NRS 425 Benchmark – Epidemiology Paper GCU

NRS 425 Benchmark – Epidemiology Paper

Tuberculosis (TB) is a respiratory tract infection caused by Mycobacterium tuberculosis. The primary infection is referred to as pulmonary tuberculosis, while extrapulmonary TB results from secondary spread to other sites such as the lymph nodes, bones, peritoneum, brain, and pleura. The paper aims to describe the epidemiological disease, its transmission mode, demographic interest, and reporting criteria. The paper will also describe epidemiological factors, levels of disease prevention, a national safety resource that addresses infectious diseases, and the global impact of TB.

Overview of TB

Mycobacterium tuberculosis, an atypical bacterium, is the causative agent of both pulmonary and extrapulmonary disease. The infection spreads from person to person through aerosol inhalation of expelled bacteria from an infected person when they cough, sneeze, or talk. Upon reaching the lungs, the macrophages internalize the bacteria as part of an immune response to the infection (Yang et al., 2023). Additionally, more cells are recruited, and a granuloma is formed, which may lyse and cause cavitation. Cavitation leads to bacterial reactivation, development of active TB, and ease of spread of the infection to another new host when the infected individual coughs, speaks, or talks. As a result, the primary infection affecting the lungs is called pulmonary tuberculosis. Extrapulmonary TB results from lymphatic, hematogenous, or direct spread to other sites such as the pleura, meninges, peritoneum, joints, and bones (Jawed et al., 2023). As a result, some patients with a past or recent TB infection may present with headache, neurological deficits, intestinal obstructions, breathlessness, lower extremity paralysis, and joint pain due to pleural effusion, TB meningitis, peritonitis, Potts disease, and osteoarthritis.

The persons at a higher risk include those whose immune status cannot clear the primary lung infection. An example is HIV-infected persons due to immunodeficiency, where most patients may present with HIV/TB co-infection (Diriba et al., 2022). Other persons that are at higher risk of infection due to impaired immune status include persons with malnutrition, immune suppressive medications such as corticosteroids, chemotherapy, uncontrolled diabetes mellitus, sepsis, drug or alcohol addiction, chronic renal failure, smoking, and malignancy. Additionally, persons living in poorly ventilated areas such as refugee and war camps, prisons, overcrowded homes, and homeless persons are also at risk of infection. It is important to note that healthcare providers and those working in TB laboratories and research centers are also at risk of infection due to recurrent and chronic exposure to the bacteria.

Healthcare providers and facilities must report every case of suspected and confirmed infection per the national and state laws. The Centers for Disease Control and Prevention (CDC) guidelines require every healthcare provider to report the disease as it can potentially cause significant epidemics resulting from its high transmission rates. The data collected is used to identify TB outbreaks, track best practices in treating TB, monitor disease outcomes, inform TB prevention and intervention guidance and policy, and monitor progress toward TB elimination in the United States (CDC, 2024). Furthermore, reporting aims to identify and prevent the rise of Multiple-drug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) by ensuring infected persons adhere to their medications and are quarantined. The public health department at the facility, state, and national level is responsible for reporting continuous data to CDC on every case diagnosed while providing the healthcare facility with measures that ensure the infection is contained to avoid outbreaks.

TB Epidemiologic Triangle

The epidemiological triangle of TB includes Mycobacterium tuberculosis, which is the infectious agent, humans as the hosts, and environmental factors that enhance the spread of the disease. Humans are the only hosts for Mycobacterium tuberculosis, making it an opportunistic infection, especially in persons with compromised immune status (John et al., 2023). However, when the infection affects immunocompetent persons, it can be cleared by the immune cells or remain as latent TB. Conditions such as malnutrition, HIV infection, immunosuppressive drugs such as corticosteroids, conditions such as leukemia and diabetes, old and young age, and bone marrow failure increase an individual’s susceptibility to the infection. Mycobacterium tuberculosis also thrives in environments that have poor ventilation, inadequate sanitation, and indoor air pollution, as they ensure continued transmission of TB among persons affected.

The Role of the Community Health Nurse in TB Prevention

A community health nurse (CHN) can actively engage in strategies that aim at primary, secondary, and tertiary TB prevention. Primary TB prevention aims to avoid any TB infection. One measure that a CHN nurse can use is encouraging TB preventative therapy (TPT) as prophylactic treatment for the infection among persons exposed or immunocompromised. Additionally, a CHN can encourage neonatal and infant BCG immunization to minimize the risk of infection in that group as they are equally at high risk. The nurse can educate the public on the importance of living in well-ventilated houses and advocate for better housing options and sanitation to avoid TB infection (Vasiliu et al., 2023). Secondary preventive measures aim to ensure TB is diagnosed early in persons with both latent, pulmonary, and extrapulmonary TB through laboratory and imaging services. The persons should be provided with the appropriate TB medications and given follow-up clinics. They should also be educated on the warning signs, such as headaches, to prevent secondary disease. A CHN should be keen on monitoring the patients already on TB treatment to provide tertiary prevention of TB. The nurse should refer critically ill patients for inpatient care. They can also treat patients for specialist and imaging services, especially those with warning signs such as neurological deficits, joint pain, and abdominal distension, to exclude the risk of extrapulmonary disease (Jawed et al., 2023). The nurse should also provide regular follow-ups to patients undergoing chemotherapy with TB drugs to monitor drug response, tolerance, and compliance and look out for TB complications.

A National Agency That Addresses TB

In collaboration with the World Health Organization (WHO), the CDC has advocated for The End TB Strategy. The strategy aims to reduce the incidence of the disease by 80%, deaths by 90%, and eliminate catastrophic costs for TB-affected households by the year 2030. As a result, CDC is tasked with developing worldwide guidelines for the prevention and treatment of TB at national, regional, healthcare facilities, and community levels (Caruso et al., 2023). Furthermore, the organization stipulates how the disease is diagnosed using microscopy and Gene-Expert in samples such as sputum and cerebrospinal fluid. WHO has also provided funds to ensure subsidized prices for TB drugs through the Global Fund. CDC has provided guidelines for the identification of MDR-TB and XDR-TB, as well as treatment approaches and quarantine measures for the two.

Global Implications of the Disease

In line with The End TB Strategy, WHO statistics revealed that 10.6 million persons had the infection in 2021. Additionally, 1.3 million persons died in that year, accounting for about 3500 deaths daily. As a result, TB is the 13th leading cause of death and the leading infectious killer in the pre and post-Covid era (WHO, 2022). The cost of TB treatment is also very expensive as the drugs used in the treatment have to be taken for at least six months. As a result, about 13 billion US dollars is needed annually for TB management, making it responsible for economic devastation. However, MDR-TB remains a public health crisis as statistics reveal that MDR-TB could cost the world 16.7 trillion US dollars for diagnosis and treatment by the year 2050. In 2022, the WHO found that TB was endemic in Southeast Asian, African, and Western Pacific regions, where regions were associated with high mortality and morbidity rates.

Conclusion

Pulmonary TB is a common lower respiratory tract infection caused by Mycobacterium tuberculosis. The infection is a notifiable disease due to its impact on persons exposed to it and those at high risk of infection, such as immunocompromised and immunosuppressed persons. The disease has had a negative impact on persons affected, necessitating the need for The End TB Strategy as a way of reducing global morbidity and mortality rates.

References

Caruso, E., Mangan, J. M., Maiuri, A., Bouwkamp, B., & DeLuca, N. (2023). Tuberculosis Testing and Latent Tuberculosis Infection Treatment Practices Among Health Care Providers — United States, 2020–2022. Morbidity and Mortality Weekly Report, 72(44), 1183-1189. https://doi.org/10.15585/mmwr.mm7244a2

CDC. (2024). Tuberculosis Case Reporting. Tuberculosis (TB). https://www.cdc.gov/tb/php/case-reporting/index.html

Diriba, K., & Awulachew, E. (2022). Associated risk factor of tuberculosis infection among adult patients in Gedeo Zone, Southern Ethiopia. SAGE Open Medicine, 10. https://doi.org/10.1177/20503121221086725

Jawed, A., Tharwani, Z. H., Siddiqui, A., Masood, W., Qamar, K., Islam, Z., Jawed, A., Shah, M., Adnan, A., Essar, M. Y., Rackimuthu, S., & Head, M. G. (2023). Better understanding extrapulmonary tuberculosis: A scoping review of public health impact in Pakistan, Afghanistan, India, and Bangladesh. Health Science Reports, 6(6). https://doi.org/10.1002/hsr2.1357

John, T. J., & Kompithra, R. Z. (2023). Eco-epidemiology triad to explain infectious diseases. The Indian Journal of Medical Research, 158(2), 107-112. https://doi.org/10.4103/ijmr.ijmr_3031_21

Vasiliu, A., Martinez, L., Gupta, R. K., Hamada, Y., Ness, T., Kay, A., Bonnet, M., Sester, M., Kaufmann, S. H. E., Lange, C., & Mandalakas, A. M. (2023). Tuberculosis prevention: current strategies and future directions. Clinical Microbiology and Infection: The Official Publication of The European Society of Clinical Microbiology and Infectious Diseases, S1198-743X(23)00533-5. Advance online publication. https://doi.org/10.1016/j.cmi.2023.10.023

Yang, J., Zhang, L., Qiao, W., & Luo, Y. (2023). Mycobacterium tuberculosis: Pathogenesis and therapeutic targets. MedComm, 4(5). https://doi.org/10.1002/mco2.353

WHO, 2022. https://www.cdc.gov/globalhealth/newsroom/topics/tb/index.html

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