TUBERCULOSIS

- TUBERCULOSIS is a chronic, sub-acute or acute respiratory disease commonly

affecting the lungs characterized by the formation of tubercles in the tissues which tend to
undergo caseation, necrosis, and calcification.

CAUSATIVE AGENT:
- The causative organism is a rod-shape organism Mycobacterium tuberculosis,
Mycobacterium africanum from human and Mycobacterium bovis from cattle.

- M. tuberculosis has an unusual, waxy coating on the cell surface (primarily mycolic acid),
which makes the cells impervious to Gram staining so acid-fast detection techniques are
used instead. The physiology of M. tuberculosis is highly aerobic and requires high levels
of oxygen. Primarily a pathogen of the mammalian respiratory system, MTB infects the
lungs and is the causative agent of tuberculosis.

MODE OF TRANSMISSION:

 The disease is transmitted by deliberate inoculation of microorganism or by droplet and

airborne.

1. The disease is transmitted through inhalation of organism directly into the lungs from
contaminated air.

2. It can also be transmitted through direct or indirect contact with infected persons, usually
by discharges from respiratory tract by means of coughing, sneezing or kissing.

3. The disease is transmitted through contact with contaminated eating or drinking utensils.

4. Rarely can the disease be transmitted through skin lesion

PERIOD OF COMMUNICABILITY:

 The patient is capable of discharging the organism all throughout life if he remains
untreated. The disease is highly communicable during its active phase.

MODE OF PREVENTION:

1. Submit all babies for BCG immunization.

2. Avoid overcrowding.

3. Improve nutritional and health status.

4. Advise persons who have been exposed to infected persons to receive tuberculin test and,
if necessary, chest x-ray and prophylactic isoniazid.
 IMMUNIZATION:

 BACILLUS CALMETTE GUERIN (BCG)

is a vaccine against tuberculosis that is prepared from a strain of the attenuated

(weakened) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its
virulence in humans by being specially cultured in an artificial medium for years. The
bacilli have retained enough strong antigenicity to become a somewhat effective vaccine
for the prevention of human tuberculosis. At best, the BCG vaccine is 80% effective in
preventing tuberculosis for a duration of 15 years; however, its protective effect appears
to vary according to geography.

PATHOGNOMONIC SIGN:

 HEMOPTYSIS: Blood in the sputum

OTHER SIGNS and SYMPTOMS INCLUDE:

1. Afternoon rise of temperature

2. Night sweating

3. Body malaise and weight loss

4. Cough, dry to productive

5. Dyspnea, hoarseness of voice

6. Occasional chest pain

DIAGNOSTIC PROCEDURES:

1. Chest x-ray

- is a projection radiograph of the chest used to diagnose conditions affecting the chest,
its contents, and nearby structures. Chest radiographs are among the most common films
taken, being diagnostic of many conditions.

2. Tuberculin Testing or Mantoux Test

- (also known as the Mantoux screening test, Tuberculin Sensitivity Test, Pirquet
test, or PPD test for Purified Protein Derivative) is a diagnostic tool for tuberculosis.
 5 mm or more is positive in

 HIV-positive person
 Recent contacts of TB case
 Persons with nodular or fibrotic changes on chest x-ray consistent with old healed TB
 Patients with organ transplants and other immunosuppressed patients

 10 mm or more is positive in

 Recent arrivals (less than 5 years) from high-prevalence countries

 Injection drug users
 Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes,
hospitals, homeless shelters, etc.)
 Mycobacteriology lab personnel
 Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged
corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption
syndromes, low body weight, etc.)
 Children less than 4 years of age, or children and adolescents exposed to adults in high-
risk categories

 15 mm or more is positive in

 Persons with no known risk factors for TB

3. Sputum Analysis for AFB - confirmatory

- is a test to detect and identify bacteria or fungi (plural of fungus) that are infecting the
lungs or breathing passages. Sputum is a thick fluid produced in the lungs and in the
airways leading to the lungs. A sample of sputum is placed in a container with substances
that promote the growth of bacteria or fungi. If no bacteria or fungi grow, the culture is
negative. If organisms that can cause infection (pathogenic organisms) grow, the culture
is positive. The type of bacterium or fungus will be identified with a microscope or by
chemical tests.
 MEDICAL MANAGEMENT:

1. Short course chemotherapy may be given through a six-month treatment with :

FIRST GENERATION:

R- ifampin

I- soniazid

P- yrazinamide

E- thambutol

SECOND GENERATION:

S-treptomycin

2. Patients with drug resistance may be given with second line drugs such as capreomycin,
streptomycin, cycloserine, amikacin, and quinolone drug.

3. WHO recommends “DIRECT OBSERVED THERAPY” (DOT) to prevent non-

compliance,

NURSING MANAGEMENT:

1. Maintain respiratory isolation until patient responds to treatment or until patient is no

longer contagious.

2. Administer medications as ordered.

3. Always check sputum for blood or purulent expectoration.

4. Encourage questions and conversation so that the patient can air his or her feelings.

5. Health teaching about the disease and disease process.