Tuberculosis

Tuberculosis (TB) is a potentially fatal contagious

disease that can affect almost any part of the body
but is mainly an infection of the lungs.
 Sites Involved
• Pulmonary TB (85% of all TB cases)
• Extra-pulmonary sites :
o Lymph node
o Genito-urinary tract
o Bones & Joints
o Meninges
o Intestine
o Skin
 Clinical Manifestation
1. Latent TB.
 Bacteria remain in your body in an inactive state
 Cause no symptoms
 Also called inactive TB or TB infection
 Isn't contagious.
 An estimated 2 billion people have latent TB
2. Active TB.
• This condition makes you sick and can spread to
others.
• It can occur in the first few weeks after infection
with the TB bacteria, or it might occur years later.
Phase 1 – Latent TB Infection
TB germs are “asleep” in your body.
This phase can last for a very long
time – even many years.
You don’t look or feel sick. Your chest
x-ray is usually normal.
You can’t spread TB to other people.
Usually treated by taking one
medicine for 9 months.
Phase 2 – Active TB Disease
TB germs are active and spreading. They are
damaging tissue in your body.
You usually feel sick. Your doctor will do
special tests to find where TB is harming your
body.
If the TB germs are in your lungs, you can
spread TB to other people by coughing,
sneezing, talking, or singing.
Treated by taking 3 or 4 medicines for at least 6
months.
Clinical manifestations of
active TB include:
• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or
coughing
• Unintentional weight loss
• Fever
• Night sweats
• Chills
• Loss of appetite
 Infectious Agent
• Mycobacterium tuberculosis
• Rod-shaped bacillus
• Highly aerobic
• Non-motile
• Divides every 15-20 hours
• Mycolic acid, waxes & lipids are present in cell wall
• Known to be very resistant
 Mode of Transmission
• Inhalation of infected droplets
• Incubation period : 2-10 weeks
 Susceptible Host
Anyone can get TB , but people at high risk generally
fall into two categories:

1. People recently infected with TB bacteria

2. People with medical conditions that weaken
the immune system
 You are at increased risk for
being infected with TB
bacteria if:
• You have spent time with a person with TB
disease
• You are from a country or have visited
areas where TB disease is very common
• You live or work where TB disease is more
common, such as a homeless shelter,
prison or jail, or long-term care facility
•
You have a higher chance of
getting TB disease once
infected if:
• You have HIV infection
• You are a child younger than 5 years of age
• You have recently been infected with TB
bacteria in the last two years
• You have other health problems that make
it hard for your body to fight disease
• You smoke cigarettes or abuse alcohol
and/or drugs
• You were not treated correctly for latent TB
infection or TB disease in the past
Diagnostic Evaluation
Size of induration Result

less than 5 mm negative for TB

positive if:
• you’ve had recent contact with someone with
TB
at least 5 mm • you are HIV-positive
• you have had an organ transplant
• you are taking immunosuppressants
• you have previously had TB

positive if:
• you recently immigrated from a country with a
high incidence of TB
• you live in a high-risk environment
at least 10 mm
• you work in a hospital, medical laboratory, or
other high-risk setting
• you’re a child under the age of 4
• you’ve used injected drugs

15 mm or more positive
 Management
1. Treatment

• With 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, the form of TB (latent or
active) and the infection's location in the body.
 Most common TB drugs
If you have latent tuberculosis, you may need to take
just one type 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
If you have drug-resistant TB, a combination of
antibiotics called fluoroquinolones and injectable
medications, such as amikacin, kanamycin or
capreomycin, are generally used for 20 to 30 months.
Some types of TB are developing resistance to these
medications as well.

A number of new drugs are being looked at as add-

on therapy to the current drug-resistant combination
treatment, including:

• Bedaquiline
• Linezolid
2. Nursing Treatment

•Obtain history of exposure to TB.

•Assess for symptoms of active disease
•Auscultate lungs for crackles
•During drug therapy, assess for liver dysfunction
 Question the patient about loss of appetite, fatigue, joint
pain, fever, tenderness in liver region, clay-colored stools,
dark urine
 Monitor for fever, RUQ abdominal tenderness, nausea,
vomiting, rash, persistent paresthesia of hands and feet
 Monitor results of periodic liver function studies