Tuberculosis (TB) is an infectious disease that spread very rapidly by communications that attack your lungs directly. In this blog, we will scrutinize the aspects, which make tuberculosis a morbid heal disorder, affecting millions of people all around the world, what could be the possible measures of prevention, and if someone confronts this unwelcoming state, what should be the treatment plan. So, let us dive in without any delay.

Why is Tuberculosis So Frightening for Society?

Tuberculosis is an infectious disease, primarily affecting the lungs, but can also make its way to affect the intestines, brain, meninges, bones, joints, and lymph nodes severely. It is caused by Mycobacterium Tuberculosis, hence a bacterial infection. Its spread is not limited to humans only; animals also get infected (bovine tuberculosis) by a strain called Mycobacterium Bovis (Edemekong & Huang, 2021).

What Could Be the Causes of Tuberculosis Infection?

Tuberculosis infection is contagious and may happen to occur by inhaling the respiratory droplets released into the air by the person who has an active form of TB (means infected by Mycobacterium Tuberculosis). Hence, when a TB-infected person talks, coughs, laughs, spits, or sings, chances are greater for the person present beside that person.

Another factor that comes to play in the spread of this lethal disease is the development of multi-drug resistant strains of bacteria with time. The antibiotics fail to produce effective results when the bacteria create resistance.

How Tuberculosis Infection Manifests Itself?

Tuberculosis infection was once rare in developed countries, but with the emergence of HIV cases in 1985, a spike in the number of TB-infected patients has been noticed. The idea behind the relation between tuberculosis and AIDS was the weakening of the immune system by HIV (human immune-deficiency virus) that paves the way for Mycobacterium to thrive pathologically. Thereby, the symptoms of TB infection are categorized based on immune functions (Balabanova et al., 2011).

Latent TB is due to a potent immune response, the pathogenesis of the bacteria can be blocked, and symptoms might not have appeared. However, infection is still present in the body, but it is producing no harm. It may progress to an active state, so prompt treatment is essential. On the other hand, symptoms of an active TB include coughing for more than 3 weeks, hemoptysis (blood-tinged coughing), fatigue, night sweats, chills, and weight loss. In the advanced stages, tuberculosis can also disseminate by the way of lymphatic or bloodstream to other parts of the body like kidneys, brain, bone, spinal cord, lymph nodes, and skin (Giovino et al., 1995).

What Are the Modes of Transmission of Tuberculosis (TB)?

Tuberculosis is primarily transmitted by droplet exchange, generated by sputum-positive patients with pulmonary tuberculosis. However, the spread is directly linked to the closeness of contact, frequency of coughing or sneezing, and ventilation of the surrounding area.

This infection cannot be transmitted by contact with utensils and accessories contaminated by sick patients. Although, sterilization is of great value in preventing the transmission of many other diseases, but is of little regard in the spread of tuberculosis (Misganaw et al., 2014).

Communicability and Complications of Tuberculosis

Communicability

Tuberculosis is regarded as a communicable disease as it may spread from person to person via inhalation of respiratory droplets. Patients remain infected as long as they manifest positive sputum tests for tubercle bacilli. However, prompt treatment can lower the infectivity by 90 percent within 48 hours. Therefore, it is advisable to come in contact with a nearby healthcare provider or community health nurse for immediate therapy.

Complications During Tuberculosis

Tuberculosis, when not treated promptly may cause severe health-related issues as the enhanced state of this infection has the property of disseminating throughout the body, affecting major organs. One of the adverse effects is spinal cord damage. It is one of the most common sites of tuberculosis spread, manifesting back pain and neurological signs of stiffness.  The next complication is tuberculosis meningitis (dissemination of TB infection into brain meninges may cause encephalitis). Additionally, hip and knee joint immobility may result from arthritis confronted due to tuberculosis.

In addition, there is renal damage too. Dissemination of this organ has two-fold effects, which means in addition to kidney damage, tuberculosis can also result in cardiac disorders, as blood volume is irregular after renal failure.

How This Morbid Condition Should Be Treated?

Chemotherapy against tuberculosis should be indicated in every active case. In this regard, attention should be paid to the correct dosage intake of the drugs, because incomplete therapy may lead to the development of resistance and increase the chances of recurrence of injection (Edemekong & Huang, 2021).

Two-phase Chemotherapy

For effective results to occur, chemotherapy is usually divided into two phases. 

The first phase is a potent, short phase, comprising aggressive drug therapy (three or more drugs combined) for 1-3 months, aimed at killing most bacteria. This phase is followed by the continuation phase where the target is set for sterilization of the existing bacteria (duration is 18 months).

The long-term regimen involves the use of the drug, isoniazid (INH) along with one or two other drugs for 18 months and the focus is to sterilize the persistent lesion. While the Short-course chemotherapy regimen comprising 6 months duration is considered highly effective, with low toxicity, and well tolerated. The initial phase lasts for 2 months and involves intensive use of four drugs regimen (isoniazid, rifampicin, pyrazinamide, and ethambutol or streptomycin), followed by the use of two drugs in the next phase in which the use of isoniazid plus rifampicin is recommended intermittently (Misganaw et al., 2014).

At What Rates TB Infection Played Havoc Worldwide?

Mortality of Tb

The mortality rate for tuberculosis is defined as the number of deaths from TB every year per 1000 population. However, with the advancement of ineffective preventive measures and chemotherapy, the importance of mortality rate as an epidemiological index has faced a decline, but it is still of great value in countries where treatment plans have not yet been strengthened.

Morbidity of TB Infection

Tuberculosis is often regarded as the disease of the past, but it continues to pose serious threats to humanity as the one-third population of the world has been infected and 9 million are infected with this contagious disease (Balabanova et al., 2011).

Epidemiological Triangle of Tuberculosis Infection

The epidemiological triangle refers to the presence of three essential components for disease occurrence, which are agent factors, host factors, and environmental factors. For tuberculosis, these are described below.

Agent Factors

Agent: The agent responsible for this infection in humans is a facultative intracellular bacterium called mycobacterium tuberculosis. For infection in animals, especially in cattle, the bovine strain (Mycobacterium Bovis) is the main culprit. Besides these, atypical strains have also been discovered recently which are named photochromogens, scotochromogens, non-photochromogens, and rapid growers (Balabanova et al., 2011).

Communicability: Infection persists in the body for as long as the patients remain untreated. With the involvement of anti-bacterial therapy, the severity of disease and infectivity can be reduced by 90n percent.

Source of infection: For humans, the source of spreading this pathogenic state in contact with the sputum of the person is positive for tubercle bacilli. The bovine source of infection is usually infected milk (Giovino et al., 1995).

Host Factors 

Age: There is no age limitation for TB infection to occur as it affects individuals of all ages. However, developing countries may show an increase in the number of patients ranging from infants to adolescents especially (Langmuir, 1963).

Sex: Tuberculosis infection is more prevalent in males as compared to females.

Heredity: Hereditary and genetics don’t play a major role in tuberculosis, but the history of twin births is associated with an increase in susceptibility to the ailment.

Malnutrition: As malnutrition is the predisposing factor for many various disorders, it exists as a risk factor for TB

Immunity: To develop immunity against tuberculosis, man has to either confront the natural disease course or acquire immunity by BCG vaccination (Misganaw et al., 2014).

Environmental Factors That Cause Tuberculosis

Low socioeconomic status puts a greater risk for the development of tuberculosis infection. People living in slums or low-lying areas are more likely to confront the disease state. Other causes include overpopulation, poor sanitation, lack of awareness of disease spread, illiteracy, and large families.

To mitigate the disease spread and to hold a firm grasp on disease control, mass education should be considered a primary step. Care should be taken to reduce the reservoir of infection. BCG vaccination should be ensured to protect the young population. To improve resistance to drug therapy, innovations in the science field should be the utmost priority (Balabanova et al., 2011).

How is the Role of Health Care Providers Critical in TB Control?

Ensuring continued drug therapy is one of the most essential steps of TB control, as slight variations in dosage are associated with higher chances for bacteria to develop drug resistance and thereby, infection relapses. Public health nurses and professional health workers can make certain of this uninterrupted treatment session.

Sometimes, patients are unable to make their way to the hospitals because of severe symptoms or reluctance. In this regard, home visits organized by public health nurses are of significant contribution. As anti-TB, drug therapy may create perplexity among patients, as they have to take numerous tablets in a specific order. This act could be made easier by the contribution of community nurses (Giovino et al., 1995).

National Organizations to Combat TB

National Tuberculosis Controllers Association is on a mission to curb the spread of tuberculosis, thereby, mitigating the harm. This organization aims to achieve the desired goals by honing its communication skills as most problems usually arise due to a lack of awareness and communication. Establishing task forces and specialized teams focuses on disease elimination at regional and national levels. In this regard, collaborating with other social organizations can also pave the way to excel as it vitalizes the process through funding and increased budget (Edemekong & Huang, 2021).

Summary of Tuberculosis

Tuberculosis is not limited to particular regions around the globe; rather, it is prevalent worldwide. According to WHO, tuberculosis is on the 13th rank among the mortality-causing diseases, killing around 1.5 million people in 2020. It exists as a life-threatening malady, especially in developing countries like India, Pakistan, Nigeria, Bangladesh, the Philippines, parts of Africa, Europe, etc. (Langmuir, 1963).

However, in these countries organizations have been set up to formulate policies and programs to control TB spread. However, this disease preventive measure may fall victim to dead luck in such communities due to lack of education, inequality of wealth and power, and financial crisis.

References

Langmuir, A. D. (1963). The surveillance of communicable diseases is of national importance. New England journal of medicine, 268(4), 182-192.

Edemekong, P. F., & Huang, B. (2021). Epidemiology of prevention of communicable diseases. Stat pearls [Internet].

Misganaw, A., Mariam, D. H., Ali, A., & Araya, T. (2014). Epidemiology of major non-communicable diseases in Ethiopia: a systematic review. Journal of health, population, and nutrition, 32(1), 1.

Balabanova, Y., Gilsdorf, A., Buda, S., Burger, R., Eckmanns, T., Gärtner, B., … & Krause, G. (2011). Communicable diseases prioritized for surveillance and epidemiological research: results of a standardized prioritization procedure in Germany, 2011. Plos one, 6(10), e25691.

Giovino, G. A., Henning field, J. E., Tamar, S. L., Escobedo, L. G., & Slade, J. (1995). Epidemiology of tobacco use and dependence. Epidemiologic reviews, 17(1), 48-65.