TB is a respiratory tract infection spread by airborne route. It is one of the oldest disease known to affect humans & is a major cause of death world wide.
Definition :
It is a chronic bacterial infection caused by Mycobacterium tuberculosis, that is characterized by formation of granulomas in infected tissue & by cell mediated hypersensitivity.
Types:
Primary TB: It occurs when patient is initially infected with Mycobacterium.
Secondary TB: The disease is reactivated in later stage.
Pathophysiology:
Inhaled bacteria lodge into alveoli activating macrophages transforming into epithelial cells & Langhan cells which aggrevate lymphocytes to form tuberculous granuloma which will form ghon's focus followed by limiting the spread of bacilli causing latent TB. Healing then occurs with late calcification of granulomas & the combination of calcified peripheral lung leision & calcified hilar lymph nodes forms Ghon's complex.
Etiology & risk factors:
Mode of Transmission:
Primary TB: Patients may develop symptoms like influenza, consolidation, conjuctivitis etc.
Miliary TB: Night swats, anorexia, weight loss, dry cough, hepatosplenomegaly, headache etc
Secondary TB: Chronic cough, hemoptysis, unresolved pneumonia, pneumothorax, cavitation & consolidation of lungs.
Extrapulmonary TB:
Lymphadenitis: Most commonly cervical & mediastinal glands are involved leading to abscess formation & discharge from lymph nodes.
GI TB: fever, night sweats, anorexia weight loss are common symptoms. Tuberculous peritonitis is characterized by abdominal distention, pain & other symptoms & sometimes patients may become icteric
Bone & joint involvement: Mostly spine is involved characterized by backache,abscess formation, subsequent kyphosis, pain & swelling if hip or knee joints are involved.
Other regions: Pericardium, CNS system, Genito-urinary system.
Medical & Nursing Management:
EARLY DETECTION : The presumptive clinical symptoms & chest examination by doctor are sufficient to confirm diagnosis. Confirmation should be made by sputum examination & radiology.
CHEMOPROPHYLAXIS : There are now 12-13 drugs active against M. tuberculosis. Out of which , 6 are considered essential.
Bactericidal drugs:
•rifampicin
•izoniazide
•streptomycin
•pyrazinamide
Bacteriostatic drugs:
•ethambutol
•thioacetazone
•fluoroquinolones
•Ethionamide
•Capromycin
•Kenamycin, Amikacin, Cycloserine
PROTECTION & DISINFECT :
•Use of PPE by medical personnel
•Use of cheap disposable tissues to receive sputum or nasal discharge
•Disinfection of utensils used by patients
ISOLATION :
•Isolation of the patient is necessary & special care to be taken of the patient
HEALTH EDUCATION :
It is a chronic bacterial infection caused by Mycobacterium tuberculosis, that is characterized by formation of granulomas in infected tissue & by cell mediated hypersensitivity.
Types:
Primary TB: It occurs when patient is initially infected with Mycobacterium.
Secondary TB: The disease is reactivated in later stage.
Pathophysiology:
Inhaled bacteria lodge into alveoli activating macrophages transforming into epithelial cells & Langhan cells which aggrevate lymphocytes to form tuberculous granuloma which will form ghon's focus followed by limiting the spread of bacilli causing latent TB. Healing then occurs with late calcification of granulomas & the combination of calcified peripheral lung leision & calcified hilar lymph nodes forms Ghon's complex.
Etiology & risk factors:
- Contact with infected person
- HIV
- Smoking
- Alcoholism
- Poverty
- Overcrowding
- Diseases such as diabetes mallitus, cancer & other immunocompromised conditions
- Certain dugs such as corticosteroids
- Silicosis & other lung diseases
Mode of Transmission:
By ingestion of unboiled milk or uncooked meat of diseased cattle.
From droplet infection by affected person.
Incubation period:
4-12 weeks from infection to primary lesion. But the disease may be seen in years. The chances of getting the disease is more during first 6-24 months of life.
Primary TB: Patients may develop symptoms like influenza, consolidation, conjuctivitis etc.
Miliary TB: Night swats, anorexia, weight loss, dry cough, hepatosplenomegaly, headache etc
Secondary TB: Chronic cough, hemoptysis, unresolved pneumonia, pneumothorax, cavitation & consolidation of lungs.
Extrapulmonary TB:
Lymphadenitis: Most commonly cervical & mediastinal glands are involved leading to abscess formation & discharge from lymph nodes.
GI TB: fever, night sweats, anorexia weight loss are common symptoms. Tuberculous peritonitis is characterized by abdominal distention, pain & other symptoms & sometimes patients may become icteric
Bone & joint involvement: Mostly spine is involved characterized by backache,abscess formation, subsequent kyphosis, pain & swelling if hip or knee joints are involved.
Other regions: Pericardium, CNS system, Genito-urinary system.
Medical & Nursing Management:
EARLY DETECTION : The presumptive clinical symptoms & chest examination by doctor are sufficient to confirm diagnosis. Confirmation should be made by sputum examination & radiology.
CHEMOPROPHYLAXIS : There are now 12-13 drugs active against M. tuberculosis. Out of which , 6 are considered essential.
Bactericidal drugs:
•rifampicin
•izoniazide
•streptomycin
•pyrazinamide
Bacteriostatic drugs:
•ethambutol
•thioacetazone
•fluoroquinolones
•Ethionamide
•Capromycin
•Kenamycin, Amikacin, Cycloserine
PROTECTION & DISINFECT :
•Use of PPE by medical personnel
•Use of cheap disposable tissues to receive sputum or nasal discharge
•Disinfection of utensils used by patients
ISOLATION :
•Isolation of the patient is necessary & special care to be taken of the patient
HEALTH EDUCATION :
The
public in general should be told about the spread of infection & importance
of BCG vaccination to children. Health education regarding hygienic &
safety precautions to be given.
Distinctive facts:
- Ix: Montaux test, AFB culture, CXR, Sputum analysis
- Granuloma & calcification can be assessed by CXR in primary TB
- Purified Protein Derivative 0.1 ml is injected Intradermally for 48-72 hours & results are measured using tuberculin skin scale.
- CT Scan may be used to detect Pott's spine.
- MRI is useful in case of intracranial TB.
- Management of TB needs to be done by RNTCP criteria.
- Bovine TB is caused by ingesting unboiled milk of cattles or poorly cooked meat.
- Drug resistant TB must be diagnosed & the drugs needs to be changed. mostly people develop resistance from rifampicin.
Prognosis:
If appropriate treatment is not taken the patients will develop multi drug resistant TB. The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year.The chance of death from a case of tuberculosis is about 4%
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