Tuberculosis (T.B.) is an infectious disease caused by Mycobacterium tuberculosis, and it affects the lungs. T.B bacteria is transmitted when tiny droplets are released into the air from one person to another. The T.B. becomes prevalent in developed countries in 1985 due to the emergence of HIV, which weakens the body’s immunity unable to fight against T.B. bacteria. T.B. has remained a significant concern in the USA despite its reduction in 1993. However, the infection can spread to the spine and brain in advanced stages. According to WHO, T.B. was a killer disease in the 20th century, although its severity has declined recently. The main aim of conducting the research is to discuss T.B. in the following facets; social determinants of health, general overview, epidemiological triangle, the role of community health nurse, national agencies for T.B., and global implications.

Overview of T.B

T.B. is a bacterial disease caused by Mycobacterium tuberculosis. There are two types of Tb latent T.B. and Active T.B. Regarding Latent T.B., the bacteria is within the body. Still, the immune system manages it and prevents it from multiplication. The patient is asymptomatic and is not contagious, although the bacteria can become active in the long run (Sterling et al., 2020). Active T.B. patients are contagious and symptomatic. 90% of the active cases among adults arise from latent T.B. infection. Both of the two types might become drug resistance making it difficult to eradicate the strains.

Signs and symptoms of active T.B

• Night sweats
• Fatigue
• Unintentional weight loss
• Loss of appetite
• Feeling tired all the time
• Coughing up blood
• Chest pain
• Coughing lasting at least three weeks

Mode of Transmission

T.B. is transmitted through the air when an infected person passes out tiny droplets via talking, singing, laughing, coughing, and sneezing. After breathing in the germs, there is a high probability of getting infected with the bacteria. However, it’s not easy to get infected with T.B. as you have to spend a lot of time with the active T.B. person and also depending on the bacterial shedding in the lungs. There is a likelihood of getting T.B. from family members, friends, and co-workers. T.B. bacteria do not multiply on surfaces; thus, you cannot get it through sharing utensils, meals, or shaking hands.

Shed TB bacteria can remain viable in the air depending on the nature of the environment (Thanassi, Sosa, Bamrah, & Buchta, 2019). Infection occurs when droplet nuclei containing the T.B. bacteria traverse through the respiratory system and reach the lung’s alveoli. However, four factors determine T.B. transmission:

1. Exposure factors such as duration, frequency, and proximity determine transmission rate.
2. Susceptibility is dependent on the immune system and environmental factors which affect germ concentration.
3. The infectiousness of an individual depends on tubercle bacilli exposed to the atmosphere.
4. Sites for T.B. occurrence include extrapulmonary and pulmonary areas.
5.  

Diagnosis and Treatment

During the physical examination, the doctor uses a stethoscope to listen to the lungs’ sounds when breathing and checking the lymph nodes’ swelling. A simple skin test is mostly used as a diagnostic tool alongside blood tests (MayoClinic, 2021). However, there is a likelihood of false-positive tests, especially when a person has been vaccinated recently with the BCG vaccine. U.S. seldom uses the T.B. vaccine, although it’s commonly used in areas that are highly susceptible to TB. False-negative test results are not common, and they may be witnessed in AIDS patients, older people, and children.

People who have recently infected by the T.B. for the previous two years can present a false-negative test to T.B. because their immune systems have not responded to the bacteria. (WHO, 2020) It isn’t easy to diagnose T.B. among children. After diagnosis, treatment procedures are started. Blood tests, imaging tests, and sputum tests are carried to rule out the presence or absence of T.B. Blood tests may identify active or latent T.B. whereby the immune system reaction to Tb is measured. The test is recommendable if the person has a negative skin test or a BCG vaccination.

Imaging tests such as C.T. scan and chest X-ray are confirmatory tests for positive skin tests whereby white spots in the lungs indicate the presence of T.B. or change of lungs. C.T. scan is more detailed than X-rays (WHO, 2020). Sputum tests are conducted when the X-ray shows signs of tuberculosis to rule out T.B. bacteria. Besides, sputum tests are used to determine drug-resistant strains and help in medical dispensation, and the tests take 4-8 weeks to be completed.

Treatment

T.B. is a curable and treatable disease with antibiotics, which are the cornerstone for T.B. eradication. T.B. treatment is a lengthy process depending on the severity and stage of the T.B. Antibiotic treatment for active T.B. takes place for at least 6-9 months. The treatment’s length depends on infection location, possible drug resistance, overall health, and age. For latent tuberculosis, a person is supposed to take two types of antibiotics, while active T.B. patients require various drugs due to drug-resistant strain. Some of the medications used include pyrazinamide, Ethambutol, Rifampin, and Isoniazid (Sterling et al., 2020). In drug-resistant T.B. patients, a combination of injectable medications and fluoroquinolones are used for 20-30 months.

Demographic of interests

According to WHO (2020), 1.4 million people succumbed to T.B. in 2019 worldwide. Tuberculosis is one of the ten causes of death globally arising from a single infectious agent. 10 million people were diagnosed with Tb in 2019 worldwide, out of which 1.2 million were children, 3.2 million were women, and 5.6 million were men. T.B. presents itself in all countries across the globe. Health practitioners might overlook the occurrence of T.B. among children and adolescents, although it poses a threat to them. 87% of the infections came from 30 high T.B. burden countries in 2019.

However, eight countries recorded the highest rate of two-thirds of the 87%. India had the highest count among the eight countries: South Africa, China, Indonesia, Bangladesh, Nigeria, the Philippines, and Pakistan. 206030 across the globe recorded rifampicin-resistant T.B. in 2019, which was an increment from 2018 (186 883). The incidence of T.B. has reduced by 2% from 2015 to 2019 across the globe per year. It translates to a 9% cumulative reduction below the target 20% END TB strategy by 2020. From 2000 to 2019, 60,000 people have been saved from T.B. successfully (MacNeil et al., 2020). T.B.’s mortality rate is reducing by 3% annually with an overall reduction of 42% from 2000 to 2017 globally.

Is T.B. a reportable disease? T.B. is a reportable infectious disease across the globe. For example, in Minnesota, any person diagnosed with T.B. should report to MDH within 24 hours after identifying both the extrapulmonary and pulmonary T.B. according to CDC (2020). It is mandatory to report to either healthcare providers, administrators, laboratories, Tribal and Federal entities.

Social determinants of health

Poverty is the primary social determinant of T.B. poorly and crowded ventilated areas are associated with poverty index either in the family or working setting. They pose direct effect on the transmission of the T.B. Poverty is related to inadequate and inefficient awareness on health related practices, which exposes people to T.B. with prevalent of T.B. risk factors such as alcohol abuse, smoking, and HIV (Duartea, Lönnroth, Carvalho, Muñoz-Torrico, & Lima, 2018).

Eradicating poverty is a milestone in reducing the risks of T.B. transmission and the development process of infection. Doing so improves accessibility to health services and treatment recommendation adherence. Some of the proposed policies for public health, economic and social include;

• Promoting healthy lifestyles and diets
• Addressing health, financial and social conditions of immigrants
• Improving living and environmental conditions such as prisons and congregating areas
• Improving working and living setting
• Reducing food insecurity
• Reducing poverty strategies and improving social protection.

Besides, malnutrition is another social determinant for T.B., which results in the development of active T.B. by increasing susceptibility (Dean, Friedman, & Duffus, 2018). Additionally, T.B. stigma is a social determinant that results in healthcare inequalities. Eventually, it leads to poor treatment outcomes and non-compliance with drug prescriptions. In achieving the END TB strategy of 2030 by WHO, a holistic approach, including addressing social determinants of health, are vital in eliminating T.B.

Epidemiological Triangle of T.B

The epidemiological triangle of T.B. includes host factors, environmental factors, and agent factors. According to Green (2017), T.B.’s environmental factors include housing, crowding, temperature, altitude, humidity, and neighborhood. Exposure to pollution such as NO2 and SO2 may increase the infection rate.

Environmental factors contribute to the pathogenesis of T.B. by interfering with the immune system. For example, high concentrations of pollutants impair lung function, resulting in decreased macrophage function and oxidative stress. Oxidative stress results in inflammation of the airways (Álvaro-Meca, Díaz, Díez, Resino, & Resino, 2016). Besides, diesel emissions suppress pro-inflammatory mediators facilitating T.B. infection. Therefore, short-term exposure to environmental risks may increase the pathogenesis of T.B.

The agent factor for tuberculosis is bacteria, Mycobacterium tuberculosis. It spreads from one person to another through inhales infected air (Green, 2017). It can remain dormant in the body for a long time until when the immunity system of the person becomes weakened, thus developing to active T.B. Therefore, the chain of infection of T.B. is through the air. A higher inhalation of T.B. germs may result in T.B. infection.

The host factor describes the family background, immune status, genetic profile, age, sex, customs, and occupation. Some people may become symptomatic after exposure to tuberculosis. It is estimated that 10% of people with latent T.B. develop active T.B. if they are not treated. People with HIV are highly susceptible to T.B. due to weakened immunity. People working or residing in areas with high rates of T.B. are at higher risk of being infected. Every gender and sex are susceptible to T.B. infection, although older people are more vulnerable.

 People with existing medical conditions are vulnerable to attack by T.B. due to a weakened immune system (Hasnain, Ehtesham, & Grover, 2019). However, people who have been recently infected with T.B. pose a significant risk of reinfection and people living with active T.B. patients. Prison inmates and nursing homes, intravenous drug users, and alcoholic and homeless people can attract T.B. pathogens (Fennelly et al., 2017). Are there special considerations for the community? There are considerations for the community by ensuring proper ventilation in gatherings to limit infection rates such as school, household, and working areas.

Role of community health nurse

Community health nurses help in identifying tuberculosis symptoms and isolate infectious people to reduce the infection rate. They help create awareness to children in schools and any signs of infections reported to the relevant authorities through systematic monitoring and evaluation. By developing a close relationship with the community, the nurses collect T.B. information and subject it for analysis. Besides, community nursed educate the community on the necessity for follow-ups to avoid drug resistance (Arshad et al., 2014). Collecting ethical and race data helps in improving quality and universal care. It helps in identifying biases in offering healthcare services to specific populations.

National agency for T.B

United States Agency for International Development (USAID) is in the frontline in collaborating with other countries in END TB strategy. It is collaborating with other agencies worldwide to reach everybody with T.B., provide treatment, and prevent the development of active T.B. Majority of T.B. treatment in the developing countries is free due to USAID partnership with such governments and WHO (USAID, 2020). USAID is committed to ending T.B. through Accelerator to END TB. 

Global Implications of T.B

According to U.N. (2018), the meeting resolved that all member countries should reach the END TB strategy’s target goal by 90% reduction by 2030, 20% incidence reduction, and 35% reduction of mortality rate. The U.N. high-level declaration agreed to mobilize at least $2 billion per year in promoting universal quality healthcare services to T.B. patients (WHO, 2020). The disease’s prevalence is low in American regions, while in the Africa region, drug resistance, rapid diagnosis, transport network, and laboratory infrastructure are a challenge.

Drug resistance in the South-East Asia region is moderate, while the European area has low resistant cases. Regarding culture, Filipino parents associate respiratory complexities in children with folk illness. Besides, directly observed therapy with cheese and ham sandwiches might disincentive Muslims who do not eat pork. According to WHO (2020) statistics, T.B. was a burden to India. It recorded the highest count of 87% in 2019, as discussed in the demographic of interest. However, it is highly endemic in developing countries such as South Africa, with a prevalence rate of 1256.7 (cases/ 10,000 pop).

Overall, Tuberculosis is a bacterial disease with air as the chain of transmission. The primary site is the lungs, although it may spread to the brain and spine. It is among the leading deadliest disease across the world. Pollutants and existing medications may act as risk factors to T.B., and demographic characteristics are essential in providing universal care to all populations and identify the healthcare business. Finally, T.B. is endemic in developing countries such as South Africa.

References #

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