Tuberculosis
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
Comments
Post a Comment