Tuberculosis is a communicable disease suffered by all ages.
INTRODUCTION
Tuberculosis is a communicable disease
suffered by all ages. Tuberculosis is
known to man since ages. Hippocrates
called this disease as ‘phithesis’ which means ‘To dry of disease accelerated
greately’. The disease primarily affects
lungs and causes pulmonary tuberculosis.
DEFINITION:
Pulmonary tuberculosis is an
infectious disease of the parenchyma of the lung caused by ‘Mycobacterium
tuberculosis’ characterized by the formation of tubercle.
EPIDEMOLOGICAL FEATURES
Geographical Distribution
World wide, particularly in developing
and under developed countries.
Agent
Mycobacterium tuberculosis
Human and bovine strains of the
bacillus are of importance to man and fairly resistant to the action of
chemicals and heat.
Source of Infection
Human and bovine. Bovine is no problem in
Host Factors
Age:
It can occur at any age. Majority of
cases 20 to 40 years. In
Sex:
More in males than in females, more
prevalent among males over 40 years. It
effects all races and is not a hereditary disease.
Nutrition:
Studies shows that nutrition and diet
had no influence on recovery of patients.
Immunity:
Man has no inhereited immunity against
the disease. It is acquired as a result
of natural infection or BCG vaccine.
Environmental factors:
Standard of living is related factors
with occurrence of disease and social factors
Ø Over
crowding
Ø Poverty
Ø Education
Ø Occupation
Ø Large
families
Ø Industrialisation
Ø Malnutrition
Social Customs
Ø Habits
of indiscriminate spitting
Ø Use
of common hooka
Economic aspects:
Mass treatment by the government is not
possible due to high costs
Mode of Transmission
1.
Droplet
infection
2.
Inhalation of
fine dust containing tubercle bacilli from infected sputum.
3.
Ingestion of
contaminated food and milk.
Clinical Features
The
outset of tuberculosis is insidious and early symptoms vary from one individual
to the
Ø Dry
cough, later moist with varying amount of sputum.
Ø Loss
of weight associated with general malaise and fatigue.
Ø A
persistent pyrexia is presented.
Ø In
some cases cough associated with blood stained sputum.
Ø Chest
pain
Ø Dysponea
Ø Marked
weakness and wasting.
Ø Heamoptysis
Prevention
and Control of Tuberculosis
Early detection of cases:
The case is one whose sputum is
positive for tubercle bacilli. All
others are termed suspects.
a) Sputum Examination:
Sputum examination of two consecutive
specimens [Eg: On the spot and overnight sputum]
1.
Cough more
than two weeks duration
2.
Chest pain
3.
Hemoptysis –
spitting of blood
4.
MMR [Mass
Miniature radiography]
5.
Tuberculin
Testing
Manlaux testing:
PPD injection ill to fore arms results
in red papule after 72 hours, palpable oedema or induration more than 10 mm in
the longitudinal diameter is considered acceptable infection with bacilli.
Examination of the chest:
It is expensive but more sensitive and
specific like sputum examination.
Chemotheraphy
Antitubercular Drugs
Thaicetazone 150mg + 1NH 300 mg in a
single tablet with streptomycin daily for first two months yield 100% success.
In order to avoid drug resistance,
treatment must be complete and regular atleast with 2 to 3 drugs in
combination. Regimens of treatment are
as follows.
1) Daily regimens
1.
1NH + Thiacetazone
2.
1NH+Ethambatol
For seriously ill sputum positive TB
patient daily streptomycin 0.75 gm may be added in one of the above mentioned
regimes for initial 2 months period.
2) Bi-weekly or intermittent
regimens
Preferable
for sputum positive cases
Streptomycin
- 0.75
gm
1NH - 600 or 700 mg
Pyridoxine - 10mg
Short Course of Chemotheraphy
There are two recommended regimens
under the programme NTCP (National Tuberculosis Control Programme). These regimes have two phases, intensive
phase of first two months and continuations phase of 4 to 6 months.
Regimens(A)
It
is a biweekly intermittent supervised regimen total duration of treatment is
only 6 months. In the first two months
patient is given streptomycin (.75mg) 1NH (600mg), rifampicin (600mg) twice a
week for 4 months.
Regimen (B)
Initial
intensive phase of four drugs comprises treptomycin (0.25mg) 1NH (300mg)
rifampicin (450mg) Pyrazinamide (1.5mg) given daily for two months followed by
daily administration of 1NH (300mg) and thiazetazone (150mg) for a period of 6
months. Total duration of treatment is 8
months.
BCG Vaccination
The aim of BCG vaccination is to
induce a benign, artificial primary infection, which will stimulate an acquired
resistance to possibly subsequent infection with virulent tubercle bacilli.
Vaccine:
BCG is the only widely used live
bacterian vaccine. It consists of living
bacteria derived from an attenuated bovine strain of tubercle baccille.
Administration:
The standard procedure recommended by
WHO is to inject the vaccine intradermally using a ‘Tuberculin’ syringe. The site of injection should be just above
the insertion of the dettoid muscle.
DIRECTLY OBSERVED TREATMENT,
SHORT COURSE PDDTS] CHEMOTHERAPY
DOTS is a strategy to ensure cure by
providing the most effective medicine and confirming that it is taken. It is the only strategy which has been
documented to effective world wide on a programme basis. In DOTS, during the intensive phase of
treatment a health worker or other trained phase of treatment a health worker
or other trained persons watches as the patient swallows the drug in his
presence.
During the continuation phase, the
patient is issued medicine for one week in a multiblister combipack, of wich
the first dose is swallowed by the patient.
The consumption of medicine in the continuation phase is also checked by
return of empty multiblister combipack, when the patient comes to collect
medicine for the next week.
Rehabilitation
a)
Divisional
reading, music and indoor games
b)
Occupational:
learning music, knitting, drawing and painting, photography, toy making.
c)
Vocational
clinical job, laboratory job, typing, weaving carpet making tailoring, poultry,
farming.
d)
Chemoprophylaxis:
The 1934 expert committee on TB emphasized that preventive treatment is
irrational ever for special group. In
this regimen BCG has priority over chemoprophylaxis.
Role of hospitals
Ø Emergencies
such as massive haemoptysis and spontaneous pneumothorax.
Ø Surgical
treatment
Ø Management
of serious types
Ø Social
indications no one to look after the patient.
Drug resistance – resistant strains
a)
All drugs used
in the treatment of TB tend to produce resistant strains
b)
Primary or
pre-treatment resistance
c)
Secondary or
post – treatment resistance
b) Prevention of drug resistance
Ø Treatment
with two or more drugs in combination
Ø Using
drugs to which the bacteria are sensitive
Ø Ensuring
that the treatment is complete, adequate and regular
HEALTH EDUCATION
It is also an important aspect of
programme more stress to be given on health education of the community to
educate them about various aspects of tuberculosis for taking timely action in
prevention and treatment of TB disease.
This will also help in getting early care and to get co-operation of the
people.
NATIONAL TUBERCULOSIS PROGRAMME
[NTP]
The national Tuberculosis programme
has been in operation since 1962. it is
essentially a permanent country wide programme, integrated with the general health
services at both the rural and urban levels.
The long term goal of the NTP is “To reduce the problem of tuberculosis
in the community sufficiently quickly to the level where it ceasts to a public
health problem”.
Main
activities strategies of NTCP
Ø BCG
Vaccination of suspectible population under universal immunization programme
Ø Isolation
and treatment of cases
Ø Setting
up of training cum demonstration centres
Ø Rehabilitations
Ø Research
activities
CONCLUSION
Despite effective case finding and
effective therapeutic tools and declines in mortality and morbidity rates in
some countries, tuberculosis appears to continue as an important communicable
disease problem, world wide.
BIBLIOGRAPHY
Community
Health Nursing
B.T.
Basavanthappa
2nd
Edition
Page
No.713-715.
Parks
Text Book of Preventive and Social Medicine
17th
Edition
Page
No.146-150
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