The Causes And Risk Factors Health And Social Care Essay

Pulmonary tuberculosis (TB) is a bacterial infection which primarily affects the lungs, but can spread to other organs. It is a contagious disease as the bacteria gets transmitted through air. Inside the body it spreads to other organs from lungs through blood and lymph nodes.

TB develops in previously infected person when his immune system weakens, such as in people with HIV or elderly adults. Those with strong immune power do not develop symptoms, even though exposed to TB bacteria.

TB can remain in an inactive (dormant) state for years without causing symptoms or spreading to other people.

When the immune system of a patient with dormant (inactive) TB is weakened, the TB can become active and cause infection in the lungs or other parts of the body.

The risk factors for acquiring TB include close-contact situations, alcohol and IV drug abuse, and certain diseases (for example, diabetes, cancer, and HIV) and occupations (for example, health-care workers).

Inactive tuberculosis may be treated with an antibiotic, isoniazid (INH), to prevent the TB infection from becoming active.

Active TB is treated, usually successfully, with INH in combination with one or more of several drugs, including Rifampin , ethambutol, pyrazinamide, and streptomycin.

Drug-resistant TB is a serious, public-health problem, especially in Southeast Asia, and African countries.

In 15–20% of active cases, the infection spreads outside the respiratory organs, causing other kinds of TB. These are called as "extrapulmonary tuberculosis". It occurs more commonly in immunosuppressed persons and young children. In those with HIV, this occurs in more than 50% of cases.  

Common extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis), and the bones & joints (in Pott's disease of the spine), among others. When it spreads to the bones, it is also known as "osseous tuberculosis" a form of osteomyelitis. 

A potentially more serious, widespread form of TB is called "disseminated" TB, commonly known as miliary tuberculosis. Miliary TB makes up about 10% of extrapulmonary cases.

Causes and risk factors:

Pulmonary tuberculosis is caused by the bacteria- Mycobacterium tuberculosis (M. tuberculosis). It is transmitted by breathing in air droplets of an infected person when he coughs or sneezes.

The following people are at higher risk for active TB:

Elderly

Infants

People with weakened immune systems, for example due to AIDS, chemotherapy, diabetes, or certain medications

Frequent contact with people who have TB

Poor nutrition

Living in crowded or unhygienic conditions

Symptoms:

The symptoms of TB usually range from without symptoms (latent tuberculosis) to symptoms of active disease. Usually the patient remains unaware of a latent TB infection until it's revealed through a skin test. 

Following are the symptoms of active disease:

Cough, at first with yellow or green mucus

Cough with bloody mucus later in the disease

Fatigue

Weight loss

Difficulty in breathing or wheezing

Fever

Sweating at night

Pain in the chest, back, or kidneys

Symptoms often improve in 2 - 3 weeks. The prognosis is far better if pulmonary TB is diagnosed early and prompt treatment is available.

Complications:

Multi drug resistant tuberculosis

Pneumonia and other lung complications

Meningitis

Bone and joints affection can lead to pain, swelling and even arthritis

Painful urination

Weight loss

Retina in eyes can get affected and lead to defective vision

Investigations:

Tuberculin skin test (also called a PPD test)

Sputum examination and cultures

Interferon-gamma blood test such as the QFT-Gold test to test for TB infection

Chest x-ray

Chest CT scan

Bronchoscopy

Thoracocentesis

Biopsy of the affected tissue (rare)

Treatment:

The aim of treatment is to cure the infection with medicines that fight the TB bacteria. Treatment of active pulmonary TB consists of a combination of drugs such as:

Isoniazid

Rifampin

Pyrazinamide

Ethambutol

Streptomycin

Patient requires taking prescribed medicines as per instructions for 6 months or longer. It is very important to take the medicines regularly. This will prevent the TB bacteria to become resistant to medicines.

Necessary hygiene and sanitization measures should be taken to prevent others n near ones getting affected with TB.

Prevention:

TB can be prevented, even in those who have been exposed to an infected person. Skin testing for TB is used in high risk populations or in people who may have been exposed to TB, e.g. health care workers.

Active tuberculosis (TB) is very contagious. According to World Health Organization (WHO) one-third of the world's population is infected with the bacteria that cause TB.

Measures of prevention from an active TB infection include:

Do not spend long periods of time in crowded, enclosed rooms with anyone who has active TB until that person has been treated for at least 2 weeks.

Use protective measures, such as face masks, if someone works in a facility that cares for people who have untreated TB.

Those living with someone who has active TB, should always take precautionary measures like above and encourage the person to follow treatment instructions.

In some countries with high incidence of TB people are given BCG vaccination to prevent TB. However, the effectiveness of this vaccine is limited.