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Arlyn Juniata
Celline
Faris Fatih
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Jerry Lim
Zesky Setiawan
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 CHAPTER 1

INTRODUCTION

What is Tuberculosis?

Tuberculosis (TB) is caused by

bacteria (Mycobacterium
tuberculosis) that most often affect
the lungs. TB is spread from person
to person through the air. When
people with lung TB cough, sneeze
or spit, they propel the TB germs into the air. A person needs to inhale only
a few ofthese germs to become infected. About one-quarter of the world's
population has latent TB, which means people have beeninfected by TB
bacteria but are not (yet) ill with the disease and cannot transmit the
disease.

People infected with TB bacteria have a 5–15% lifetime risk of falling ill with
TB. Personswith compromised immune systems, such as people living with
HIV, malnutrition or diabetes, or people who use tobacco have a higher risk
of falling ill.

When a person develops active TB disease, the symptoms (such as cough,

fever, nightsweats, or weight loss) may be mild for many months. This can
lead to delays in seekingcare, and results in transmission of the bacteria to
others. People with active TB can infect 5–15 other people through close
contact over the course of a year. Without propertreatment, 45% of HIV-
negative people with TB on average and nearly all HIV-positivepeople with
TB will die.
Treatment

TB is a treatable and curable disease. Active, drug-susceptible TB disease is

treated with astandard 6-month course of 4 antimicrobial drugs that are
provided with information andsupport to the patient by a health worker or
trained volunteer. Without such support, treatment adherence is more
difficult.Between 2000 and 2018, an estimated 58 million lives were saved
through TB diagnosis andtreatment.

Definition of Terms

HIV is infection with the Human Immunodeficiency Virus, the virus that
causes AIDS (Acquired Immunodeficiency Syndrome). A person with both
latent TB infection and HIV infection is at very high risk for developing TB
disease.

Malnutrition is a condition that results from eating a diet in which one or

more nutrients are either not enough or are too much such that the diet
causes health problems. It may involve calories, protein, carbohydrates, fat,
vitamins or minerals.

Antimicrobial is an agent that kills microorganisms or stops their growth.

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Research Framework

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 Chapter 2
Review of Related Literature

Tuberculosis is spread from one person to the next through the air when
people who have active TB in their lungs cough, spit, speak, or sneeze.
People with latent TB do not spread the disease. Active infection occurs more
often in people with HIV/AIDS and in those who smoke. Diagnosis of active
TB is based on chest X-rays, as well as microscopic examination and culture
of body fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST)
or blood tests.

Sign and Symptoms

Tuberculosis may infect any part of the body, but most commonly occurs in
the lungs (known as pulmonary tuberculosis). Extrapulmonary TB occurs
when tuberculosis develops outside of the lungs, although extrapulmonary
TB may coexist with pulmonary TB.

General signs and symptoms include fever, chills, night sweats, loss of
appetite, weight loss, and fatigue. Significant nail clubbing may also occur.

 Pulmonary
If a tuberculosis infection does become active, it most commonly
involves the lungs (in about 90% of cases). Symptoms may include
chest pain and a prolonged cough producing sputum. About 25% of
people may not have any symptoms (they remain "asymptomatic").
Occasionally, people may cough up blood in small amounts, and in
very rare cases, the infection may erode into the pulmonary artery or
a Rasmussen's aneurysm, resulting in massive bleeding. Tuberculosis
may become a chronic illness and cause extensive scarring in the
 upper lobes of the lungs. The upper lung lobes are more frequently
affected by tuberculosis than the lower ones. The reason for this
difference is not clear. It may be due to either better air flow, or poor
lymph drainage within the upper lungs.

 Extrapulmonary
In 15–20% of active cases, the infection spreads outside the lungs,
causing other kinds of TB. These are collectively denoted as
"extrapulmonary tuberculosis". Extrapulmonary TB occurs more
commonly in people with a weakened immune system and young
children. In those with HIV, this occurs in more than 50% of cases.
Notable extrapulmonary infection sites include the pleura (in
tuberculous pleurisy), the central nervous system (in tuberculous
meningitis), the lymphatic system (in scrofula of the neck), the
genitourinary system (in urogenital tuberculosis), and the bones and
joints (in Pott disease of the spine), among others. A potentially more
serious, widespread form of TB is called "disseminated tuberculosis", it
is also known as miliary tuberculosis. Miliary TB currently makes up
about 10% of extrapulmonary cases.

Causes
The main cause of TB is Mycobacterium tuberculosis (MTB), a small, aerobic,
non-motile bacillus. The high lipid content of this pathogen accounts for
many of its unique clinical characteristics. It divides every 16 to 20 hours,
which is an extremely slow rate compared with other bacteria, which usually
divide in less than an hour. Mycobacteria have an outer membrane lipid
bilayer. If a Gram stain is performed, MTB either stains very weakly "Gram-
positive" or does not retain dye as a result of the high lipid and mycolic acid
content of its cell wall. MTB can withstand weak disinfectants and survive in
a dry state for weeks. In nature, the bacterium can grow only within the
cells of a host organism, but M. tuberculosis can be cultured in the
laboratory.
 Chapter 3

THE SUBJECT

There’s a case of a 43-year-old male, visiting from China, who presented to

the emergency department complaining of hemoptysis of 10 days’ duration.
This was associated with mild right-sided pleuritic chest pain and night
sweats. The patient denied any shortness of breath, fever, or weight loss.
The patient did not report any history of sick contacts. The patient was
admitted from the emergency department to the floor. On admission, the
patient had a normal physical examination and no significant laboratory
abnormalities. Informed consent was obtained. A chest computed
tomography scan showed a cavitary lesion with an air-crescent sign in the
apical segment of his right lower lobe, suggestive of fungal infection.

Acid fast bacillus and fungal cultures were performed on three consecutive
early morning sputum specimens after admission; all were positive for acid
fast bacteria but were negative for fungi. Tuberculosis infection was
confirmed by the DNA probe method. The patient was discharged on first-
line therapy with isoniazid, rifampin, pyrazinamide, and ethambutol with
pyridoxine. The patient’s country of origin, China, created concern for MDR-
TB. As a result, further evaluation of the isolates was performed.

A molecular test for the rpoB gene coding for rifampin resistance was
negative. Two weeks later, susceptibility testing of the isolate showed
resistance to isoniazid, pyrazinamide, and ethambutol. Therapy was
subsequently changed to amikacin, linezolid, moxifloxacin, and rifampin.
After discussion with the Center for Disease Control (CDC), the isolate was
sent to the CDC for evaluation of resistance genes. Over the following two
weeks, the patient’s symptoms were stable. Results from the CDC were
negative for resistance genes. Repeat susceptibility testing showed that the
strain was susceptible to isoniazid, pyrazinamide, and ethambutol. With
these results in hand, the patient was restarted on his original anti-TB
regimen. The patient was then able to return to China. It is our suspicion
that the initial susceptibility test was contaminated with oral flora or a
respiratory tract organism that was resistant to isoniazid, pyrazinamide, and
ethambutol.
 CHAPTER 4

CONCEPT SYNTHESIS

Conclusion

Tuberculosis (TB) is an ancient human disease caused by

Mycobacterium tuberculosis which mainly affects the lungs.
The organ system most commonly affected include the
respiratory system, the gastrointestinal (GI) system, the
lymphoreticular system, the skin, the central nervous system,
the musculoskeletal system, the reproductive system, and the
liver.

Framework of the Subject

Symptoms
 Coughing that lasts three or
more weeks.
 Coughing up blood.
 Chest pain, or pain with
breathing or coughing.
 Unintentional weight loss.
 Fever.
 Clinical
Procedures
 Blood tests.
 Imaging tests.
 Sputum tests.

Diagnosis  CT scan, MRI scan or

ultrasound scan ofthe affected
part of the body.
 Urine and blood tests.
 Chest X-ray.

Treatment
 taking antibiotics for
severalmonths (Isoniazid,
Rifampin, Ethambutol,
Pyranamide).
Plan
 Quit smoking.
 Taking antibiotics for several
months.
 Chapter 5

RECOMMENDATION

This chapter presents about the recommendation to the person who

diagnosed with tuberculosis.

Tuberculosis (TB) diet plan

There is no special food that is required by a person with TB. A person with
TB does not need special food, although they should try and have a balanced
diet.

Some people with TB also believe that more expensive foods are better than
less expensive ones. This is not true. For example, it is not true that costlier
varieties of rice are better than cheaper ones.

It is often better that a person with TB has the same diet as normal but
possibly with some changes being made to increase their intake of food.
People with TB often have a poor appetite initially, but having more frequent
food intake can be helpful. Within a few weeks of starting TB treatment, the
person’s appetite should increase and come back to normal. A person with
TB should aim to have three meals and three snacks each day to increase
the amount of food they eat.
A healthy balanced meal for a person with TB

A person with TB should aim to have a healthy balanced meal. A healthy

balanced meal can be achieved by having foods from four basic food groups.
These are:
 Cereals, millets and pulses.
 Vegetables and fruits.
 Milk and milk products.
 Meat, eggs and fishes.
 Oils, fats and nuts and oils seeds.

A food group is a collection of foods that share similar nutritional properties.

If the food eaten contains food from all the above food groups, then the diet
is considered healthy. Not all the food groups need to be eaten at every
meal.

An essential nutrient is a nutrient that must be provided by a person’s diet.

These nutrients are necessary for the body to function properly. The six
essential nutrients include carbohydrates, protein, fat, vitamins, minerals &
water.

A person with TB should avoid the following:

 Alcohol in any form, as it increases the risk of drug toxicity.
 Carbonated drinks.
 Excess of tea and coffee, or their intake with food.
 Tobacco and tobacco products.
 An excess of spices & salt.
 BIBLIOGRAPHY

https://www.who.int/news-room/fact-sheets/detail/tuberculosis
https://en.m.wikipedia.org/wiki/Tuberculosis
https://www.cdc.gov/tb/topic/basics/default.htm
https://en.m.wikipedia.org/wiki/Tuberculosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5669528/
https://www.ncbi.nlm.nih.gov/books/NBK441916/

https://www.mayoclinic.org/diseases-conditions/tuberculosis/symptoms-
causes/syc-20351250

https://www.mayoclinic.org/diseases-conditions/tuberculosis/diagnosis-
treatment/drc-20351256

https://tbfacts.org/food-tb/