizing disease that detrimentally affects the social perception of an individual affected by it (Duarte et al., 2018). Furthermore, lesser income is associated with lower education levels and more deficient health education generally – these factors result in individuals not recognizing TB risks and not knowing the prevention methods, making it easier for the disease to disperse. Lack of education prevents a number of individuals from identifying risks of the disease, as health knowledge and the desire to act on it is the product of a specific type of environment.
The Epidemiologic Triangle in Relation to Tuberculosis
Host factors can influence the clinical manifestations of infections. In the case of TB, such factors as hosts’ age, collateral illnesses, the state of their immune system, and immunization play a role in the progression of the disease (Yang & Kong, 2015). It is argued that host genes are also involved in the spread of TB. According to Yang and Kong (2015) “after M. tuberculosis infection, bacterial replication and dissemination are first controlled by the host innate immune response, and then by a T cell-mediated adaptive immune response” (p. 256). Socioeconomic status, sex, ethnicity, age, and many others are able to enhance or decrease the chances of a person’s vulnerability to infections.
As an agent in the case of an epidemiologic triad refers to a microorganism that spreads an infection; for TB, it is Mycobacterium tuberculosis, and it should be present for the disease to occur. Nevertheless, for some diseases, an agent’s presence is not always imperative (Raviglione, 2016). Such a factor as life duration determines, to an extent, the period for which an agent remains infectious (Raviglione, 2016). TB causative agent is able to stay alive and contagious for several weeks if not exposed to sunlight; otherwise, it dies under its direct influence. Mycobacterium tuberculosis, comparatively to other bacteria, grows slowly, which correlates with its longevity (Raviglione, 2016). As an aerobic bacterium, Mycobacterium tuberculosis needs oxygen to survive, which is part of the reason why pulmonary type of TB is the most common (Raviglione, 2016). These factors determine the character of TB as a chronic disease. Consequently, the causative agent’s factors such as conditions that are needed to sustain its vitality may determine, for instance, a place of an infection’s localization.
Environmental factors are capable of affecting the course and gravity of the disease, since certain temperatures, humidity levels, infection transmitting insects, pollution, et cetera combine to form beneficial or hostile conditions. Seasonality seems to be somewhat a critical factor for TB, as findings suggest that the most significant amount of its cases concur with specific year periods (Raviglione, 2016). Nonetheless, purely environmental factors may not be the primary determinants – socioeconomic factors play, comparatively, a more significant role in the TB propagation.
In courtiers or regions where TB incidence is high mandatory notifications are an essential part of community protection. According to Uplekar et al. (2016), “TB is notifiable in 11 out of 15 high-incidence countries, all 16 intermediate-incidence countries, and all nine low-incidence countries contacted” (p. 1571). Notification facilitation by assigning this responsibility to organizations in the private sector is also practiced in several courtiers, where TB rates are high (Uplekar et al., 2016). This procedure helps to accelerate and make more effective the eradication of TB on a defined territory.
The Role of a Community Nurse in TB Prevention and Management
TB control aims to maximize the efficiency of data gathering methods in order to localize and restrain the disease’s spread – the process in which a significant function is allocated to community nurses. These medical professionals are in charge of several procedures that aim at TB prevention and management; for instance, they may refer patients with suspicion of the infection for further assessment. This role contributes to case findings and information collection that facilitate the prevention of the infection’s outbreak. As a communicable disease, TB necessitates reporting and control measures, and a community nurse, in this case, takes responsibility for the adherence to the established policies.
Demographic data performs a prognostic function for health care services. It can help plan which ones would be more in demand and what sectors need revision or complementary financial support. For instance, data about a population’s weight and age may be used to predict the rates of cardiovascular diseases and plan health care supplies for a particular community accordingly. In the case of TB, demographic data, potentially, serve to determine likely incidence and disease localization based on socioeconomic factors. Therefore, statistical information about a specific population prepares its health care facilities for current and future challenges.
National Tuberculosis Controllers Association
National Tuberculosis Controllers Association is a non-profit organization founded, approximately, in the second half of the nineties as a reaction to the worsening of the TB situation in the country. Its mission is to accelerate the eradication of the disease on the territory of the United States through collective efforts. The organization holds annual conferences that engage researchers and medical professionals in the field to present the latest advances and discuss topical issues regarding TB. Antimicrobial resistance is one of the most acute problems in the disease’s treatment, and the National Tuberculosis Controllers Association directs significant efforts to enhance medication. Despite numerous activities in the USA, the organization also provides technical and professional support in an array of high incidence countries. National Tuberculosis Controllers Association strives to eliminate TB propagation both on a global level and on the country’s level and distributes its efforts respectively.
Global Situation of TB
TB can be a fatal disease unless it is treated adequately, and it is one of the most common causes of death globally. The mortality of drug-resistant forms of TB is even higher, as medical services cannot ensure recovery. Although there is no age-disaggregated TB mortality statistic, children are a vulnerable category, and in 2015 only, approximately one million cases worldwide among the youngest were registered (Dodd et al., 2017). Furthermore, Dodd et al. (2017) state that “tuberculosis is one of the top ten causes of death in children and a key missing component in previous analyses of under-5 mortality” (p. 906). The number of death could be reduced if children with suspicion of TB were identified and diagnosed more frequently. On a global scale, the infectious disease takes away many lives even among younger generations – TB, as many other illnesses, seems to affect the most vulnerable, targeting individuals with low socioeconomic status and minors.
In Kenya, TB is one of the principal issues in the healthcare sector as the disease there is endemic. That is why Kenya has one of the oldest TB control systems and systematically dedicates resources and effort to manage and stop its propagation. According to Abdullahi et al. (2019), in the country, every health care institution is prepared to provide TB treatment: sputum from potential patients is forwarded to the closest laboratory for Xpert MTB/RIF test, results of which are supposed to return in two days. Kenya has substantial amalgamated expertise with TB, which assisted in managing outbreaks of other diseases, HIV, for instance (Abdullahi et al., 2019). Overall, developing regions seem to be affected by TB more drastically and constitute a larger part of the TB high incidence countries list. This situation additionally underlines the imbalance and disparity in the current state of the world.
Conclusions
TB is an infectious disease with a long history, which, due to its bacterial qualities, is rather vital and survives the eradication efforts. Nowadays, several issues related to TB are not resolved, despite constant attention from medical researchers and professionals. Antimicrobial resistance is one of the complex aspects that reduce a patient’s chances to survive, as it renders the disease in some cases hardly curable. In the United States and all over the globe, TB’s danger is still persistent. Its control necessitates the involvement of a community as a whole, and considerable attention from medical staff on all levels, beginning with community nurses.
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