Communicable Diseases: Tuberculosis
Tuberculosis (TB) (also known as Koch’s disease) is a communicable disease that is spread through the air. The incidence and the prevalence of this disease are not considerable to warrant immediate attention of the entire global health care system. However, the symptoms and complications of the disease can be severe, causing death. Additionally, since it is a communicable disease, it is important that the community health nurses prioritize the preventive measures to stop its spread. This paper analyses TB, focusing on the causes, symptoms, transmission, complications, and treatment and discusses the epidemiology, determinants of health, and the role of the National Tuberculosis Controllers Association and the community health nurses in TB management.
TB is caused by bacteria, which originate in the family of Mycobacterium. According to Jordao and Vieira (2011), the bacteria that cause TB are Mycobacterium bovis, Mycobacterium tuberculosis, and Mycobacterium avium. Importantly, most TB cases are caused by Mycobacterium tuberculosis. Jordao and Vieira (2011) further ascertain that despite the comprehensive knowledge regarding the etiology of TB, the molecular mechanism underlying the host defense against the bacilli remains elusive (p.1). Trying to understand this mechanism has been vital in devising appropriate treatment.
Patients with tuberculosis present with various symptoms. According to Wani (2013), cough is the commonest symptom. A patient can cough up blood, which causes chest pain and pain when breathing. Patients with TB also experience unexplained weight loss, anorexia, fever, weakness, and night sweats (Wani, 2013, p. 53). An individual with TB may also experience loss of appetite and fatigue. If TB advances, some of the symptoms that patients may exhibit include hemoptysis, dyspnea, enlargement of lymph nodes, and extreme loss of weight (p. 53). Some body organs such as the heart might also be affected.
Mode of Transmission
According to Wood et al. (2016), tuberculosis is spread from an infected person to a susceptible host by droplet infection. The transmission happens when an individual with pulmonary TB coughs up heavily infected sputum into the air. Though many people may become exposed to TB infection, only a few usually develop the actual disease. The reason is that the majority of people have acquired natural immunity to the disease. However, if this immunity is depressed by, for example, age or HIV infection, tuberculosis may flare up again and cause apparent clinical symptoms. Other factors that may predispose one to the TB include living in a crowded house, unsanitary environment and smoking (Godoy et al., 2013).
If an individual does not seek treatment earlier, TB might progress to severe complications, affecting other organs. Mbata and Iroezindu (2013) contend that the involvement of the lungs and other body systems are the major cause of mortality and morbidity in patients. TB might progress to the heart and cause heart failure. Consequently, a patient can present with symptoms such as dyspnea and edema (Mbata & Iroezindu, 2013, p. 4). TB may also affect the spine, leading to back pain and paraplegia (Mbata & Iroezindu, 2013, p.4). Additionally, TB can affect the meninges, causing meningitis, headache, and mental changes. Other organs such as the liver and the kidney may also be involved in advanced TB, triggering renal strictures, hydronephrosis and renal damage.
TB infection takes much longer to treat than other bacterial infections. According to the World Health Organization [WHO] (2010) guidelines, appropriate drugs for the management of tuberculosis include Rifampicin, Ethambutol, Isoniazid, and Pyrazinamide. Usually, Isoniazid is combined with Ethambutol for effective treatment. The aim of tuberculosis treatment is to kill the Mycobacterium within the shortest possible time. Therefore, the drugs are combined into regimens, namely first regimen, second regimen and third regimen, to ensure adequate eradication of the Mycobacterium.
Incidence, Prevalence/Morbidity, and Mortality of TB in the Dade County Florida
In this case, incidence measures all new cases of TB in Dade County of Florida during the year 2015. The United States Census Bureau (2015) indicates that Dade County had a population of 2.642 million in 2015. The Florida Health (2016) reports that 125 new cases of TB were reported in 2015. Therefore, the incidence of TB in Dade County of Florida IS 125/2.642 million which amounts to 0.000047, which translates into 4.7 cases per 100,000 people. The prevalence/Morbidity rate gives information about the total number of TB cases in Dade County in 2015, whether new or old cases. Prevalence rates enable the health care system to know how big a problem is. In Dade County, the available statistics indicate that there were 125 people with TB (Florida Health, 2016). Therefore, the prevalence is 125/2.642 million times 1000. It totals approximately five cases per 100,000 people in Dade County. There was no mortality case due to TB reported in Dade County.
Determinants of Health
According to WHO (2016), determination of disease involves interpretation of the distribution of illness regarding its possible causal factors. The disease determinant factors are the social and economic environment, physical environment, and characteristics and behaviors of an individual. According to Narasimhan, Wood, MacIntyre, and Mathai (2013), the social and economic situation that lead to TB includes poverty and overcrowding. Oxlade and Murray (2012) contend that TB happens mostly in poor people due to poor housing conditions that lead to congestion, which facilitates the transfer of the disease through the air. Similarly, the socio-environmental risk factors that cause TB include homelessness, alcohol, drug use, and smoking. However, the exact mechanism that leads to TB as a result of alcohol and drug use is not yet understood (Narasimhan et al., 2013). Homeless people are exposed to air which might be carrying the Mycobacterium. Individuals who have a suppressed immune system are also at a high risk of contracting TB (Narasimhan et al., 2013, p. 3). In people whose immune system is influenced by such diseases as HIV/AIDS and cancer the defense mechanism against the Mycobacterium is not efficient; thus, the individual can easily contract the disease. Similarly, malnutrition leads to immunosuppression, which predisposes one to TB infection (Narasimhan et al., 2013, p. 4). Diabetes mellitus has also been associated with risk factors due to its ability to impair the innate immune system (Narasimhan et al., 2013, p. 4). Finally, health care workers caring for TB patients are also at risk of contracting TB due to continuous exposure to the infected air (Narasimhan et al., 2013, p. 5).
According to the Centers for Disease Control and Prevention [CDC] (2012), the epidemiologic triangle is a model of disease causation, and it comprises the agent, the host, and the environment. In this case, the agent is the TB causative organism (Mycobacterium), the host is the person at risk of contracting TB, and the environment is a situation that brings the susceptible host (the person) close to the agent (Mycobacterium). The epidemiologic triangle for TB is illustrated below.
Figure 1. The epidemiologic triangle for TB.
From this model, the host, agent, and environmental factors have an equal role in causing TB. A delicate balance exists between the Mycobacterium, the susceptible host, and the environmental factors. From the determinants of health, it is noted that individual characteristics or environmental characteristics can cause TB, and they are variable. Therefore, the three factors can change in different ways. For instance, the Mycobacterium and the susceptible host can be dependent on the environment. If the environment does not support the Mycobacterium, it dies. Similarly, the TB causative agent and the environment can be reliant on the host (Individual characteristics). In this case, the Mycobacterium needs a suitable environment to infect the susceptible host. An immunocompromised person, a person with diabetes mellitus or an individual who abuses drugs stands a higher chance of contracting TB (Narasimhan et al., 2013). The communicable disease chain, which relates to the epidemiologic triangle, is illustrated in the appendix.
Role of Community Health Nurse
TB control needs not only pharmacologic care but also preventive care. Therefore, the community health nurse can check hospital records to understand the prevalence of TB in an area. The nurse can then collaborate with the community stakeholders in a medical and nonmedical TB management team. Afterward, the nurse should ensure that all susceptible people are tested for TB. Further, the role of the nurse is to facilitate the education of the community members regarding TB and the way it infects people. Then, the nurse can conduct surveillance by collecting data and tracking test results, which can be analyzed to determine the prevalence, incidence, and mortality rates. Finally, the nurse should monitor the needs of the community and advocate for the improvement of conditions that might lead to TB.
National Tuberculosis Controllers Association
The National Tuberculosis Controllers Association [NTCA] (2016) gathers the leaders of tuberculosis control programs in all states and territories. Its mission is to make the world free of tuberculosis by advocating for policies to advance TB control measures. Additionally, NTCA works with other organizations to eliminate TB in all states and territories. Finally, it advocates for TB monitoring and elimination activities, which have a significant impact on reducing TB.
From understanding the way TB spreads, it is possible to prevent it. TB is a communicable disease that is transmitted by the Mycobacterium. For it to spread, the susceptible host, the Mycobacterium, and the environment must interact. The illness affects people selectively due to various factors. Some people have a higher risk of getting TB due to compromised immune systems, drug abuse, malnutrition, and homelessness among others. Community health nurses have a significant role in ensuring that the community is aware of the disease and seeks prevention and treatment. Furthermore, the National Tuberculosis Controllers Association is equally relevant because it advocates for treatment and control of the disease.