Tuberculosis

 

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Original Editors -Lori McGarrh from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Tuberculosis (TB) is an inflammatory, infectious disease that is spread by bacteria called mycobacterium tuberculosis. Pulmonary tuberculosis is a systemic disease that most commonly affects the lungs.1 Eventually, the TB could spread to other organ systems, which it then becomes extrapulmonary tuberculosis. TB can be placed into the following two categories:

• Primary Tuberculosis1 (Dormant or Latent) – Although a person’s body can be infected with mycobacterium tuberculosis, they may not be showing clinical signs and symptoms. Most people have healthy immune systems that will never allow the TB to take over their bodies.
• Secondary Tuberculosis1 (Active) – This will develop after the immune system of a person is lowered. Reinfection will occur and the person will start to show clinical signs and symptoms.
  
  

Prevalence

Before the 1940’s, tuberculosis was the leading cause of death in the United States.1 With the advancement of drug therapy, scientific and public knowledge, improvement in public health and general living standards, there was a large decline in the incidence of TB. However, immigrants started migrating from third world countries, the number of homeless people started to rise, people having prolonged lifespans, and the increase of the population with HIV resulted in an increase of TB in the mid 1980’s. Between 1985-1992, there was a 20% increase of new cases in the United States.1 The U.S. is just now beginning to see a decline in TB rates.

There were 11,545 tuberculosis cases in the United States that were reported to the Center for Disease Control in 2009.2 This is estimated to be around 3.8 cases per 100,000 people. This has been the lowest rate reported since 1953, which is when national reporting began. In 2007, the United States reported 544 deaths from Tuberculosis.2 

The TB rate in foreign-born persons in the United States (18.7 cases per 100,000 persons) was approximately 11 times greater than that of U.S.-born persons (1.7 cases per 100,000 persons) in 2009.2 In 2009, approximately 59% of all TB cases in the United States occurred in foreign-born persons, unchanged from 2008. 2

Although the rates are declining in the United States, TB is still a worldwide epidemic. The highest rates of TB can be found in Southeast Asia, sub-Saharan Africa, and eastern Europe. There are about 200 to 400 cases per 100,000 each year.2

Statistics3:

• One third of the nation’s population is infected with TB.
• Each year, about 9 million people worldwide are infected with TB
• There are approximately 2 million worldwide deaths each year from TB.
• TB is the most prevalent killer of people who are infected with HIV.

Rates of TB for different racial and ethnic populations2

• American Indians or Alaska Natives: 4.3 cases per 100,000 persons
• Asians: 23.3 cases per 100,000 persons
• African Americans: 7.6 cases per 100,000 persons
• Native Hawaiians and other Pacific Islanders: 16.7 cases per 100,000 persons
• Hispanics or Latinos: 7.0 cases per 100,000 persons
• Whites: 0.9 cases per 100,000 persons
  

Characteristics/Clinical Presentation

There are usually no symptoms of tuberculosis during the first year of exposure. This is when the disease would be the most curable. Symptoms suggestive of TB include1:

• Productive cough last longer than 3 weeks
• Weight Loss
• Fever
• Night sweats
• Fatigue
• Malaise
• Anorexia
• Rales could be heard in the lobes of involvement in the lungs
• Bronchial Breath Sounds
• Dull chest pain, tightness, or discomfort4
• Dyspnea4
  
  

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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