Sample Health Care Research Paper on Tuberculosis

Tuberculosis

Abstract

Studies have pointed out that tuberculosis has been responsible for many deaths in the community; the disease can be transmitted from one person to another especially upon contamination with the drops containing the microbes. The symptoms may vary from one person to another but in most cases suspected cases of tuberculosis have had symptoms like lack of appetite and weight loss, high temperature, sweating at night, extreme tiredness and fatigue among others. As discussed below the methods to contain the disease include administrative measures, environmental controls and use of respiratory protective equipment and devices, and treatment is available through drugs. Experts have opined that in order to reduce the spread of TB all-encompassing research should be conducted to highlight ways of controlling the contagion to the populace.

History of the disease

Over the past decades tuberculosis has been known to humans and most people believed that it had the capability of consuming the entire body of patients. This was supported by the ability of the disease to cause severe weight loss to the patient and the extreme pallor that was evident among those individuals who were infected by the disease. Despite the developments in dealing with the disease through comprehensive screening and diagnosis, many people are still exposed to infections with the number estimated to be 90 percent mostly in the developing countries across the world. Moreover, the surfacing of HIV infections had led to a dramatic resurgence of tuberculosis with experts estimating that about 8 million cases of the disease are reported and a further 2 million people are believed to be dying from it.

Historically, medical specialists have opined that the organism causing the disease existed between 15,000 to 20,000 in Egypt and China with archaeologists discovering Pott’s disease associated with tuberculosis among the Egyptian mummies. In the middle ages, a disease that was termed as king’s evil that could be closely linked to tuberculosis affected the cervical lymph nodes; it was widely believed that only the kings of England and France could heal the patients from the ailments simply by touching them.

Medical experts have asserted that in the 18th century the disease reached its peak with an estimated 900 out of 100,000 people dying courtesy of the disease (Lange et al, 2012). The deaths and the high prevalence rate of infections were blamed on poor ventilations and overcrowded housing, poor sanitation and malnutrition among the population; it is during this time that extreme pallor emerged. It is worth pointing out that there are some famous people who suffered from the disease and notably they comprised poets John Keats and Percy Bysshe Shelley, the authors Robert Louis Stevenson, Emily Bronte, and Edgar Allen Poe, the musicians Nicolo Paganini and Frederic Chopin among others.

Discoveries that were pertinent to the disease was demonstrated by individuals such as Robert Koch, who in 1982 discovered that the organism causing the disease had a unique protein coating that made it impossible to comprehend. However, Wilhelm Roentgen developed X-rays that was vital in improving and advancing diagnosis of the disease in 1895, this prompted early diagnosis of the disease and isolation of the already infected individuals to mitigate the spread of the disease to other individuals of the population.

In the 19th century the concept of isolating infected individuals gained more ground with Hermann Brehmer and Edward Livingston initiating the first sanatorium in the United States. This was considered a milestone as infectious patients were isolated from the community for treatment, rest and improved nutrition; this mitigated and controlled the spread of the disease to other members of the society. Developments were also witnessed with United States establishing National Tuberculosis Association which later evolved into the American Lung Association in 1904 (Lange et al, 2012). 

As the world witnessed major developments in the field of medicine, Louis Pasteur began developing vaccines that could be used against diseases like anthrax, chicken pox and rabies around 1880s. Similarly, in 1908 Albert Calmette and Camille Guerin, French scientists grew Koch’s bacillus in several mediums to decrease their virulence and increase the capacity to produce immunity (Lange et al, 2012).  It is believed that their efforts led to the now famous vaccine called BCG introduced in 1921 and named after the two founders (Lange et al, 2012). 

It has been established that James Carson a Scottish physician began the treatment that involved draining pleural effusion from around the lungs and found out that surgery helped prolong life (Lange et al, 2012).  However, myriad techniques evolved, but due to lack efficiency disappeared later after the inventions of anti-tubercular drugs that could help treat the disease. It was established that these antibiotics were useful against tuberculosis until 1944 when streptomycin was discovered (Lange et al, 2012). However, due to the resistance against antibiotics, scientists developed PAS that was oral unlike streptomycin. Consequently, more effective drugs were developed and currently there are fewer than 20 agents with activity against mycobacterium (Patterson and CDC, 2006). 

Symptoms

Medical practitioners have opined that the symptoms of TB profoundly are contingent on where the contagion ensues as it usually develops slowly (Patterson and CDC, 2006).  Studies have established that the main symptoms of the disease include lack of appetite and weight loss, high temperature, sweating at night, extreme tiredness and fatigue (Patterson and CDC, 2006).  In addition, a patient may show other symptoms depending on the part of the body that is infected for instance, pulmonary TB that infects the lungs will have symptoms like a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody breathlessness that gradually gets worse. On the other hand, Extra-pulmonary TB that is not common and infects areas outside the lungs, bones and joints, digestive systems, bladder, reproductive systems and the nervous systems (Patterson and CDC, 2006).  This kind of tuberculosis is associated with symptoms such as persistently swollen glands, abdominal pain, and loss of movement in the affected bone, confusion, a persistent headache and seizures.

The cause of the disease

Experts have confirmed that tuberculosis is caused by a type of bacteria called Mycobacterium tuberculosis (Patterson and CDC, 2006).  It is worth noting that the condition can be spread from one person to another especially if the former exhibits an active TB infection, this is made possible through coughs and sneezes where the latter inhales the expelled droplets from the patient with an active infection. Studies conducted further affirm that an individual spending prolonged time next to an individual with the infection may be easily infected and that is why TB infections usually spread between family members who live in the same house (Patterson and CDC, 2006). 

Significantly, it is believed that the populace with TB may be infectious however children with TB or people with TB that occurs outside the lungs may not spread the infection to others easily (Patterson and CDC, 2006). This is described as latent TB and so may make it possible for the bacteria to infect the body but does not cause any symptoms, or the infection begins to cause symptoms within weeks or months (Patterson and CDC, 2006). 

Studies have found out that anyone is at risk of being infected especially those who live in, come from, or have spent time in a country or area with high levels of tuberculosis where there is prolonged close contact with someone who is infected living in crowded conditions (Patterson and CDC, 2006). Secondly, individuals with a condition that weakens their immune system, such as HIV stands a greater chance of being infected. Third, individuals involved in the treatments that weaken the immune system, such as corticosteroids, chemotherapy or tumor necrosis factor inhibitors may also acquire the disease easily (Patterson and CDC, 2006). Fourth, those members of the community who are too young or very old may acquire the disease because the immune systems of such people tend to be weaker than those of healthy adults. Lastly, medical professionals have established that who are in poor health or with a poor diet because of lifestyle and other problems, such as drug misuse, alcohol misuse, or homelessness may also acquire the disease through infection.

Method to spread the disease

Methods of spreading the disease are dependent on the contact between an individual with an active TB condition and an individual without. Significantly, medical experts have established that when a person with the disease in their lungs or throat cough, laugh, sneeze, sing, or even talk, the germs that cause TB may be spread into the air (Patterson and CDC, 2006).  Consequently, if another individual breathes these germs there is a possibility of contamination and hence will become infected. It is important to point out that it is always not easy for someone to be infected with the disease however usually a person has to be close to someone with tuberculosis disease for a long period of time (Patterson and CDC, 2006). Research studies have established that even if someone becomes infected with TB that does not mean they will get active TB disease (Patterson and CDC, 2006). 

Methods to contain the disease

Transmission of the disease is well documented in health care settings where health care workers and patients come in contact with those individuals with the TB disease (Street and Victorian Infectious Diseases Service, 2012). In communities individuals come in contact with friends and families with the disease and so there is need for mechanisms to be put in place to contain the spread of the disease (Street and Victorian Infectious Diseases Service, 2012).  Concerns have been raised on the people who work or receive patients in medical facilities; they are at a higher risk of being infected with the disease. This means that there is need for prompt detection of infectious patients, airborne precautions, and treatment of people who have suspected or confirmed TB disease; this should also apply to the individuals occupying the community (Street and Victorian Infectious Diseases Service, 2012).

In order to contain the spread the disease in all health care settings and community, particularly those in which people are at high risk for exposure to TB, policies and procedures for TB control should be developed, revised intermittently, and evaluated for efficacy to determine the actions necessary to minimize the risk for transmission of TB (Street and Victorian Infectious Diseases Service, 2012). Measures to contain the spread the disease could be divided into administrative measures, environmental controls and use of respiratory protective equipment and devices.

Administrative control measures are very important in containing the transmission of the disease; they are believed to be management measures that are aimed at reducing the risk of exposure to persons with TB (CDC, 2016). Studies have established that these measures may entail activities such as assigning someone the responsibility for TB infection control in the health care setting, conducting a TB risk assessment of the setting, developing and implementing a written TB infection-control plan and ensuring the availability of recommended laboratory processing, testing, and reporting of results associated with the disease. In addition, there is need to implement effective work places for managing patients, ensuring proper cleaning, sterilization, or disinfection of equipment that might be contaminated and educating, training, and counseling health care workers, patients, and visitors about TB infection and TB disease.

Moreover, it is paramount to ensure that testing and evaluation of workers and those who are at risk of contacting the disease are conducted, applying epidemiology-based prevention principles, including the use of setting-related TB infection-control data and using posters to remind members of the community of the importance of proper cough etiquette and hygiene.

Environmental control measures to contain the spread of TB are aimed at controlling the source of infection through improving ventilation so as to dilute and remove the contaminated air especially in places with large numbers of member in hoods, tents or booths. There is also need to control the airflow so as to prevent contamination of air in areas contiguous to basis midair contagions of the disease (CDC, 2016). This may also involve cleaning the air using high efficiency particulate air filtration.  

Respiratory protection control measures consists the use of personal protective equipment and gadgets in situations that the risk of exposure to TB is high (CDC, 2016). Measures to put in place in containing TB would be to implement a respiratory protection program, train health care workers on respiratory protection and educate patients and members of the community on respiratory hygiene and the importance of cough etiquette procedures.

Number of people infected or affected

According to the World Health Organization, tuberculosis is a top infectious disease worldwide that in the year 2014 accounted for 1.5 million demises out of the 9.6 million that were diseased (WHO, 2016). World Health Organization further points out that over 95 percent of the demises befell individuals in low and middle income states (WHO, 2016). It is worth noting that tuberculosis as a disease is a leading killer of HIV-positive people and in 2015, one out of three HIV deaths was due to tuberculosis (WHO, 2016).  

It is estimated that in 2014, half a million people developed multi-drug resilience tuberculosis that prompted the millennium development goals to be reversed to the tuberculosis epidemic, this was reported by the assertion that deaths due to the diseases dropped by 47 percent between the period of 1990 and 2015. World Health Organization further points out that a projected 43 million lives were salvaged through TB analysis and treatment between 2000 and 2014. Therefore, it is clear that bringing to an end the tuberculosis epidemic by the year 2030 is among the health goals of the newly adopted development goals.

According to CDC a third of the world’s populace is infected with tuberculosis (CDC, 2016). In respect to United States the cases were 9,421 in 2014 however, it is appraised that the stated cases represented a 1.5 percent decline in comparison to 2013 (CDC, 2016).  “In United States a total of 66 percent cases of tuberculosis were reported among foreign-born individuals, this was 13 times higher than the cases reported among the United States born persons” (CDC, 2016).  “The breakdown of tuberculosis case in United States is as follows; 5 tuberculosis cases per 100,000 persons among the American Indians, Asians account for 17.8 cases per 100,000 persons, 5.1 cases per 100,000 persons among the African Americans” (CDC, 2016).  “In addition, Native Hawaiians registered 16.9 cases per 100,000 individuals while Hispanics registered 5 tuberculosis cases per 100,000 persons and the whites had 0.6 TB cases per 100,000 persons” (CDC, 2016).

Reported TB Cases, United States, 1982–2014.  The resurgence of TB in the mid-1980s was marked by several years of increasing case counts until its peak in 1992. Case counts began decreasing again in 1993, and 2014 marked the twenty-second year of decline in the total number of TB cases reported in the United States since the peak of the resurgence. From 1992 until 2002, the total number of TB cases decreased 5%–7% annually. From 2002 to 2003, however, the total number of TB cases decreased by only 1.4%. An unprecedented decrease occurred in 2009, when the total number of TB cases decreased by more than 10% from 2008 to 2009. In 2014, a total of 9,421 cases were reported from the 50 states and the District of Columbia (DC). This represents a decline of 1.5% from 2013 and a decline of 64.7% from 1992.

Figure 1: Reported TB cases in United States, 1982-2014

Public health costs

Research studies have discovered that the costs associated with tuberculosis consists of both patient-incurred costs and provider costs (Patterson and CDC, 2006). Tuberculosis treatment costs for patients are estimated to be 14,659 dollars in high income countries, an estimated 840 dollars in upper middle income countries, 273 dollars in lower middle countries and 258 dollars in low-income countries thus showing a positive correlation.

The cost of hospitalization in United States for one tuberculosis patient is estimated at 483,000 dollars which is nearly 25 times the average for all primary hospital stays for tuberculosis (WHO, 2016).  Medical professionals have opined that in order to make new tuberculosis vaccines to the whole world in the next 15 years the cost to be incurred may range from $600 million to $1 billion and will be dependent on the probability of success of the different candidates.

Treatments

Medical professionals have affirmed that treatment of tuberculosis have additional consideration for instance, people living with HIV and additionally have TB disease can be efficiently treated of the ailment (Patterson and CDC, 2006). It has been pointed out that the initial step would be for such people to be tested for tuberculosis and then start treatment based on the results from the tests conducted. For individuals with HIV virus the recommended treatment for latent TB would be a daily dose of isoniazid for nine months and for adult patients with HIV is a six month dose of regimen that consists of an initial phase of isoniazid, a rifamycin, pyrazinamide and ethambutol for the first two months (WHO, 2016).

For pregnant women, untreated tuberculosis may present a greater hazard to the woman and her unborn child and so treatment should be initiated whenever the probability of tuberculosis is moderate to high (CDC, 2016). Experts have confirmed that if tuberculosis is left untreated then the effects would be felt and include reduced birth weight and to extreme circumstance, the baby may be born with TB (CDC, 2016). The treatment would include Isoniazid daily or twice weekly for nine months, with pyridoxine supplementation, and medical scientists have affirmed that 3HP INH and rifapentine is not recommended for pregnant women or women expecting to be pregnant in the next 3 months. It is worth noting that streptomycin should not be used because it has been shown to have harmful effects on the fetus and likewise pyrazinamide is not recommended to be used because its effect on the fetus is unknown. Nevertheless, pregnant women who are being treated for drug resistant tuberculosis should access counseling services regarding the peril to the unborn (CDC, 2016).  

Medical professionals have asserted that the risk of infection in children to tuberculosis is more than that of the adults and is usually due to fact that adults are affected from past infection that transforms to active contagion after some time later (CDC, 2016). Studies have discovered that a pediatric tuberculosis expert should be involved in treating tuberculosis in children to reinforce the importance of completing the dosage based on instructions (CDC, 2016). In children, the treatment process will entail taking the medicines for six to nine months; in a situation that the child stops taking the drugs threw is high possibility that the child may become sick again. This is because the microorganisms causing the disease may still be alive to become resistant to such drugs, and studies have recognized TB that is resistant to drugs is more problematic and expensive to treat, the treatment may last even longer than expected (Patterson and CDC, 2006). 

Current and future educational efforts

As much as the public health professionals need education in order to reduce the spread of the disease, the patients too need the knowledge (CDC, 2016). Education is necessary for people living with tuberculosis so as to help them know how to take their drugs in the right way, need knowledge on how to limit the spread of the disease to others in the community (CDC, 2016).

Specifically, public health professionals are involved in intensive research towards innovation that would assist in controlling tuberculosis, the fundamental research is aimed at gaining understanding of the biology of various strains of mycobacterium tuberculosis and how they affect and interact with humans and will inform the research and development of better tools for tackling the crisis. Secondly, in the current public health professionals are coming up with new diagnostic technologies that will provide quick and accurate diagnosis of the disease (Patterson and CDC, 2006). The technologies are also important in determining drug susceptibility or resistance of the infection and are also essential to ensuring that patients receive the best treatment and cease to spread the disease.

Majority of the patients have complained of the longer duration that it takes for the patient to complete the medication, future research and education should put much focus on how to shorten the duration of therapy and reducing its toxicity, while also bolstering its efficacy against resistant forms of tuberculosis. Health professionals should also be involved in extensive research and studies to develop a new vaccine that will help in protecting against new infections. Finally a consistent and operational research aimed at investigating the best ways to provide optimal care and implement new technologies for TB patients must take place to develop better policies and strategies for future tuberculosis management and help reduce the spread of the disease (Patterson and CDC, 2006).   

Conclusion

Public health professionals have affirmed that tuberculosis is a killer disease responsible for many deaths in the community and countries across the world (Patterson and CDC, 2006).   The symptoms for the diseases are visible but mostly a cough that goes beyond three weeks may be a suspected case of the disease. Apart from patients completing the medication dose there is need for international agencies to find methods of controlling the spread of the disease in collaboration with local health ministries. However, bulk of the efforts must come from the local stakeholders so as to ensure that tuberculosis treatment reach people where they live, and active case finding is the only way forward in dealing with the disease (Lange et al, 2012). 

References

CDC. (2016). Tuberculosis. Web. https://www.cdc.gov/tb/

Lange, C., Migliori, G. B., & European Respiratory Society. (2012). Tuberculosis. Sheffield:

            European Respiratory Society.

Patterson, R. M., & CDC (U.S.). (2006). The CDC’s tuberculosis guidelines: Key strategies for

            compliance. Marblehead, MA: HCPro.

Street, A., & Victorian Infectious Diseases Service. (2012). Management of tuberculosis: A

 handbook for clinicians. Parkville, Vic: Victorian Infectious Diseases Service.

WHO. (2016). Tuberculosis. Web. http://www.who.int/topics/tuberculosis/en/