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Tuberculosis
1. • Student name: ziad medlej
• Coordinator: Mr. abed alkarim
• Subject: pulmonary tuberculosis
• University: al rassoul al aazam
2.
3. INTRODUCTION
• TUBERCULOSIS (TB) IS ONE OF THE MOST PREVALENT INFECTIONS OF HUMAN
BEINGS AND CONTRIBUTES CONSIDERABLY TO ILLNESS AND DEATH AROUND
THE WORLD. IT IS SPREAD BY INHALING TINY DROPLETS OF SALIVA FROM THE
COUGHS OR SNEEZES OF AN INFECTED PERSON. IT IS A SLOWLY SPREADING.
CHRONIC, GRANULOMATOUS BACTERIAL INFECTION, CHARACTERIZED BY
GRADUAL WEIGHT LOSS.
4. DEFINITION
• TUBERCULOSIS IS A BACTERIAL INFECTION THAT CAN PASS THROUGH THE AIR
BETWEEN PEOPLE, IS MOST OFTEN CAUSED BY MYCOBACTERIUM TUBERCULOSIS.
WHEN IT AFFECTS THE LUNGS, THE MEDICAL NAME FOR THIS IS PULMONARY
TUBERCULOSIS. IT CAN CAUSE CHEST PAIN, SEVERE COUGHING, AND A RANGE
OF OTHER SYMPTOMS. IT MAY SPREAD TO ANY PART OF THE BODY INCLUDING
MENINGES, KIDNEYS, BONES, AND LYMPHNODES.
5.
6. TYPES
ACTIVE TUBERCULOSIS DISEASE:
• THIS MEANS THE GERMS MULTIPLY AND CAN MAKE YOU SICK. YOU CAN SPREAD
THE DISEASE TO OTHERS. NINETY PERCENT OF ADULT CASES OF ACTIVE TB ARE
FROM THE REACTIVATION OF A LATENT TB INFECTION.
7. MILIARY TB
• MILIARY TB IS A RARE FORM OF ACTIVE DISEASE THAT OCCURS WHEN TB
BACTERIA FIND THEIR WAY INTO THE BLOODSTREAM. IN THIS FORM, THE
BACTERIA QUICKLY SPREAD ALL OVER THE BODY IN TINY NODULES AND AFFECT
MULTIPLE ORGANS AT ONCE. THIS FORM OF TB CAN BE RAPIDLY FATAL.
8. LATENT TB INFECTION
• YOU HAVE THE GERMS IN YOUR BODY, BUT YOUR IMMUNE SYSTEM STOPS THEM
FROM SPREADING. THAT MEANS YOU DON’T HAVE ANY SYMPTOMS AND YOU’RE
NOT CONTAGIOUS. BUT THE INFECTION IS STILL ALIVE IN YOUR BODY AND CAN
ONE DAY BECOME ACTIVE. IF YOU’RE AT HIGH RISK FOR RE-ACTIVATION -- FOR
INSTANCE, YOU HAVE HIV, YOUR PRIMARY INFECTION WAS IN THE PAST 2
YEARS, YOUR CHEST X-RAY IS ABNORMAL, OR YOUR IMMUNE SYSTEM IS
COMPROMISED --- YOUR DOCTOR WILL TREAT YOU WITH ANTIBIOTICS TO
LOWER THE RISK FOR DEVELOPING ACTIVE TB.
9.
10. CAUSES
• TUBERCULOSIS IS CAUSED BY BACTERIA THAT SPREAD FROM PERSON TO PERSON
THROUGH MICROSCOPIC DROPLETS RELEASED INTO THE AIR. THIS CAN HAPPEN
WHEN SOMEONE WITH THE UNTREATED, ACTIVE FORM OF TUBERCULOSIS
COUGHS, SPEAKS, SNEEZES, SPITS, LAUGHS OR SINGS.
• ALTHOUGH TUBERCULOSIS IS CONTAGIOUS, IT'S NOT EASY TO CATCH. YOU'RE
MUCH MORE LIKELY TO GET TUBERCULOSIS FROM SOMEONE YOU LIVE WITH OR
WORK WITH THAN FROM A STRANGER. MOST PEOPLE WITH ACTIVE TB WHO'VE
HAD APPROPRIATE DRUG TREATMENT FOR AT LEAST TWO WEEKS ARE NO
LONGER CONTAGIOUS
11. RISK FACTOR
ANYONE CAN GET TUBERCULOSIS, BUT CERTAIN FACTORS CAN INCREASE YOUR
RISK OF THE DISEASE. THESE FACTORS INCLUDE:
• WEAKENED IMMUNE SYSTEM (HIV/AIDS, DIABETES, SEVERE KIDNEY DISEASE,
CERTAIN CANCERS, CANCER TREATMENT SUCH AS CHEMOTHERAPY, DRUGS TO
PREVENT REJECTION OF TRANSPLANTED ORGANS, SOME DRUGS USED TO TREAT
RHEUMATOID ARTHRITIS, CROHN'S DISEASE AND PSORIASIS, MALNUTRITION,
VERY YOUNG OR ADVANCED AGE).
• TRAVELING OR LIVING IN CERTAIN AREAS (AFRICA, ASIA ,LATIN AMERICA…).
• POVERTY AND SUBSTANCE USE (LACK OF MEDICAL CARE, TOBACCO USE,
ALCOHOLISM).
• WHERE YOU WORK OR LIVE (HEALTH CARE WORK, LIVING WITH SOMEONE
INFECTED WITH TB).
• CLOSE CONTACT WITH SOMEONE WHO HAVE ACTIVE TB.
12. PATHOPHYSIOLOGY
• INHALATION. TUBERCULOSIS BEGINS WHEN A SUSCEPTIBLE PERSON INHALES
MYCOBACTERIA AND BECOMES INFECTED.
• TRANSMISSION. THE BACTERIA ARE TRANSMITTED THROUGH THE AIRWAYS TO
THE ALVEOLI, AND ARE ALSO TRANSPORTED VIA LYMPH SYSTEM AND
BLOODSTREAM TO OTHER PARTS OF THE BODY.
• DEFENSE. THE BODY’S IMMUNE SYSTEM RESPONDS BY INITIATING AN
INFLAMMATORY REACTION AND PHAGOCYTES ENGULF MANY OF THE BACTERIA,
AND TB-SPECIFIC LYMPHOCYTES LYSE THE BACILLI AND NORMAL TISSUE.
• PROTECTION. GRANULOMAS NEW TISSUE MASSES OF LIVE AND DEAD BACILLI, ATE
SURROUNDED BY MACROPHAGES, WHICH FORM A PROTECTIVE WALL.
13. • GHON’S TUBERCLE. THEY ARE THEN TRANSFORMED TO A FIBROUS TISSUE MASS,
THE CENTRAL PORTION OF WHICH IS CALLED A GHON TUBERCLE.
• SCARRING. THE BACTERIA AND MACROPHAGES TURNS INTO A CHEESY MASS
THAT MAY BECOME CALCIFIED AND FORM A COLLAGENOUS SCAR.
• DORMANCY. AT THIS POINT, THE BACTERIA BECOME DORMANT, AND THERE IS
NO FURTHER PROGRESSION OF ACTIVE DISEASE.
• ACTIVATION. AFTER INITIAL EXPOSURE AND INFECTION, ACTIVE DISEASE MAY
DEVELOP BECAUSE OF A COMPROMISED OR INADEQUATE IMMUNE SYSTEM
RESPONSE.
14. SIGNS AND SYMPTOMS
• ALTHOUGH YOUR BODY MAY HARBOR THE BACTERIA THAT CAUSE
TUBERCULOSIS (TB), YOUR IMMUNE SYSTEM USUALLY CAN PREVENT YOU FROM
BECOMING SICK. FOR THIS REASON, DOCTORS MAKE A DISTINCTION BETWEEN:
• LATENT TB. IN THIS CONDITION, YOU HAVE A TB INFECTION, BUT THE BACTERIA
REMAIN IN YOUR BODY IN AN INACTIVE STATE AND CAUSE NO SYMPTOMS.
LATENT TB, ALSO CALLED INACTIVE TB OR TB INFECTION, ISN'T CONTAGIOUS. IT
CAN TURN INTO ACTIVE TB, SO TREATMENT IS IMPORTANT FOR THE PERSON
WITH LATENT TB AND TO HELP CONTROL THE SPREAD OF TB. AN ESTIMATED 2
BILLION PEOPLE HAVE LATENT TB.
• ACTIVE TB. THIS CONDITION MAKES YOU SICK AND IN MOST CASES CAN SPREAD
TO OTHERS. IT CAN OCCUR IN THE FIRST FEW WEEKS AFTER INFECTION WITH
THE TB BACTERIA, OR IT MIGHT OCCUR YEARS LATER.
15. SIGNS AND SYMPTOMS OF ACTIVE TB INCLUDE:
• COUGHING THAT LASTS THREE OR MORE WEEKS
• DYSPNEA, CHEST TIGHTNESS, SPUTUM WITH HEMOPTYSIS
• CHEST PAIN, OR PAIN WITH BREATHING OR COUGHING
• WEIGHT LOSS
• FATIGUE
• FEVER
• NIGHT SWEATS
• CHILLS
• LOSS OF APPETITE
TUBERCULOSIS CAN ALSO AFFECT OTHER PARTS OF YOUR BODY, INCLUDING YOUR KIDNEYS,
SPINE OR BRAIN. WHEN TB OCCURS OUTSIDE YOUR LUNGS, SIGNS AND SYMPTOMS VARY
ACCORDING TO THE ORGANS INVOLVED. FOR EXAMPLE, TUBERCULOSIS OF THE SPINE MAY
GIVE YOU BACK PAIN, AND TUBERCULOSIS IN YOUR KIDNEYS MIGHT CAUSE BLOOD IN YOUR
16. IF MILITARY TB A PHYSICAL EXAM MAY SHOW:
• SWOLLEN LIVER
• SWOLLEN LYMPH NODES
• SWOLLEN SPLEEN.
17.
18. DIAGNOSES
• DURING THE PHYSICAL EXAM, YOUR DOCTOR WILL CHECK YOUR LYMPH NODES
FOR SWELLING AND USE A STETHOSCOPE TO LISTEN CAREFULLY TO THE
SOUNDS YOUR LUNGS MAKE WHILE YOU BREATHE.
• THE MOST COMMONLY USED DIAGNOSTIC TOOL FOR TUBERCULOSIS IS A SIMPLE
SKIN TEST, THOUGH BLOOD TESTS ARE BECOMING MORE COMMONPLACE. A
SMALL AMOUNT OF A SUBSTANCE CALLED PPD TUBERCULIN IS INJECTED JUST
BELOW THE SKIN OF YOUR INSIDE FOREARM. YOU SHOULD FEEL ONLY A SLIGHT
NEEDLE PRICK.
• WITHIN 48 TO 72 HOURS, A HEALTH CARE PROFESSIONAL WILL CHECK YOUR
ARM FOR SWELLING AT THE INJECTION SITE. A HARD, RAISED RED BUMP MEANS
YOU'RE LIKELY TO HAVE TB INFECTION. THE SIZE OF THE BUMP DETERMINES
WHETHER THE TEST RESULTS ARE SIGNIFICANT.
19. • BLOOD TESTS
• BLOOD TESTS MAY BE USED TO CONFIRM OR RULE OUT LATENT OR ACTIVE
TUBERCULOSIS. THESE TESTS USE SOPHISTICATED TECHNOLOGY TO MEASURE
YOUR IMMUNE SYSTEM'S REACTION TO TB BACTERIA.
• THESE TESTS REQUIRE ONLY ONE OFFICE VISIT. A BLOOD TEST MAY BE USEFUL IF
YOU'RE AT HIGH RISK OF TB INFECTION BUT HAVE A NEGATIVE RESPONSE TO THE
SKIN TEST, OR IF YOU'VE RECENTLY RECEIVED THE BCG VACCINE.
20. • IMAGING TESTS
• IF YOU'VE HAD A POSITIVE SKIN TEST, YOUR DOCTOR IS LIKELY TO ORDER A
CHEST X-RAY OR A CT SCAN. THIS MAY SHOW WHITE SPOTS IN YOUR LUNGS
WHERE YOUR IMMUNE SYSTEM HAS WALLED OFF TB BACTERIA, OR IT MAY
REVEAL CHANGES IN YOUR LUNGS CAUSED BY ACTIVE TUBERCULOSIS. CT SCANS
PROVIDE MORE-DETAILED IMAGES THAN DO X-RAYS.
21. • SPUTUM TESTS
• IF YOUR CHEST X-RAY SHOWS SIGNS OF TUBERCULOSIS, YOUR DOCTOR MAY
TAKE SAMPLES OF YOUR SPUTUM — THE MUCUS THAT COMES UP WHEN YOU
COUGH. THE SAMPLES ARE TESTED FOR TB BACTERIA.
• SPUTUM SAMPLES CAN ALSO BE USED TO TEST FOR DRUG-RESISTANT STRAINS
OF TB. THIS HELPS YOUR DOCTOR CHOOSE THE MEDICATIONS THAT ARE MOST
LIKELY TO WORK. THESE TESTS CAN TAKE FOUR TO EIGHT WEEKS TO BE
COMPLETED
22.
23. TREATMENT
• MEDICATIONS ARE THE CORNERSTONE OF TUBERCULOSIS TREATMENT. BUT
TREATING TB TAKES MUCH LONGER THAN TREATING OTHER TYPES OF BACTERIAL
INFECTIONS.
• FOR ACTIVE TUBERCULOSIS, YOU MUST TAKE ANTIBIOTICS FOR AT LEAST SIX TO
NINE MONTHS. THE EXACT DRUGS AND LENGTH OF TREATMENT DEPEND ON
YOUR AGE, OVERALL HEALTH, POSSIBLE DRUG RESISTANCE AND THE INFECTION'S
LOCATION IN THE BODY.
24. • MOST COMMON TB DRUGS
• IF YOU HAVE LATENT TUBERCULOSIS, YOU MAY NEED TO TAKE ONLY ONE OR
TWO TYPES OF TB DRUG. ACTIVE TUBERCULOSIS, PARTICULARLY IF IT'S A DRUG-
RESISTANT STRAIN, WILL REQUIRE SEVERAL DRUGS AT ONCE. THE MOST
COMMON MEDICATIONS USED TO TREAT TUBERCULOSIS INCLUDE:
• ISONIAZID
• RIFAMPIN (RIFADIN, RIMACTANE)
• ETHAMBUTOL (MYAMBUTOL)
• PYRAZINAMIDE
25. DRUG-RESISTANT TB
• ANOTHER REASON TUBERCULOSIS REMAINS A MAJOR KILLER IS THE INCREASE IN
DRUG-RESISTANT STRAINS OF THE BACTERIUM. SINCE THE FIRST ANTIBIOTICS
WERE USED TO FIGHT TUBERCULOSIS MORE THAN 60 YEARS AGO, SOME TB
GERMS HAVE DEVELOPED THE ABILITY TO SURVIVE DESPITE MEDICATIONS, AND
THAT ABILITY GETS PASSED ON TO THEIR DESCENDANTS.
• DRUG-RESISTANT STRAINS OF TUBERCULOSIS EMERGE WHEN AN ANTIBIOTIC
FAILS TO KILL ALL OF THE BACTERIA IT TARGETS. THE SURVIVING BACTERIA
BECOME RESISTANT TO THAT PARTICULAR DRUG AND FREQUENTLY OTHER
ANTIBIOTICS AS WELL. SOME TB BACTERIA HAVE DEVELOPED RESISTANCE TO
THE MOST COMMONLY USED TREATMENTS, SUCH AS ISONIAZID AND RIFAMPIN.
27. NURSING INTERVENTIONS
• NURSING INTERVENTIONS FOR THE PATIENT INCLUDE:
• PROMOTING AIRWAY CLEARANCE. THE NURSE INSTRUCTS THE PATIENT
ABOUT CORRECT POSITIONING TO FACILITATE DRAINAGE AND TO INCREASE
FLUID INTAKE TO PROMOTE SYSTEMIC HYDRATION.
• ADHERENCE TO THE TREATMENT REGIMEN. THE NURSE SHOULD TEACH THE
PATIENT THAT TB IS A COMMUNICABLE DISEASE AND TAKING MEDICATIONS IS
THE MOST EFFECTIVE MEANS OF PREVENTING TRANSMISSION.
• PROMOTING ACTIVITY AND ADEQUATE NUTRITION. THE NURSE PLANS
A PROGRESSIVE ACTIVITY SCHEDULE THAT FOCUSES ON INCREASING ACTIVITY
TOLERANCE AND MUSCLE STRENGTH AND A NUTRITIONAL PLAN THAT ALLOWS
FOR SMALL, FREQUENT MEALS.
28. • PREVENTING SPREADING OF TUBERCULOSIS INFECTION. THE NURSE CAREFULLY
INSTRUCTS THE PATIENT ABOUT IMPORTANT HYGIENIC
MEASURES INCLUDING MOUTH CARE, COVERING THE MOUTH AND NOSE WHEN
COUGHING AND SNEEZING, PROPER DISPOSAL OF TISSUES, AND HANDWASHING.
• ACID-FAST BACILLUS ISOLATION. INITIATE AFB ISOLATION IMMEDIATELY,
INCLUDING THE USE OF A PRIVATE ROOM WITH NEGATIVE PRESSURE IN RELATION
TO SURROUNDING AREAS AND A MINIMUM OF SIX AIR CHANGES PER HOUR.
• DISPOSAL. PLACE A COVERED TRASH CAN NEARBY OR TAPE A LINED BAG TO THE
SIDE OF THE BED TO DISPOSE OF USED TISSUES.
• MONITOR ADVERSE EFFECTS. BE ALERT FOR ADVERSE EFFECTS OF MEDICATIONS.
30. DISCHARGE AND HOME CARE GUIDELINES
• BEFORE THE DISCHARGE, THE NURSE SHOULD INSTRUCT THE PATIENT TO:
• DISPOSAL OF SECRETIONS. COUGH AND SNEEZE INTO TISSUES AND TO DISPOSE
OF ALL SECRETIONS IN A SEPARATE TRASH CAN.
• ISOLATION. WEAR A MASK WHEN GOING OUTSIDE OF THE ROOM.
• ACTIVITY AND NUTRITION. REMIND THE PATIENT TO TAKE A LOT OF REST AND
TO EAT BALANCED MEALS TO AID RECOVERY.
• ADVERSE EFFECTS. ADVISE THE PATIENT TO WATCH OUT FOR ADVERSE EFFECTS
OF MEDICATIONS AND TO REPORT THEM TO THE PHYSICIAN IMMEDIATELY.
31. SUMMARY
• PULMONARY TB IS A BACTERIAL INFECTION OF THE LUNGS THAT CAN CAUSE A
RANGE OF SYMPTOMS, INCLUDING CHEST PAIN, BREATHLESSNESS, AND SEVERE
COUGHING. PULMONARY TB CAN BE LIFE-THREATENING IF A PERSON DOES NOT
RECEIVE TREATMENT.
• PEOPLE WITH ACTIVE TB CAN SPREAD THE BACTERIA THROUGH THE AIR.
HOWEVER, A PERSON USUALLY NEEDS TO BE IN PROLONGED CLOSE CONTACT
TO BECOME INFECTED.
• MOST INDIVIDUALS WHO BECOME INFECTED WITH TB BACTERIA DO NOT FEEL
SICK OR EXPERIENCE ANY SYMPTOMS. DOCTORS DESCRIBE THIS AS HAVING
LATENT TB. LATENT TB IS NOT CONTAGIOUS BUT IT CAN EVENTUALLY DEVELOP
INTO ACTIVE TB.
• DOCTORS TREAT LATENT OR ACTIVE TB WITH A LONG COURSE OF ANTIBIOTICS.
