Tuberculosis. By Veronica Serrano

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1 Tuberculosis By Veronica Serrano General Disease Description: Tuberculosis (commonly referred to as TB) is a disease resulting from a bacterial infection usually of the lungs, causing symptoms such as severe cough, chest pain and weakness. This disease can become extremely dangerous because the bacteria are capable of attacking not only the lungs, but also any part of the body including the kidney, brain, and spine. Brief History of Tuberculosis: This disease has been found to exist in humans since 2400 BCE. Mummies with signs of TB have actually been discovered dating back to this time period. Greek literature from 460 BCE describes TB illness as phthsis referring to wasting away of the lungs, and the illness was thought to be fatal in anyone that contracted it. The name of this disease derived from scientific discoveries of tubercles as a characteristic change of the lungs and other areas of infected patients, leading to the name Tuberculosis. Robert Koch was the scientist credited with finding the actual bacterium causing the disease (M. tuberculosis) by developing a staining technique able to identify the microbe in 1882, which lead to diagnosis and treatment for the disease. Etiologic Agent: Mycobacterium tuberculosis Characteristics of this bacterium Non- motile Rod- shaped Obligate aerobe (why it is found mostly in well- aerated upper lobes of the lungs) Facultative intracellular parasite (able to grow and reproduce inside and outside of host cells, macrophages being the usual host) Slow generation time (15-20 hours) Virulence mechanisms of this bacterium Slow generation time (physiological factor) High concentrations of lipids in the cell wall contribute to the bacterium s resistance to antibiotics, resistance to killing by acidic/alkaline compounds, resistance to osmotic lysis and lethal oxidations, and survival in macrophages Specific lipid fractions include the mycolic acids which form a lipid shell and prevent attack from outside substances and organisms, and the cord factor which is toxic to mammalian cells Transmission and Reservoirs: Tuberculosis is spread through droplet transmission in human reservoirs. The disease is spread through the air from person to person. When a contagious person with the

2 disease of the lungs throat coughs, sneezes, speaks or sings other people close by are at risk of breathing in the harmful bacteria, which causes infection. Symptoms and Signs: Intense cough for 3 weeks or longer Chest pain Coughing up blood Coughing up sputum (phlegm from deep inside the lungs) Weakness/fatigue Weight loss Loss of appetite Chills Fever Sweating at night Key tests for diagnosing TB disease: The fist tests taken when a patient in suspected of having TB are the TB skin and/or the TB blood test. TB skin test- test carried out by injecting a patient with tuberculin into the skin of the lower part of the arm, a positive test results in an observation of a size determined area of raised hardness and swelling TB blood test- this test measures how strong the immune system reacts to the bacteria that cause TB using IGRAs (interferon gamma release assays), the two types of IGRAs used include the QuantiFERON- TB Gold In- tube test, and the T- Spot test If the tests turn out to be positive the patient has M. tuberculosis inside of them and further testing will take place to determine if the patient has TB disease or latent TB infection (LTBI) where the bacteria are inside of a patient that experiences no symptoms, but are at risk of eventually developing the disease. Ziehl- Neelsen stain- this is a type of acid- fast stain where a smear of sputum is fixed, carbol- fuchsin stained, decolorized with acid- alcohol, and then counterstained with methylene blue or other similar dyes. M. tuberculosis appears as bright pink rods on a contrasting back round, which indicates the patient has TB disease. If the bacteria are not apparent after this test and the patient has no symptoms they would be diagnosed with LTBI. Chest x- ray- this may also be a test taken to check if the patient has the disease or not, tubercles seen on the lungs would be a possible positive result for this test Treatment: The total treatment time for this disease is 6-9 months with medication. The FDA for treatment of TB currently approves 10 drugs. The four core drugs are Isoniazid (INH), Rifampin (RIF), Ethambutol (EMB), and Pyrazinamide (PZA). Treatment includes an initial phase of treatment where all four of these drugs are taken on a prescribed weekly or daily basis for 2 months. There is then a

3 continuous phase that lasts for 4 to 7 months where INH and RIF are prescribed on a daily or weekly basis until the patient is cured. It is important to take the medication as prescribed because if the patient stops too soon they become at risk of becoming sick again and if they take it incorrectly they are at risk of the bacteria staying alive and becoming resistant to the medication which can make treatment much more difficult and expensive. There is only one vaccine currently approved for TB. It is called the Bacille Calmette- Guerin (BCE) vaccine is only partially effective. It provides some protection for severe forms of pediatric TB, but is unreliable against adult pulmonary TB that accounts for most of the worldwide burdens that TB causes. Outbreaks and cases: Globally According to the Worldwide Health Organization (WHO), TB remains a global health issue and has been declared a public health emergency for over 20 years. In the most recent study created in million people were reported with having TB and 1.3 million out of those people died from the disease. Progress is being made toward target goals set for 2015 to reduce the burdens of TB worldwide. Most of the goals set have been reached ahead of schedule and the most recent report from 2013 shows the rates of TB incidence, prevalence, and mortality are falling worldwide. Charts from the WHO Locally In the most recent report from the Texas Department of State Health Services (DSHS) in 2012 displayed 1,233 cases of TB reported at a rate of 4.7 per a population of 100,000. Out of these cases only 5 were diagnosed with multi- drug resistant TB, and there were no reports of the most extreme condition, extensively

4 drug resistant TB. The state describes TB to be under control and curable with proper treatment. Chart from DSHS showing the 1,233 cases separated by counties Control/prevention: There are four basic strategies established worldwide for control and prevention of TB Promptly detect and report persons with contracted TB by providing cost effective strategies for testing and treatment Protect close contact of persons with contagious TB from contracting and spreading the disease Prevent TB from the population with LTBI through treatments and testing that specifically target the infection Reduce the burden of TB from transmission of M. tuberculosis by identifying settings at high risk for transmission and applying effective infection control measures to reduce the risk Research: There remains an urgent need for development of a new TB vaccine effective against all forms of TB including drug- resistant strains. There are only two that have made it to phase II trails, both of which are virus- vectored vaccines expressing TB antigens. Areas 402 which is based on adenovirus 35 virus vector expressing several TB antigens MVA- 85A, which is based on the modified vaccine Ankara vector and expresses TB antigen 85A. This vaccine currently underwent infant trials in South Africa where 2794 infants ranging from 4-6 months were used in studying safety and efficiency of the new TB vaccine. The control group

5 consisted of 1395 infants injected with placebo, while 1399 were injected with the MVA- 85A vaccine. The study resulted with the vaccine being safe and well tolerated in the infants and no deaths related to the vaccine were reported. Efficiency rates were not as impressive, with a rate of 17.3% efficiency for disease and only 3.8% for infection. The development of a new TB vaccine depends mostly on efficiency and the first new one in 100 years is may become available in Works Cited Baddeley, Annabel, Anna Dean, Hannah M. Dias, Dennis Falzon, and Tom Hiatt. "Global Tuberculosis Report 2013." WHO. World Health Organization, Web. 02 May < "Robert Koch and Tuberculosis." Tuberculosis. Nobel Media, 09 Dec Web. 06 May < ml>. Todar, Kenneth. "Tuberculosis." Tuberculosis Web. 02 May < "Tuberculosis (TB)." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 13 Mar Web. 02 May < "Tuberculosis (TB)." Tuberculosis (TB). The Texas Department of State Health Services, Web. 02 May <

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