Tuberculosis

1. Tuberculosis

2. Tuberculosis (TB) • Caused by: • Mycobacterium tuberculosis • In the United States: • Rates declining • Incidence decreased with: • Improved sanitation • Surveillance • Treatment of people with active disease • Rates still high in selected populations • The Disease Process: • Chronic and recurrent • Affects the lungs • Can invade any organ

3. Resurgence of Tuberculosis!! • 1980s and 1990s • Causes • HIV AIDS • Multiple drug resistant strains • Social Factors • Immigration • Poverty • Homelessness • Drug Use • Continues to decline • TB-control programs • Initiation and completion of appropriate medications

4. Worldwide TB • Countries that account for 90% of world cases of TB • Countries of ASIA • Africa • Middle East • Latin America • In Austin Texas • Large number of immigrants, college students and visitors FROM: • INDIA • MIDDLE EAST • LATIN AMERICA

5. Other Risk Factors for TB • Overcrowded Conditions • Nursing homes, Rehabilitation Facilities and Hospitals • Homeless shelters • Drug treatment centers and Prisons • People with Altered Immune Functions • Older Adults • People with AIDS • People on Chemotherapy

6. Spreading the Disease • M. tuberculosis • Slow-growing, rod shaped, acid fast • ***Waxy outer capsule which makes it resistant to destruction • Transmission • Infectious person • Coughs, sneezes, sings or talks • Airborne droplets • Remain suspended in the air for several hours • Susceptible Host • Breaths in microorganism • Normal defenses of the upper respiratory system do not protect.

7. Risk For Infection • Characteristics of the Infected Person • TB is active • How much of the lung is involved • Coughing • Extent of contamination of the Air • Overcrowded Conditions • Air circulation • Susceptibility of the Host • Immuno-compromised • Nutrition • Health

8. Infection Takes Hold • Minute droplet nuclei inhaled -> • Upper lobe • Lodges in Alveolus or Bronchiole • Leads to Inflammation • Neutrophils and macrophages isolate seal off but cannot destroy • Sealed off colony of bacilli (tubercle) • Inside infected tissue dies • Creating a cheese-like center

9. The Immune Response • Adequate • Scar Tissue encapsulates the bacilli • Inadequate • Tuberculosis develops • Extensive lung destruction can occur • Spread by the blood to other organs • Genitourinary tract • Brain (meningitis) • Skeletal

10. Tuberculosis Can Spread within The Body

11. Signs & Symptoms • Fatigue, malaise (late afternoon) • Low grade fever, Night sweats • Anorexia, weight loss • Hemoptysis • Frequent productive cough • mucoid or mucopurulent • Tight, dull chest • Joint Pain

12. Skin testing • Tuberculin Skin Test (Mantoux) • positive test does not signify active disease • 0.1 ml PPD intradermally • Read in 48-72 hours

13. Results • Measure induration • Positive 10 mm • Possible 5-9 mm • Negative 0-4 • Repeat x2 or x3 if any clinical signs • 25% false negative

14. Diagnosing • Skin test positive 3-12 weeks after exposure • Chest x-ray • Sputum - Acid Fast Bacillus (AFB) • Smear not definitive • Culture is only definitive diagnosis • May need up to 8 weeks to grow

15. Newly converted to positive PPD • Isoniazid 300 mg X 6-9 months prophylactive prevents active Tb

16. Medications • Newly Diagnosed Patients with active disease typical treated with Four medications • isoniazid (INH) oral 300mg daily or 900mg twice a week. • rifampin oral 600mg daily or twice a week • pyrazinamide (PZA) oral 15 to 30 mg/kg up to 2G per day or 30 to 70 mg/kg once a week • minimum 9 months • take in AM • 90% have negative sputum in 3 months • ethambutal oral 15 mg/kg daily • Other Medications • rifabutin • rifapentine

17. isoniazid • Most effective TB drug • Take in AM with food • Continue until sputum negative 6 months • Adverse Effects: • peripheral neuropathy • hepatitis • Monitor • Liver Functions Studies (AST and ALT) • Avoid hepatotoxins (alcohol, acetominophen)

18. rifampin • Take on empty stomach • Monitor liver function tests • Can cause: • Hepatitis • Suppression of oral contraceptives • Do not stop medication • Will cause flu-like syndrome and fever when resumed • Colors body fluids • Sweat urine saliva tears: turn orange-red

19. pyrazinamide • Increase fluids • Take with food • Adverse Effects • Hepatotoxicity • Hyperuricemia • Monitor • Uric Acid Levels • AST and ALT • Avoid hepatotoxins (ETOH; Tylenol)

20. ethambutol • Protect from light • Adverse effects: retrobulbar neuritis, skin rash, reversible with discontinuation of the drug • Monitor color vision and acuity

21. Symptoms of Liver Toxicity • loss of appetite • N/V • dark urine • juandice • malaise • unexplained elevated temperature • for longer than 3 days • abdominal tenderness

22. Close Monitoring While Taking Antituberculosis Medications • Monitor liver Functions • Regular Office visits • Check for compliance • Rifampin • Check color of urine • INH • Check urine for metabolites • Give medication • Twice week in the office if compliance is a problem

23. Isolation • negative flow room • vent to outside • masks, not ordinary • molded to fit face • patient wears a standard mask when outside room • ultraviolet light

24. General teaching • cover mouth and nose to cough • dispose of tissues • hand washing • take meds as prescribed • 35% noncompliant • monitor side effects

25. Chronic Management • Follow up in 12 months • 5% recurrence, relapse • Test frequent contacts • Factors which can cause relapse • immunosuppression • HIV/AIDS • prolonged debilitating illness

26. Compliance • Therapeutic, consistent relationship • Understand lifestyle flexibility • Education • Reassurance, reduce social stigma • Take meds at clinic

27. Nursing Diagnosis labels appropriate for the patient with tuberculosis • Ineffective airway clearance • Impaired gas exchange • Nutrition, less than body requirements • Activity intolerance • Risk for noncompliance • Knowledge deficit • Ineffective health maintenance

28. The End