Global Health Risk: Tuberculosis Essay

Global Health Risk: Tuberculosis Essay

Tuberculosis (TB) is a disease caused by Mycobacterium tuberculosis, which mainly affects the lungs. The primary infection is usually propagated by airborne aerosol droplet nuclei. Tuberculosis is a global health concern. Terminating the TB epidemic by 2030 is among the United Nations’ sustainable development goals (SDGs). It is the 13^th leading cause of death globally and the second leading infectious killer following COVID-19 (Chakaya et al., 2021). One-fourth of the global population has latent TB. An estimated 10 million people had TB as of 2020, including 5.6 million men, 3.3 million women, and 1.1 million children (Chakaya et al., 2021). TB incidence is high in developing countries, particularly the South-East Asian Region (43%), African Region (25%), and Western Pacific region (18%) (World Health Organization (WHO), 2021).

For instance, in 2020, China, India, Pakistan, Nigeria, Bangladesh, South Africa, Indonesia, and the Philippines accounted for two-thirds of the new TB cases (WHO, 2021). However, the incidence of TB has been declining globally at a rate of 2% per year, although multidrug-resistant TB remains a threat (WHO, 2021). According to WHO (2021), US$ 13 billion is required annually for the prevention, diagnosis, and treatment of TB. In the United States, the incidence of TB has been declining slowly and was approximately 2.7 cases per 100 000 in 2019, while the prevalence of latent TB is estimated at 5% (WHO, 2021). The subsequent sections will explore contributing factors, signs and symptoms, prevention strategies, diagnostic tests, medical treatment, and follow-up.

Contributing Factors

Tuberculosis is usually caused by the Mycobacterium tuberculosis complex. Risk factors for tuberculosis exposure include homelessness, crowded living conditions, working in the healthcare industry, migration from regions with a high TB burden (100 cases per 100 000 population), travel to countries with enormous TB burden, and close contact with a patient with active TB. On the other hand, risk factors for the progression of latent TB to TB disease include HIV infection, age, particularly under two years old, recent infection with M. tuberculosis, immunosuppressive therapy, other immunosuppressive conditions, and a history of previously poorly treated TB.

Prevention Strategies

Several strategies can be executed to prevent TB. These include vaccination with Bacillus Calmette-Guerin Vaccine (BCG), disinfection with disinfectants active against M. tuberculosis such as hydrogen peroxide and glutaraldehyde, and contact tracing and post-exposure management (Furin et al., 2019). Similarly, infection control measures such as case notification and airborne precautions such as surgical masks for patients and sufficient personal protective equipment for caregivers and healthcare providers. Finally, hand washing, TB preventive treatment for households, and health education can reduce the burden of TB if implemented.

Signs and Symptoms

Latent tuberculosis is ordinarily asymptomatic. Similarly, individuals with primary tuberculosis are mostly asymptomatic. However, it is important to highlight that signs and symptoms usually become prominent with disease progression as a consequence of immunosuppression. Pulmonary tuberculosis manifests as non-productive cough, shortness of breath, and pleuritic chest pain in addition to systemic symptoms such as low-grade fever, anorexia, night sweats, weight loss, and malaise (Furin et al., 2019). Signs of pulmonary tuberculosis include pallor, clubbing, consolidation, pleural effusion, cavitation, and bronchial obstruction. TB may also manifest with extrapulmonary features depending on the organ or site of involvement. Various forms of extrapulmonary TB include tuberculous lymphadenitis, tuberculous hilar lymphadenopathy, tuberculous pleurisy, miliary tuberculosis, tuberculous meningitis, pericardial tuberculosis, adrenal tuberculosis, gastrointestinal tuberculosis, urogenital tuberculosis, and TB of bones and joints (Furin et al., 2019).

Diagnostic Tests

All patients with suspected TB must have a comprehensive history and physical exam as an initial workup coupled with microbiological studies, including microscopic examination for acid-fast bacilli, nucleic acid amplification tests, mycobacterial culture, and drug susceptibility testing. It is critical to outline that culture remains the confirmatory and gold standard test (Gill et al., 2022). Imaging tests that can be considered include CT Chest or chest X-ray. Additional tests that are crucial for treatment include HIV tests, complete blood count, basic metabolic panel, ESR, and liver function tests. Finally, tuberculin skin test and interferon-gamma release assay do not aid in the diagnosis of active TB but are screening tests for latent TB (Gill et al., 2022).

Advanced Practice Nursing Role and Management Strategies

Advanced practice nurses have a critical role in preventing and managing TB. For instance, they usually implement measures and preventive strategies such as vaccination and pretreatment of TB in households. Similarly, they carry out case notifications and contact tracing. Advanced practice nurses also promote health through health education. They enlighten patients regarding TB, its prevention, treatment, medications, and side effects. Similarly, advanced practice nurses can screen patients for TB, actively care for patients with active TB, evaluate TB patients during follow-up and ensure treatment adherence through directly observed therapy.

Medical/Pharmacologic Management

Antituberculosis therapy is the mainstay treatment for confirmed TB. Standard antituberculosis therapy involves two months of rifampin plus isoniazid, pyrazinamide, and ethambutol as the intensive phase (Peloquin & Davies, 2021). The continuation phase consists of 4 months of rifampin and isoniazid. All individuals should be given pyridoxine supplementation to prevent vitamin B6 deficiency resulting from isoniazid. However, the continuation phase of TB meningitis and TB of the bone and joints is typically ten months (Peloquin & Davies, 2021). Besides, steroid therapy is indicated for TB meningitis, pulmonary Tb with respiratory distress, pulmonary TB with airway obstruction by hilar lymph nodes, and severe miliary TB or pericardial effusion. Additional treatment considerations include restarting full treatment if the intensive phase is interrupted for more than fourteen days. Similarly, Pyrazinamide use during pregnancy is controversial.

Multidrug-resistant and extensively drug-resistant forms of TB should be treated with a combination of at least five drugs during the intensive phase and four drugs during the continuation phase (Peloquin & Davies, 2021). These drugs include fluoroquinolones, linezolid, amoxicillin-clavulanic acid, amikacin, streptomycin, carbapenem, cycloserine, and bedaquiline. Finally, latent TB has usually treated with once-weekly isoniazid and rifapentine for three months plus pyridoxine or once daily rifampin for four months or once daily isoniazid for 6 or 9 months plus pyridoxine (Peloquin & Davies, 2021).

Follow-up

All patients on antituberculosis treatment should be followed up monthly. During these visits, adherence to treatment, symptom review, and side effects should be assessed for all patients. Furthermore, sputum smear microscopy and culture, weight and vision assessment, and laboratory studies such as liver function tests, platelet count, and creatinine should be performed for all patients with active TB.

Conclusion

Tb is a public health concern and remains a major cause of morbidity and mortality. Its incidence has declined globally, although multi-drug resistant TB remains a threat. Primary and latent TB is usually asymptomatic in immunocompetent individuals. Culture is the gold standard for the diagnosis of TB. Antituberculosis therapy with isoniazid, rifampin, ethambutol, and pyrazinamide remains the standard regimen for TB.

 

References

Chakaya, J., Khan, M., Ntoumi, F., Aklillu, E., Fatima, R., Mwaba, P., Kapata, N., Mfinanga, S., Hasnain, S. E., Katoto, P. D. M. C., Bulabula, A. N. H., Sam-Agudu, N. A., Nachega, J. B., Tiberi, S., McHugh, T. D., Abubakar, I., & Zumla, A. (2021). Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts. International Journal of Infectious Diseases: IJID: Official Publication of the International Society for Infectious Diseases, 113 Suppl 1, S7–S12. https://doi.org/10.1016/j.ijid.2021.02.107

Furin, J., Cox, H., & Pai, M. (2019). Tuberculosis. Lancet, 393(10181), 1642–1656. https://doi.org/10.1016/S0140-6736(19)30308-3

Gill, C. M., Dolan, L., Piggott, L. M., & McLaughlin, A. M. (2022). New developments in tuberculosis diagnosis and treatment. Breathe (Sheffield, England), 18(1), 210149. https://doi.org/10.1183/20734735.0149-2021

Peloquin, C. A., & Davies, G. R. (2021). The treatment of tuberculosis. Clinical Pharmacology and Therapeutics, 110(6), 1455–1466. https://doi.org/10.1002/cpt.2261

World Health Organization (WHO). (2021). Tuberculosis. Who.int. https://www.who.int/news-room/fact-sheets/detail/tuberculosis

 

Choose a global health issue. For this assignment, you will introduce the health issue and discuss the interventions necessary to prevent the issue and promote health.

Some topics to consider may include:

Anthrax
Bioterrorism
Cholera
Clostridium botulinum infection
Community-associated methicillin-resistant Staphylococcus
Ebola virus disease
Escherichia coli
Human immunodeficiency virus disease

Malaria

Plague

Severe respiratory distress syndrome

Small pox

Suicide

Tuberculosis

Vancomycin-resistant enterococcus infection

West Nile virus
Include the following in your paper:

Introduction/overview of the health issue and the prevalence in the United States and worldwide

Contributing factors

Prevention strategies

Signs and symptoms

Diagnostic tests (if applicable)

Advanced practice nursing role and management strategies

Medical/pharmacological management (if applicable)

Follow-up care

Conclusion

Write a 3–4 page paper following APA format. You must include 2–3 scholarly sources in your citations and references.