Tuberculosis: Maria’s Case Study

Transmission and pathophysiology

Tuberculosis is potentially a very infectious disease that affects mainly the respiratory system, particularly the lungs. In severe conditions, sometimes, TB affects other body parts like the spine, kidney, and brain (Clay et al. 2019). Tuberculosis is caused by a mycobacterium called the tubercle bacillus. It is spread through the air from one person to another through the minute droplets released when a TB patient sneezes, sings, or coughs. The mycobacterium tuberculosis tiny droplets are commonly referred to as droplet nuclei, and their size is usually about 1 to 5 microns in diameter (Cadena et al. 2017). According to the World Health Organization (2016), the droplet nuclei that spread TB are released to the air when suffering from active pulmonary TB sneezes, sing, or cough. The contagious tubercle bacillus can stay in the air for a few hours, which also depends on the existing environmental conditions. Mycobacterium TB is transmitted when the droplet nuclei in the air get inhaled by another person via the nose or mouth.

Once inhaled, the droplets move through the respiratory tract until they get to the highly sensitive lungs alveoli. There, the tubercle bacillus is ingested by the macrophages though the majority of them are routinely destroyed by white blood cells. The bacilli, which get ingested by the lungs, alveoli reproduce drastically. The incubation period for M. tuberculosis varies from 2 to 12 weeks (Cadena et al. 2017). When the macrophages die due to bacterial infections, the bacilli are then released to the air. Although TB is highly contagious, it is not easy to get it from strangers but rather someone you work with or live with for some time.

Clinical Manifestations

Sometimes the body might host the M. tuberculosis bacteria but lack to cause the TB disease because strong immune systems can a person from becoming sick. Therefore some infections may not show any signs. Doctors and physicians classify TB into two distinct categories, latent TB and active TB. In potential TB cases, patients have the bacteria in their body but exhibit no signs or symptoms of the disease. The bacteria remain in their body in an inactive state and, therefore, not contagious. According to Cadena et al. (2017), approximately 10% of the latent infections usually develop active tuberculosis.

On the other hand, active tuberculosis is what makes people sick and often occurs years after infection. An active TB patient exhibits symptoms and has a high potential of spreading to other people (Lewinsohn et al. 2017). The notable signs and symptoms of active TB include chronic cough, fever, night sweat, blood-stained mucus, and weight loss.

A successful clinical diagnosis of TB requires a combination of physical examination, body fluids culture, chest x-rays, or microscopic examination. During TB testing, HIV status test is typically conducted since the virus has been proved to increase tuberculosis infections dramatically. The immune system gets suppressed by the virus infection, making it difficult to fight the tubercle bacilli.

Primary Medical and Psychosocial concerns

Maria’s TB condition raises some medical and psychosocial concerns. Given the facts of the case, Maria was infected with TB while stile in Peru two years ago while taking care of her grandfather. Therefore, it is clear that the bacteria have stayed in her body for quite long without treatment. Initial diagnosis by the physician indicates a reactivation TB, which means the TB has already progressed from latent to active stage because of the continued weakening of the immune system. When TB remains untreated for long, it can lead to more health complications like bronchial stenosis causing lobar collapse, parenchymal disease, pleural disease, as well as chest wall involvement due to the destruction of chest bone and cartilage. At the same time, it develops to multidrug-resistant TB. Maria’s TB poses enormous psychosocial challenges because of its highly infectious nature and the potential to infect co-workers and her family. At advanced stages, the disease has been identified to affect the psychosocial wellbeing of patients resulting from unsuccessful treatment (World Health Organization, 2016). After ineffective treatment in the first two months, we notice an increase in Maria’s stress levels. Such stress has the potential to affect her socioeconomic life and ability to adhere to treatment.

Treatment implications

Latent TB is easy to treat because of the ability of the body’s immune system to contain the disease. Treatment of the disease at this stage eliminates the chances of progression of infecting other people. While on medication, patients must avoid alcohol and acetaminophen to prevent liver damage (Siagian, 2019). The available regimen for treating latent TB include;

Rifampin administered daily for four months
Isoniazid and rifampin daily for three months
Isoniazid and rifapentine which is given weekly by a trained caregiver for three months
Isoniazid is taken daily for 6 to 9 months

Treatment for active TB involves administering a combination of drugs like isoniazid, rifampin, and other fluoroquinolones. The drugs are administered for up to seven months, depending on severity. Multidrug-resistant TB is more difficult to treat and requires a combination of four to six medications that need a more extended period (Siagian, 2019). TB treatment includes frequent visits to a doctor to ensure medical compliance and assess recovery progress. Compliance with medication is essential because failure can lead to the development of resistance, making the TB challenging to treat. Failure to comply with treatment therapy has been identified as the most dangerous challenge facing the treatment and control of the TB disease globally (World Health Organization, 2016). Patients who fail to follow the treatment plan may take longer to heal or develop resistance to drugs.

Role of community clinic

Community clinics in the United States are mandated to offer healthcare to all patients who may face challenges in accessing treatment at other institutions (Clay et al. 2019). Such challenges may include a lack of proper immigration documents or financial difficulties. The services offered in community clinics are meant to prevent and control contagious diseases and are supported financially by the state government. They help families and communities in promoting healthy living. The community clinic was able to offer treatment to Maria despite her lack of proper documentation. Besides, her treatment medications were funded by the clinic to reduce the cost burden (Clay et al. 2019). Moreover, community clinics promote healthy communities by educating patients on hygienic methods and other practices that prevent the spread of TB and other diseases.

Implications of TB on critical care and advanced practice nurses

As noted earlier, TB is very contagious, and if untreated for long, it may result in other health complications (Clay et al. 2019). Critical care nurses, as well as advanced practice nurses, are tasked with the provision of care to critically sick patients. These healthcare professionals are likely to handle patients of TB who develop complications due to the disease spreading to other body parts. Complications such as s back pain and stiffness, meningitis, tuberculosis arthritis, and liver, kidney, and heart disorders may cause patients to be bedridden. Nurses must practice caution to avoid self infection and infection to other patients by segregating hospitalized TB patients.

References

Cadena, A. M., Fortune, S. M., & Flynn, J. L. (2017). Heterogeneity in tuberculosis. Nature Reviews Immunology, 17(11), 691-702.

Clay, K., Egedesø, P. J., Hansen, C. W., Jensen, P. S., & Calkins, A. (2019). Controlling Tuberculosis? Evidence from the First Community-Wide Health Experiment (No. w25884). National Bureau of Economic Research.

Lewinsohn, D. M., Leonard, M. K., LoBue, P. A., Cohn, D. L., Daley, C. L., Desmond, E., … & O’Brien, R. J. (2017). Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clinical Infectious Diseases, 64(2), e1-e33.

Siagian, E. (2019). Tuberculosis Patient Adherence to Treatment and Transmission to Home Contact Family Members. Journal of Nursing Care, 2(2).

World Health Organization. (2016). WHO treatment guidelines for drug-resistant tuberculosis. World Health Organization.

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