Introduction
Tuberculosis (TB) is an infectious, contagious illness caused by Mycobacterium tuberculosis that has been a constant problem throughout the history of humanity, owing to its catastrophic societal consequences (CDC, 2022). It is thought that the genesis of the genus Mycobacterium dates back over 150 million years (Behr et al., 2021). Scrofula, a cervical lymph node disease, was a unique TB clinical manifestation in the Middle Ages. In France and England, the ailment was called “king’s evil” and thought to be cured by royal touch (Floyd et al., 2018).
Benjamin Marten, an English physician, postulated for the first time in 1720 that tuberculosis was caused by an infectious agent, while the invention of the sanatorium cure was the first effective treatment for TB. On March 24, 1882, in the Berlin Physiological Society, Robert Koch reported his tubercle bacillus discovery (Floyd et al., 2018). Researchers made significant discoveries in the following decades: Mantoux and Pirquet discovered tuberculin skin tests, Selman Waksman discovered streptomycin, and Camille Guérin and Albert Calmette produced the BCG vaccination.
Many deaths have been caused by TB around the globe. According to Hsu (1995), TB is one of the world’s most common and deadly infectious diseases. According to the WHO, 9 to 10 million individuals die from tuberculosis each year globally, estimated to have infected around 1.7 billion individuals worldwide (Koo et al., 2020). Badash and Horn (2018) indicate that this illness is spread by tiny droplets of saliva emitted from the lips or nose of an affected individual. Those susceptible to getting this illness include those with a compromised immune system. TB may present in both latent and active states.
During the latent phases, the carrier cannot transmit the illness, but the sickness is infectious during the active stages (Al-Zanbagi & Shariff, 2021). In addition to chest discomfort and nighttime sweating, frequent symptoms include a chronic cough with a bloody stain and chest pain. Those affected by the illness can access various types of treatment, including antibiotic drugs (Behr et al., 2021). As a result, this assessment seeks to explore an in-depth analysis of tuberculosis, its various causes, symptoms, pathogenesis, epidemiology, prevention, treatment, and a novel plan that can help eliminate the disease from the community.
Causation
Mycobacterium tuberculosis is the causative agent of tuberculosis. In a few instances, M. pinnipedii, M. microti, M. caprae, M. canetti, and M. africanum may be responsible for this illness (Al-Zanbagi & Shariff, 2021). While its relevance has diminished, M. Bovis is still one of the causes of TB in humans. For instance, 1.4% of the cases reported in 2016 were attributed to M. Bovis (CDC, 2022).
Following contact with an infected individual, TB is a rare outcome of host-bacilli interaction in recently infected individuals. The most likely outcome will be a latent, asymptomatic illness (Behr et al., 2021). Consequently, the illness is transmitted when an individual with untreated, active tuberculosis in their lungs sneezes or coughs, and another inhales the ejected droplets containing TB germs. Therefore, although TB is infectious, it is difficult to acquire.
Signs and Symptoms
Most individuals exposed to the bacterium do not immediately exhibit signs of TB. The disease may instead progress through three phases. The primary TB infection occurs when the bacterium first enters the body (Al-Zanbagi & Shariff, 2021). This generates no symptoms in most individuals, while some may have a fever or pulmonary problems.
In most individuals with a sound immune system, no indications of infection will occur; nevertheless, in a few individuals, the bacteria may spread and evolve into an active illness. According to the CDC (2022), most initial TB infections are asymptomatic, followed by latent TB. With latent TB infection, the bacterium is present but inactive. According to Behr et al. (2021), this stage has no symptoms and cannot transmit the illness.
Most individuals do not experience symptoms since the organism enters their bodies and is subsequently dealt with by their immune systems. Those who acquired the virus lately, such as within the last two years, have a higher risk of the disease becoming active. It is also more active in persons with weaker immune systems due to malnutrition, old age, HIV infection, immunosuppressant medicines, or dialysis. Latent tuberculosis would be asymptomatic; therefore, most individuals with it would be unaware unless tested (Behr et al., 2021). The World Health Organization estimates that 25% of people worldwide have latent TB (CDC, 2022).
Once tuberculosis is active, signs arise. A persistent cough or chest discomfort may be the first symptom that a patient experiences. These signs are often overlooked or misdiagnosed as a different ailment. However, during the active stage of TB, patients may have a variety of symptoms, such as fatigue, widespread body pains, intermittent fever, weight loss and lack of appetite, night sweats, difficulty breathing, chest discomfort, coughing up blood or phlegm, and an overall feeling of ill health (Koo et al., 2020). In addition, the signs of TB differ based on the afflicted body part. TB of the lungs is indicated by coughing up blood or mucus (sputum). Bone pain may indicate bacterial invasion of the bones.
Pathogenesis
The dissemination of Mycobacterium tuberculosis aerosols begins the TB infection cycle. Between one and ten bacilli are disseminated throughout the atmosphere, elevating the likelihood of spread (Koo et al., 2020). In the patient’s lung, alveolar macrophage cells phagocytize the bacilli and infiltrate the epithelium. Here, monocytes from surrounding blood vessels form a granuloma as the immune system fights the infection. This is a defining feature of TB.
In the granuloma, lymphocytes, mononuclear phagocytes, and foamy macrophages surround a contaminated macrophage core (Koo et al., 2020). The outcome is a foamy macrophage fibrous capsule believed to produce the distinctive caseous debris at the granuloma’s core. While immunologically seeming to be confined, the caseous center tends to cavitate and liquefy as it releases huge amounts of Mycobacterium tuberculosis bacilli into the airway (Nyarko et al., 2021). The cycle concludes when the injured lungs generate a cough with infectious droplet nuclei.
Epidemiology
Tuberculosis only infects those who come into contact with those who have it. Others may be infected by going to countries where TB is prevalent. If a person moves to or lives in a region where TB is prevalent, their risk of exposure to the TB bacterium increases. TB tends to concentrate in metropolitan areas. For example, London has over 40% of all TB cases in the United Kingdom (Koo et al., 2020). Over 80 percent of the world’s TB cases are in only 22 nations (Nyarko et al., 2021).
Babies, toddlers, and adolescents exposed to tuberculosis patients are also susceptible to developing the disease. According to Al-Zanbagi and Shariff (2021), homeless, medically impoverished, low-income, and drug-addicted areas may have high case rates. This is because people who are homeless, living in overcrowded or poorly ventilated dwellings, or both, make it easier for the TB bacterium to spread and prolong its duration in the airborne suspension.
Constraints on the immune system, such as malnutrition, poverty, inadequate housing, and drug abuse, may all damage the immune system. For instance, kids under five are at a greater risk before and after infection since their immunity is weak (Al-Zanbagi & Shariff, 2021). Some diseases might also make a person more susceptible to tuberculosis. HIV-positive individuals are at increased risk for TB.
Prevention
Tuberculosis prevention is often better than treating it. While there is currently no guaranteed method to prevent tuberculosis transmission, several actions can be employed to reduce the transmission.
The BCG (Bacille Calmette-Guérin) Vaccination
The BCG vaccination is an efficient TB vaccine. TheBCG vaccine is made using Mycobacterium bovis. According to Koo et al. (2020), BCG has been the only approved TB vaccine since 1921. Despite being the most commonly used vaccination, there are still 9 million new TB cases yearly, proving the BCG’s low efficacy. The BCG has a 15-year effectiveness rate of 80 percent in preventing tuberculosis (Nyarko et al., 2021). Also, because of the high concentrations of environmental mycobacteria found in equatorial locations, it is less effective when administered to patients with complicated forms of TB. It is more successful in treating children under the age of 35.
Early Diagnosis
According to Koo et al. (2020), early detection and treatment are the best techniques to prevent TB transmission. One person with contagious TB may infect between 10 and 15 more individuals yearly. However, if found with tuberculosis and prescribed medication, most people are no longer contagious after only two weeks.
Case Finding
Infected individuals must be identified and treated to prevent them from infecting others and reduce tuberculosis spread. This may be accomplished by promoting knowledge of tuberculosis so that persons with TB signs are informed to seek care. In neighborhoods with a high incidence of tuberculosis, community professionals and volunteers also seek out individuals with signs and recommend them for screening (Pezzella, 2019). When one is found with active TB, their close friends are screened for it through the contact tracking process.
Managing the Environment
Although tuberculosis is an airborne illness, infected TB patients discharge TB germs into the environment when they sneeze or cough. A few basic steps may help lower the risk of illness. First, provide enough ventilation since TB may stay floating around without ventilation for many hours. Moreover, natural light is required since UV light destroys TB bacteria (Floyd et al., 2018).
Furthermore, hygiene is essential. For example, concealing the nose and mouth during sneezing or coughing prevents the spread of TB bacteria. In a hospital environment, tuberculosis spread is moderated by regularly screening healthcare personnel for TB, isolating potentially infected patients from other patients, using ventilation systems, and using protective masks.
A Healthy Immune System
A strong immune system is the most significant barrier against tuberculosis. 60% of people with sound immune systems may eliminate TB bacteria (CDC, 2022).
Diagnosis
Depending on the kind of testing resources available and TB suspected, various tests may be performed to detect TB.
Culture Test
Human tissue or fluid samples are obtained from a person believed to have tuberculosis. When pulmonary tuberculosis is suspected, sputum may be gathered in a jar. If it is suspected that TB has spread to another part of the body, a biopsy might be conducted (Pezzella, 2019). Any germs discovered in the samples may be propagated in culture under laboratory conditions. Culture tests are very dependable and may assist in deciding the correct treatment for the kind of tuberculosis identified, since they can differentiate between drug-sensitive and drug-resistant TB.
Chest X-ray
A chest X-ray may detect lung damage, a sign of pulmonary tuberculosis. Further tests are necessary to confirm TB as the cause of harm is detected.
Sputum Smear Microscopy
When coughing produces sputum, a microscope may be used to examine a sample. From the microscope, if one observes TB germs, then this may show that the patient has an active TB infection in the pharynx and lungs, also known as pulmonary tuberculosis (Pezzella, 2019). This is the only type of tuberculosis that may be contagious to other people. If tuberculosis germs are not visible, this does not rule out the disease. There might be too few germs for detection. A culture test is necessary to determine this.
GeneXpert
Here, using sputum samples, the GeneXpert device can detect TB germs. It may also determine if any current TB germs resist rifampicin (RIF) — a first-line TB medication. The cartridge-based, user-friendly technology offers findings within 90 minutes (Nyarko et al., 2021). The product received WHO approval in 2010 for TB-endemic nations (Pezzella, 2019). Although it is less accurate than a culture test, this test is more effective than sputum smear microscopy. Since they have fewer germs in their sputum, youngsters, those living with HIV, those with low CD4 counts, and those with additional pulmonary illness are less likely to benefit from this test.
TB Skin Test
The tuberculin skin test (TST) measures the immune system’s reaction to TB germs. It is performed by injecting the skin with a small quantity of tuberculin extract. If the skin gets red and elevated, the immune system has been exposed to TB (Pezzella, 2019). Nonetheless, a positive test does not always indicate an active infection. More testing is necessary. Besides this, latent tuberculosis and a previous BCG vaccine will trigger an adverse reaction.
Blood Test
Blood tests for tuberculosis are trustworthy indicators of TB disease. One clinic visit is sufficient to obtain results. A positive outcome, however, does not reveal if an illness is active or latent (Behr et al., 2021). More such experiments are required to figure this out. Today, there are two blood test technologies: T-SPOT. TB and QuantiFERON.
Treatment and Side Effects
The treatment for TB is very successful. Globally, over 90% of TB patients and 49% of drug-resistant TB cases are treated (CDC, 2022). Unfortunately, treatment is neither rapid nor straightforward. The treatment duration and adverse effects of the medications employed pose enormous challenges for tuberculosis patients and worldwide efforts to combat the illness.
Standard Treatment
The minimum duration of TB treatment is six months. TB is often treated with a combination of four antibiotics, namely Ethambutol, Pyrazinamide, Rifampicin, and Isonazid. In addition, Pyrazinamide, Rifampicin, and Isoniazid are available as a single tablet known as Rifater (Floyd et al., 2018). After two months of this therapy, patients may be switched to Isoniazid and Rifampicin for four months, also available in the same Rifinah tablet format (Floyd et al., 2018).
After two weeks of treatment, patients may start to feel better, and during this time, those with pulmonary TB usually stop being contagious. Nonetheless, patients must finish their therapy so that the TB germs in their bodies are entirely eradicated (Pezzella, 2019). This inhibits the recurrence of symptoms and the development of drug-resistant microorganisms.
Treating Drug-Resistant TB
Drug-resistant tuberculosis necessitates a lengthier course of therapy with various medication combinations that might cause additional adverse effects (Pezzella, 2019). Patients can be evaluated to determine the most effective treatment plan.
Treating Latent TB
According to the CDC (2022), 90% of latent TB patients do not progress to active TB disease; hence, most cases are not considered therapeutic. Those with a weakened immune system are advised to get treatment since they are more prone to acquiring active TB. This covers HIV-positive adults as well as kids. Latent TB may be cured using some of the same medications as active TB.
Directly Observed Treatment (DOT)
The duration of therapy for tuberculosis is at least six months; patients are required to take many pills daily, and adverse reactions are prevalent. To guarantee they are entirely treated and to avoid the development of drug-resistant tuberculosis, patients must take their medication as recommended and finish the course. DOT is a very effective method of assisting individuals in finishing treatment. It entails TB nurses, outreach volunteers, or trained volunteers interacting with patients regularly to monitor their medicine intake (Floyd et al., 2018). This may occur at the client’s home, a clinic, a pharmacy, or a neighborhood business. DOT guarantees that the right drug is given in the correct dosages, at the correct time, for the needed duration. In the United Kingdom, for example, DOT is prescribed for those with difficulties adhering to a treatment regimen, maybe due to lifestyle considerations such as homelessness, and those with MDR-TB.
Side Effects
It is normal to suffer adverse reactions to any drug. Most are harmless and will soon disappear. Before initiating therapy, the TB nurses or physician should inform patients about these. Frequent side effects of TB medications include flu-like symptoms, pins and needles, rashes, nausea, and dizziness (Pezzella, 2019).
In rare instances, jaundice may occur, characterized by yellowing of the eyes or skin (Floyd et al., 2018). If this occurs, the individual must immediately cease taking their medicine and inform their physician. Patients must always address adverse effects with their physician since it may be feasible to alter their TB treatment.
Novel Disease Control Plan
Although studies indicate that TB has been significantly eradicated, over 9 million new tuberculosis infections remain each year. This suggests that techniques to aid in eradicating the illness must be developed. Thus, it is important to devise a novel approach to controlling the spread of TB. The plan will consist of three sections: threat, readiness, and rapid detection and response.
Threat Awareness
In the case of a TB attack, there must be an advocate for effective management and communication links that ensure efficient containment of the threat. The procedure may be done by setting up a central coordinating body where local authorities can report outbreaks and request resources (people, materials, and facilities) to help (Cole et al., 2020). The central coordinating authority must ensure that it maintains communication links with local governments and, at the same time, be able to coordinate with the international community when such an event occurs (Cole et al., 2020).
Another critical part of this plan is providing information about specific situations that may occur during an attack. This includes outbreaks in different communities. This information must be made available to the general public and organizations so that they can understand what is happening comprehensively.
Preparedness
Preparedness is also advisable as it is a necessary measure of action that can be undertaken when dealing with TB threats. Cross-cutting issues, including proper financing, guaranteeing a continuous supply of TB drugs, and changing or creating new legislation to promote TB control, should be considered at the national and local levels (Cole et al., 2020). In an epidemic, this will guarantee a sufficient supply of drugs. This is especially important since such an attack may occur unexpectedly and at any time, and the citizens will need more time to prepare themselves properly.
The preparedness contributes to the availability of medical facilities, materials, and staff that can be employed to address the problem at hand successfully. In addition, readiness requires the existence of documented rules and procedures that specify the standard of care for tuberculosis prevention and treatment (Cole et al., 2020). These priorities, goals, and tactics should be evaluated and amended periodically and as necessary.
Prompt Detection and Response
The final essential component of this plan is a clear strategy for attaining quick disease containment and elimination. Authorities will likely need a rapid diagnosis and reaction mechanism to tackle health concerns properly. In addition, rules should be in place to ensure fast, obligatory reporting of each confirmed and suspected case of tuberculosis illness and safeguard public health by isolating and treating TB patients (Cole et al., 2020). Additionally, those who have started TB treatment and acquired a noninfectious level but are unable or unwilling to finish medication and are in danger of returning to or regaining infectious status should be detained immediately.
In addition, establishing an efficient, centralized coordinating body is one of this plan’s most important components since it guarantees that all state municipalities have access to the necessary information to react efficiently during an epidemic. Thus, developing technology, such as electronic health records, telemedicine, and electronic platforms for remotely seeing patients taking their drugs, should be incorporated to facilitate treatment in different ways (Cole et al., 2020). This approach must also examine high-risk TB patients, prescribe and monitor therapy, and quickly test and report findings.
Establishing an efficient communication network between the central coordinating body and other necessary parties guarantees that all reports are easily issued and received. Here, the plan should guarantee that contact is established between physicians and the health board for all hospital admissions and that patients with tuberculosis get treatment until they are healed, perhaps involving DOT (Cole et al., 2020). Priority should be given to treating people irrespective of their capacity to pay.
Conclusion
Tuberculosis is a highly infectious and sometimes fatal disease. The disease has existed for many years. For years, efforts have been made to combat the disease. However, despite the availability of a BCG vaccine and other prevention efforts, millions of individuals worldwide continue contracting the disease, and others end up dying. Many inventions have been made, but until now, individuals are still contracting TB at a high rate. Additionally, although everyone can contract tuberculosis, children, HIV-infected individuals, and the elderly are at a high risk of contracting the disease.
However, upon contacting TB, there is a higher chance of recovery because over 90% of TB patients and 49% of drug-resistant TB cases are treated. The best treatment of TB is through standard treatment, which involves four antibiotics, namely Ethambutol, Pyrazinamide, Rifampicin, and Isoniazid, excluding drug-resistant cases. Signs such as coughing up blood are significant indicators of active tuberculosis infection. Culture, blood, and skin tests are some diagnostic procedures that may help determine if one is infected. Therefore, TB is here to stay, and we can only defeat it if we adhere to the highlighted TB prevention recommendations.
References
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