Tuberculosis (TB) is a contagious, life-threatening infectious disease that primarily affects the lungs and is caused by the mycobacterium germ (Delogu, Sali, and Fadda, 2013). General symptoms are a wracking cough, extreme weakness and fatigue, coughing up blood or phlegm (sputum), marked weight loss, fever and chills, profuse sweating, and severe chest pain while breathing or coughing (CDC: Signs and symptoms, 2016). A skin test or TB blood test are used to determine if a person has tuberculosis.
The TB mode of transmission occurs when a person with TB coughs, sneezes, speaks, or opens his or her mouth; mycobacterium germs are released into the air and remain for hours— even days (CDC: How TB spreads, 2016). Complications of pulmonary TB include structural, metabolic, vascular, and infectious conditions (Shah & Reed, 2014). An acute complication of TB is sepsis (Shah & Reed, 2014). Chronic complications are pulmonary mycetoma or focal neurologic deficits from tuberculomas; pulmonary complications include hemoptysis (coughing up blood) or pneumothorax (collapsed lung) (Shah & Reed, 2014). TB is treated with or more first-line drugs for 6 to 12 months: isoniazid (INH), rifampin (RIF), ethambutol (EMB), and/or pyrazinamide (PZA) (CDC: Treatment for TB disease, 2016). If the strain of TB is resistant to first-line drugs, second-line group 2 drugs are given (CDC: Treatment for TB disease, 2016). Other TB drugs are categorized as second-line groups 3 and 4, and third-line group 5. The vaccine for TB is Bacille Calmette–Guèrin (BCG) (CDC: Treatment for TB disease, 2016).
Demographic of interest
The global mortality rate for tuberculosis is more than 50 percent in patients who do not receive adequate treatment (Adigun & Bhimji, 2018). The CDC (2018) reports the morbidity of TB as 10.4 million people around the world of which the mortality was 1.7 million (Adigun & Bhimji, 2018). The morbidity of TB cases in the U.S. was 9,547 cases reported in the U.S. in 2015, of which 470 people died; of the 9, 272 TB cases reported in 2016, the CDC has yet to compile mortality rates (CDC, 2017). The incidence rate for TB cases in the United States is 3.0 per 100,000 in 2015 and 2.9 per 100,000 in 2016 (CDC: TB Incidence…, 2017). WHO (2017) estimates the global incidence rate for TB decreases 1.5 percent every year; the prevalence of TB in the U.S. in 2015 was 0.00002974 percent in a population of 321 million; in 2016, the prevalence was 0.0000287058 in a population of 323.4 million people (Adigun & Bhimji, 2018).
Determinants of health/host, agent, environmental factors
Common TB determinants of health are socioeconomic factors, physical environment, and individual behaviors. Poverty is one of the leading social determinants of TB, as it determines the conditions in which people live. Undernutrition is also another risk factor for developing the disease. Malnutrition leads to secondary immunodeficiency, which amplifies a person’s susceptibility for TB infection (Narasimhan et al., 2013). Smoking and alcohol abuse also increase a person’s chances of getting TB because these behaviors cause other medical conditions that weaken the immune system. Smoking damages the lungs in many ways, and people who smoke are 40 – 60 percent more likely to develop pulmonary TB, the leading form of the condition (Narasimhan et al., 2013). Excessive alcohol consumption damages the body and interferes with TB treatment drugs. People who have been diagnosed with cancer, diabetes, Crohn’s disease, chronic obstructive pulmonary disease, HIV/AIDS, or other medical conditions that attack the immune system are at great risk to contract TB. These conditions cause an already compromised immune system to become defenseless against TB (Narasimhan et al., 2013).
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