Definition

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. According to the World Health Organization
(WHO), it’s the most deadly infectious disease in the world, killing 1.5 million people in 2014.

Clinical Manifestation

Although the body may harbor the bacteria that cause tuberculosis, your immune system
usually can prevent you from becoming sick. For this reason, doctors make a distinction
between:

1. Latent TB. In this condition, you have a TB infection, but the bacteria remain in your
body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB
infection, isn't contagious. It can turn into active TB, so treatment is important for the
person with latent TB and to help control the spread of TB. 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.

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 leading to anorexia
 Fever
 Night sweats
 Chills
 Loss of appetite

Infectious Agent

A bacterium called Mycobacterium tuberculosis causes TB. This bacterium resembles a fungus
and multiplies at varying rates. There are a variety of TB strains, and some are resistant to
medication.

Mode of Transmission

The mode of transmission is inhalation of infected droplets. This can happen when someone
with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.
The incubation period is 2 to 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 are a health-care worker who works with clients or patients who are at increased
risk for TB disease

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

Management

1. Treatment
Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer
than treating other types of bacterial infections.

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.

Recent research suggests that a shorter term of treatment — four months instead of nine —
with combined medication may be effective in keeping latent TB from becoming active TB. With
the shorter course of treatment, people are more likely to take all their medication, and the risk
of side effects is lessened. Studies are ongoing.

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
o Question the patient about loss of appetite, fatigue, joint pain, fever, tenderness
in liver region, clay-colored stools, dark urine
o Monitor for fever, RUQ abdominal tenderness, nausea, vomiting, rash, persistent
paresthesia of hands and feet
o Monitor results of periodic liver function studies