Tuberculosis also known as Koch’s infection, phthisis, galloping consumption, and pulmonary tuberculosis. Is a respiratory infection that usually affects the lungs but can also affect other parts of the body like the bones. Causative agents for tuberculosis can be Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium avis. Mycobacterium bovis (bovine) is a bacilli from cattles that transfers to humans through unpasteurized milk. Mycobacterium avis (avian) is a bacilli from birds. A derivation from the Mycobacterium avis, Mycobacterium Avium Complex (MAC), is an opportunistic infection for patients with AIDS.
Mode of Transmission of Tuberculosis
Airborne
Signs and Symptoms of Tuberculosis
- Low grade fever
- Night sweats
- Anorexia
- Weight loss
- Fatigability
- Body malaise
- Chest and back pain
- Productive cough
- Hemoptysis (the erosion of lung capillaries)
- Dyspnea
Diagnostic Exam for Tuberculosis
Tuberculin Testing or Mantoux Tuberculin Skin Test
A screening test that when the result is positive, the patient is positive for EXPOSURE to tuberculosis. If the result is consistently positive, there is sensitivity to the microorganism. Tuberculins are purified protein derivative and is administered intradermally. It is left for 48-72 hours after which the client is asked to return and see the doctor. A positive result yields an induration more than 10mm.
Sputum Exam (Acid Fast Bacilli)
The sputum exam is the confirmatory exam for the presence of tuberculosis in a client.
Chest X-ray
A chest X-ray is used to evaluate the extent of the infection.
Medical Management for Tuberculosis
Administration of Anti-Tubercular Agents
Short Course Chemotherapy (SCC)- Rifampicin – an antibiotic, administered regularly daily and is used in combination with other medications to prevent Rifampicin resistance.
- Isoniazid – an anti-tuberculosis medication, it is bacteriocidal to rapidly multiplying mycobacteria and bacteriostatic to slow multiplying mycobacteria. It is used in combination with other medications to prevent Isoniazid resistance.
- Pyrazinamide – largely bacteriostatic but is bacteriocidal to rapidly multiplying mycobacteria.
- Ethambutol – is a bacteriostatic antimycobacterial drug. It is used in combination to other drugs to prevent drug resistance.
- Streptomycin – is an antibiotic used in combination to other anti-tubercular drugs.
Nursing Care for Clients with Tuberculosis
- Provide adequate rest
- Provide adequate nutrition (Small frequent, High Caloric diet)
- Encourage drug compliance – Direct Observable Treatment Short Course (DOTS)
Prevention of Tuberculosis
Immunization
Bacillus-Calmet Guerin (BCG), is given at at birth, 0.05cc, intradermally at the right deltoid. School entrants are also given the vaccine at 0.1cc, intradermally at the left deltoid. Always remember not the massage the injection site to prevent spillage.
Observe the site of injection. An abscess heals with a scar within 2-3 months. If an indolent abscess occurs (Koch’s phenomenon), incision and drainage is done as prophylaxis.
