Chapter 23 Tuberculosis

Tuberculosis: An infectious disease in humans that is caused by tubercle bacillus. It results tubercles forming on the lungs and other tissues.

The World Health Organization (WHO) has determined that one new person becomes infected with the tubercle bacilli every second, resulting in eight million new cases of TB disease and over two million deaths annually.

A Brief History Tuberculosis originally spread from animals to humans, probably from cows, about 80,000 or 100,000 years ago. TB afflicted the Ancient Egyptian civilization. The introduction of the sanatorium cure provided the first public health step against TB. In the early 1880s Koch visualizes the TB agent under a microscope. The first vaccine against tuberculosis, the Bacille de Calmette et Guérin (BCG), was developed in France in the 1920s. In the 1940s the disease becomes curable with the discovery of streptomycin.

Two manifestations: –Tuberculosis Infection (Latent TB) 2 billion people worldwide Do not present symptoms, are not sick, and not contagious –Tuberculosis Disease (Active TB) 8-9 million new cases worldwide Are sick, frequently symptomatic, and very often contagious Two categories: –Pulmonary TB Only kind which is contagious –Extrapulmonary TB (EPTB) Ex. Skin, cervical, lymph nodes

Transmission TB is an air-borne disease. It can be spread when a patient with pulmonary TB talks, spits, coughs, or sneezes. It is estimated that each person with active TB who is not put on appropriate TB treatment will infect an average of ten to fifteen people annually.

DOTS (Directly Observed Treatment Short course): a clinical approach to patients where drug intake is monitored daily by a nurse or a trained healthcare worker to ensure patient compliance a management strategy for public health systems that includes political commitment, maintenance of adequate drug supply and sound recording and reporting systems

Public Health Considerations Strains of TB which are resistant to both first- and second-line drugs exist and are called extensively drug-resistant strains (XDR-TB). The Case of Andrew Speaker : –Was diagnosed with TB which he was later informed (while in Europe)was updated to XDR-TB –AS is informed not to fly on commercial airplane. AS asks the CDC for help getting home as a non- commercial flight will cost $100,000. He receives no word of the air ambulance being prepared. –AS boards a commercial plane thinking his last hope for survival is in Denver, despite the specialized clinic in Italy.