1. Definition of Tubercullosis Tuberculosis, MTB, or TB (short for tubercle bacillus) is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. [1] Tuberculosis typically attacks the lungs, but can also affect other parts of the body. It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air.
[2] Most infections are asymptomatic and latent, but about one in ten latent infections eventually progresses to active disease which, if left untreated, kills more than 50% of those so infected. 2. Types of Tubercolosis Primary Tuberculosis Pneumonia This uncommon type of TB presents as pneumonia and is very infectious. Patients have a high fever and productive cough. It occurs most often in extremely young children and the elderly. It is also seen in patients with immune suppression, such as HIV-infected and AIDS patients, and in patients on long term corticosteroid therapy.
Tuberculosis Pleurisy This usually develops soon after initial infection. A granuloma located at the edge of the lung ruptures into the pleural space, the space between the lungs and the chest wall. Usually, a couple of tablespoons of fluid can be found in the pleural space. Once the bacteria invade the space, the amount of fluid increases dramatically and compresses the lung, causing shortness of breath (dyspnea) and sharp chest pain that worsens with a deep breath (pleurisy). A chest x-ray shows significant amounts of fluid. Mild- or low-grade fever commonly is present.
Tuberculosis pleurisy generally resolves without treatment; however, two-thirds of patients with tuberculosis pleurisy develop active pulmonary TB within 5 years. Cavitary TB Cavitary TB involves the upper lobes of the lung. The bacteria cause progressive lung destruction by forming cavities, or enlarged air spaces. This type of TB occurs in reactivation disease. The upper lobes of the lung are affected because they are highly oxygenated (an environment in which M. tuberculosis thrives). Cavitary TB can, rarely, occur soon after primary infection.
Symptoms include productive cough, night sweats, fever, weight loss, and weakness. There may be hemoptysis (coughing up blood). Patients with cavitary TB are highly contagious. Occasionally, disease spreads into the pleural space and causes TB empyema (pus in the pleural fluid). Miliary TB Miliary TB is disseminated TB. “Miliary” describes the appearance on chest x-ray of very small nodules throughout the lungs that look like millet seeds. Miliary TB can occur shortly after primary infection. The patient becomes acutely ill with high fever and is in danger of dying. The disease also may lead to chronic illness and slow decline.
Symptoms may include fever, night sweats, and weight loss. It can be difficult to diagnose because the initial chest x-ray may be normal. Patients who are immunosuppressed and children who have been exposed to the bacteria are at high risk for developing miliary TB. Laryngeal TB TB can infect the larynx, or the vocal chord area. It is extremely infectious. 4. BCG – the current vaccine for tuberculosis Bacille Calmette Guerin (BCG) is the current vaccine for tuberculosis. It was first used in 1921. BCG is the only vaccine available today for protection against tuberculosis.
It is most effective in protecting children from the disease. 5. TB Signs and Symptoms Patients with tuberculosis may present without symptoms or may present in an extremely debilitated state. Symptom-free TB may be detected during routine screening. Symptoms of tuberculosis may include malaise, weight loss, and night sweats. Most patients with TB have pulmonary disease; extrapulmonary disease usually is seen in immunocompromised patients. TB in patients infected with HIV may present atypically. These patients have a higher risk for developing multidrug-resistant TB (MDR-TB) and miliary TB.
Usually, a longer course of therapy is needed and, because of interactions with other medications, the regimen may require adjustment. TB symptoms include: cough that is worse in the morning (sometimes with hemoptysis, blood in the sputum), chest pain, breathlessness, night sweats, and signs of pneumonia. In advanced disease, there may be extreme weight loss. Examination with a stethoscope may reveal diminished breath sounds, bronchial breathing, tracheal deviation, and coarse crackles. Tuberculosis is difficult to diagnose because the signs and symptoms are similar to those caused by other diseases, such as the following:
* Lung cancer (carcinoma of the lung, frequently creates cavities in lung tissue) * Pneumonia (can proceed to cavitation and resemble TB on chest x-ray) * Allergic bronchopulmonary asperigollosis (marked by inflammatory granulomatous lesions in bronchi) * Sarcoidosis, allergic alveolitis, pneumoconiosis, silicosis (biopsy and allergy screening eliminate these from diagnosis; silicosis predisposes to tuberculosis) * Anorexia nervosa, diabetes mellitus, hyperthyroidism (chronic malaise, fatigue and cachexia [wasting]) * Mediastinial lymphadenopathy (may also be lymphoma).
7. Complications Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Examples include: * Bones. Spinal pain and joint destruction may result from TB that infects your bones. In many cases, the ribs are affected. * Brain. Tuberculosis in your brain can cause meningitis, a sometimes fatal swelling of the membranes that cover your brain and spinal cord. * Liver or kidneys. Your liver and kidneys help filter waste and impurities from your bloodstream.
These functions become impaired if the liver or kidneys are affected by tuberculosis. * Heart. Tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart’s ability to pump effectively. This condition, called cardiac tamponade, can be fatal. 8. Treating and Preventing Tuberculosis Antibiotics are used to treat TB, since it’s a bacterial infection. You may be hospitalized or told to avoid contact with other people until tests show that you’re not contagious.
For TB lung infections, 3 or 4 antibiotics are combined for the first 2 months of therapy. 2 of these are then taken for another 4 to 7 months, depending on the number and type of antibiotics used as well as the sensitivity pattern of the TB bacteria that were cultured from the individual. Some people may need to take antibiotics for up to 12 months. The antibiotics most commonly used include isoniazid, rifampin, pyrazinamide, and ethambutol. Most people will take medications every day for the first 2 months, then a few times a week for the remaining treatment.
It’s important to take your medication as instructed by your doctor, and for the full course of the treatment. This helps to ward off types of TB bacteria that are antibiotic-resistant, which take longer and are more difficult to treat. If a particular type of TB infection is resistant to regular antibiotic treatment (a condition known as multidrug resistant TB or MDRTB), a combination of different medications must be taken for 18 to 24 months. Once symptoms clear up, a doctor may re-test your sputum to see if the TB bacteria are still present.
If you have a TB infection in other parts of your body (e. g. , bones or joints), you may require treatment for more than one year. If you are taking isoniazid, you doctor may suggest that you take 50 mg of pyridoxine (vitamin B6) daily to prevent a side effect called peripheral neuropathy. To prevent spreading TB, it’s important to get treatment quickly and to follow it through to completion. This can stop transmission of the bacteria and the appearance of antibiotic-resistant strains. A vaccine is available to limit the spread of bacteria after TB infection.
The vaccine is generally used in countries or communities where the risk of TB infection is greater than 1% each year. It is used in newborns in these communities to prevent TB and its complications in the first few years of life. In Canada, there’s controversy over the use of this vaccine because it doesn’t prevent the initial infection. If a positive skin test is detected and other tests have confirmed that active TB is not present, your doctor may choose to prescribe a medication that prevents a TB infection from progressing to the active disease.
The antibiotic most commonly used is isoniazid, which is usually taken daily for 9 months. Other medications that may be used include rifampin or a combination of isoniazid and rifampin. It is important to take your medications for as long as your doctor recommends. If you stop taking your medications before your doctor suggests, the TB infection can recur, you could get active TB, or the TB bacteria may become resistant to the medications you are taking. 9. Nursing Management and Intervention Pulmonary Tuberculosis.
Help incubation emergency if necessary. Give medications: bronchodilators, corticosteroids as indicated as per order. Maintain a fluid intake. Clean secretions from the mouth and trachea, suction if necessary. Give the patient or the semi-Fowler position for effective coughing and breathing exercises. Encourage or provide good mouth care after coughing. Breath deeply and slowly when sitting as straight as possible. Teach the client about the proper method of controlling cough.