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Tuberculosis

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VOL: 102, ISSUE: 02, PAGE NO: 25

AETIOLOGY
AETIOLOGY
- Tuberculosis (TB) is generally transmitted by the inhalation or ingestion of droplets that have been emitted by infected people when they cough, laugh or sneeze.


- The disease usually affects the lungs, although infection of other organ systems by other modes of transmission occurs. It may spread from the lung via the lymphatic and blood systems.


TYPES OF MYCOBACTERIA CAUSING THE DISEASE
1. Mycobacterium tuberculosis - the cause of most infections.


2. Mycobacterium bovis - spread to humans by cow's milk (rare).


3. Atypical or opportunistic mycobacteria - may infect people who are immunocompromised. The bacteria are mainly resistant in vitro to drugs for M. tuberculosis.


SIGNS AND SYMPTOMS
- Early signs: fever, anorexia, weight loss, vague chest pain and pleurisy.


- As the disease progresses: night sweats, expectoration of purulent sputum, dyspnoea and pulmonary haemorrhage.


DIAGNOSIS
- Medical history.


- Physical examination.


- Chest X-ray will reveal infiltrates, mediastinal lymphadenopathy, caseation, pleural effusion and calcification.


- Sputum cultures.


- Laboratory tests will show leukocytosis and an increased erythrocyte sedimentation rate (ESR).


TREATMENT
- Drug therapy - the bacillus is usually sensitive to isoniazid, streptomycin and rifampicin. Therapy usually lasts for one year.


- Ultraviolet radiation.


REGULAR TESTS
- Check the function of the kidneys, liver, eyes and ears to discover early signs of drug toxicity.


- Take sputum samples - when the bacillus is no longer present in the sputum the disease ceases to be infectious.


NURSING IMPLICATIONS
Before discharge patients are taught the following:


- How to prevent the spread of the disease;


- The elements of good nutrition;


- The names, doses and side-effects of all medications prescribed;


- The importance of taking their drugs regularly and keeping future appointments;


- Details of future appointments;


- Symptoms that must be reported including coughs and fever (see symptoms).


PROPHYLAXIS
- In the Mantoux, Heaf or Tine test, tuberculin (a protein taken from cultures of tubercle bacilli) is injected under the skin. After 48-72 hours, a raised red area at the injection site indicates a measure of immunity to TB. No reaction indicates the need for BCG vaccination.


- BCG (bacillus Calmette-Guerin) vaccination reduces the incidence of pulmonary TB in young adults by 80 per cent.


- Protection lasts up to seven years.


RESEARCH
- Trials using medication event monitoring systems (MEMS) are looking at TB patients' adherence patterns. Medication is held in a modified plastic phial that has a cap containing a microprocessor which records the exact time that the phial is opened and closed. This gives an idea of adherence (although it cannot prove that the medication was actually taken). Using MEMS, researchers can investigate whether it matters if patients adhere to a particular regimen in terms of efficacy.




FURTHER READING
Linton, A.D. et al (2000)
Introductory Nursing Care of Adults. Philadelphia, PA: WB Saunders.
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