INTRODUCTION:

Tuberculosis is an infectious disease that primarily affects the lung parenchyma.¹ It also may be transmitted to other parts of the body, including meanings, kidneys, bones and lymph nodes.² The primary infectious agent is Mycobacterium tuberculosis.³ Tuberculosis is Airborne infection that affects the lungs.⁴ It is Contagious disease. Not everybody develops symptoms. There is Active and inactive forms (latency). Tuberculosis is Potentially fatal if untreated.⁵

Risk Factors:

· Close contact with the infected person

· Immunocompromised status (e.g.Those with HIV infection, cancer, transplanted organs)

· Substance abuse (IV or injection drug users and alcoholics)

· Any person without adequate health care⁶

Diagnostic Investigations:

A complete history, physical examination, tuberculin skin test, chest X-ray and sputum culture are used to diagnose TB.⁷

· Tuberculin Skin Test (Most Common)

· PPD tuberculin injected just below skin of forearm

· Raised red bump within 48-72 hours indicates positive test

· TB Blood Test

· Measure immunes system’s response to TB

· Imaging Tests

· Chest X-ray or CT scan –white spots in lungs

· Sputum Tests

· Take samples of mucus from coughing

Symptoms:

· Both the systemic and pulmonary symptoms are usually chronic and may have been present for weeks to months.⁸

· The signs and symptoms of pulmonary TB are insidious. Like,⁹

· Low grade fever

· Cough

· Night sweats

· Fatigue

· Weight loss

· Hemoptysis

· The cough may be non-productive, or muco purulent sputum may be expectorated.¹⁰

Treatment:

Patient was originally administered isoniazid, rifampin, pyrazinamide, and ethambutol for 7 days per week for 8 weeks, followed by isoniazid and rifampin 7 days per week for 24 weeks. After two months he returned to the hospital, concerned that he had been “coughing up blood” over the previous 3 days. In addition to hemoptysis, he revealed that, since his previous visit, he had continued to feel malaise, was continuing to lose weight, and had been experiencing night sweats. The emergency room physician immediately transferred the patient for isolation in a local hospital. A repeat chest radiograph revealed progressive bilateral fibronodular disease with a “miliary” pattern. The patient was given a 20-month regimen of levofloxacin, kanamycin, cycloserine, pyrazinamide and prothionamide. Following completion of therapy, closure of the destruction cavity was found with local pneumofibrosis.

CASE STUDY:

A 47 year old male, was admitted to the hospital because of pain in his chest and a persistent cough, occasionally containing blood. For the past few weeks in addition to the cough, he has experienced various symptoms including chills, fatigue, fever, and loss of appetite. He has been a heavy smoker most of his life. Later he diagnosed with pulmonary tuberculosis. A complete history, physical examination, tuberculin skin test, chest X-ray and sputum culture are used to diagnose TB. Isoniazid, Rifampin, Ethambutol, Pyrazinamide are used for the treatment. Patient A was originally administered isoniazid, rifampin, pyrazinamide, and ethambutol for 7 days per week for 8 weeks, followed by isoniazid and rifampin 7 days per week for 24 weeks. After two months he returned to the hospital, concerned that he had been “coughing up blood” over the previous 3 days. In addition to hemoptysis, he revealed that, since his previous visit, he had continued to feel malaise, was continuing to lose weight, and had been experiencing night sweats. The emergency room physician immediately transferred the patient for isolation in a local hospital. A repeat chest radiograph revealed progressive bilateral fibronodular disease with a “miliary” pattern. The patient was given a 20-month regimen of levofloxacin, kanamycin, cycloserine, pyrazinamide and prothionamide. Following completion of therapy, closure of the destruction cavity was found with local pneumofibrosis.

CONCLUSION:

Tuberculosis is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to other parts of the body, including meninges, kidneys, bones and lymph nodes. The primary infectious agent is Mycobacterium tuberculosis. Tuberculosisis Potentially fatal if untreated. A complete history, physical examination, tuberculin skin test, chest X-ray and sputum culture are used to diagnose TB. Both the systemic and pulmonary symptoms are usually chronic and may have been present for weeks to months. Low grade fever, Cough, Night sweats, Fatigue, Weight loss, Hemoptysis, cough may be non-productive, or muco purulent sputum are the symptoms. For the treatment antibiotics are advised for at least 6-9 months like Isoniazid, Rifampin, Ethambutol, Pyrazinamide. Antibiotics competitively bind to enzymes inhibiting transcription of mycobacterial cells.

REFERENCES:

1. World Health Organization (WHO), Multidrug-resistant Tuberculosis (MDR-TB) [Online] Accessed: 03 June 2014.

2. Tenover FC, Crawford JT, Huebner RE, et al. (1993) The resurgence of tuberculosis: is your laboratory ready? J Clin Microbiol 31:767–770.

3. WHO, TB diagnostics and laboratory strengthening - WHO policy. The use of liquid medium for culture and DST, 2007. [Online] Accessed: 03 June 2014. Available at: http://www.who.int/tb/laboratory/policy_liquid_medium_for_culture_dst/en/index.html?Utm_source=feedblitz&utm_medium=feedblitzemail &utm_content=565123&utm_campaign=Twelve-hourly_%272011-08-10%2000%3A00%3A00%27

4. WHO (2010) WHO endorses new rapid tuberculosis test. [Online] Accessed: 03 June 2014. Available at: http://www.who.int/mediacentre/news/releases/2010/tb_test_20101208/en/

5. Boehme, C.C., Nabeta, P., Hilleman, D. Et al. (2010) Rapid molecular detection of tuberculosis and rifampin resistance. New Eng J Med. 363: 1005-15.

6. Miotto, P., Cabibbe, A.M., Manteganai, P. Et al. (2012) genotype mtbdrsl performance on clinical samples with diverse genetic background. Eur Respir J. 40:690-8.

7. Lawn, S.D., Kerkhoff, A.D., Vogt, M., Wood, R. (2008) Diagnostic accuracy of a low-cost urine antigen, point of care screening assay for HIV-associated pulmonary tuberculosis before antiretroviral therapy: A descriptive study. Lancet Infect Dis. 2012 1293): 201-97.

8. Ling, D.I., Zwerling, A., Pai, M. (2008) genotype MTBDR assays for the diagnosis of multidrug-resistant tuberculosis: a meta-analysis. Eur Respir J. 32:1165-74.

9. Dheda, K, Ruhwald, M., Theron, G. Et al. (2013) Point-of-care diagnosis of tuberculosis: Past, present and future. Respirol. 18: 217-232.

10. Mitnick, C.D., Shin, S.S., Seung, K.J. et al. (2008) Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med. 359: 563–74.

Received on 19.10.2020 Modified on 29.12.2020

Int. J. of Advances in Nur. Management. 2021; 9(2):160-161.

DOI: 10.5958/2454-2652.2021.00036.6