Mar 31, 2020 in Informative

Infectious Disease

Abstract

Tuberculosis is a dangerous communicable affliction that causes numerous fatal cases worldwide. It can substantially deteriorate the health condition of the population, particularly in tuberculosis low-prevalence countries. Due to morphological properties of the tubercle bacillus and favorable environmental conditions, the disease has managed to attack various continents and states and provoke the recurrent epidemics. In 2014, tuberculosis infected approximately 9.6 people and led to the death of 1.5 TB-affected patients and continues seeking for new casualties. The disease can still get activated and jeopardize the humankind due to the existence of inappropriate socioeconomic factors and combination of other various risks that facilitate TB contamination. The preventive strategy of different health care organizations and medical facilities contributes to decreasing the quantity of TB-affected people worldwide due to the promotion of the policy of tuberculosis elimination and control and by the implementation of TB-preventive programs. Inefficient prevention and control, as well as inappropriate TB management may trigger repetitive epidemic or even cause pandemic in countries with TB high incidence. 

Multiple bacteria and viruses threat the humanity every day. Various communicable diseases may cause high incidence and mortality worldwide. Unawareness regarding particularly dangerous maladies may be a reason of contracting infection and tuberculosis is one of them. The current paper provides an accurate overview of tuberculosis and the way the tubercle bacillus manages to evolve and affect the population. Furthermore, it describes social determinants that influence the TB groups of risk along with highlighting feasible consequences in case of ignoring social precautions. Additionally, the paper discusses the modes of disease management conducted by various medical and public health institutions. 

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Overview of Tuberculosis

Tuberculosis belongs to the most widely spread fatal maladies. It is one of the primary reasons of morbidity and mortality worldwide. Centers of Disease Control and Prevention reports that one third of the world population is infected with TB. “In 2014 there are 9.6 million people all over the world infected with TB disease and 1.5 million TB-related deaths worldwide”. The majority of fatal cases get registered in developing countries of Asia and Africa. The World Health Organization expresses its concern regarding approximately 480,000 drug-resistance TB casualties.

The humankind got acquainted with tuberculosis in the ancient times and periodically peaked in epidemic outbursts in Western Europe and North America. In the eighteenth and nineteenth centuries, tuberculosis prevailed among other communicable diseases. Approximately “70 to 90% of the urban populations of Europe and North America” were affected by TB-bacillus and “about 80% of the infected persons” died of it. Later, growing industrialization, increased international trade, travelling opportunities, and poverty rate contributed to the substantial infection scores. “About 40% of working-class deaths in cities were from tuberculosis”. The tubercle bacillus could improve its properties, whereas tuberculosis was considered as a hereditary sickness. The incredible discovery made by Robert Koch regarding the bacterial nature of the tubercle bacillus made people review their attitude to the studied affliction. Consequently, medical and public health communities mobilized to initiate preventive measures aimed at bringing the disease under control. Implementation of the tuberculosis preventive policy became “the first large-scale public health campaigns”. 

Tuberculosis is caused by the variable and highly virulent causative agents. People primarily acquire infection caused by the infectious Mycobacterium tuberculosis, sometimes Mycobacterium bovis, or Mycobacterium africanus. The tubercle bacillus infiltrates the organism specifically through the “inhalation of” infectious “respiratory droplets” and start producing symptoms that promote it further. However, a long-lasting physical contact, consumption of infected food and water, and intrauterine route cannot be excluded from the transmission modes of TB contamination. The tubercle bacilli generally affect respiratory organs, particularly lungs, but can also attack any other organ of the body due to its high toxicity and virulence. The initial stage of TB progresses as a respiratory disorder or asymptomatically. The post-primary TB results from the initial contamination or relapse. Formation of new caverns and sites prone to conjugation specifies this stage of tuberculosis. TB can behave latently or actively. Active disease manifests in constant fatigue, extreme weakness, somnolence, weight loss, decreased appetite, extensive night sweats, and permanent low-grade temperature. Swollen lymph nodes observed in the neck, axillary cavities, or supraclavicular region are a reason to suspect TB against the background of other worrisome signs. The very telling TB symptoms are persistent dry or productive long-lasting cough, hemoptysis, and pains in the chest, breathlessness, painful coughing. Thorough physical exam, repetitive TB skin test, imaging tests, blood count, and sputum analysis for mycobacterial DNA are common diagnostic methods in detecting tuberculosis. The stated affliction can be deadly dangerous without prompt and appropriate medical management. Having a bacterial nature, TB treatment requires the mandatory antibiotics administration along with practicing alternative treatment modalities. TB resistant to antibiotics requires drugs “combination called fluoroquinolones and injectable medications, such as amikacin, kanamycin or capreomycin”. Nowadays, health care professionals advise practicing a directly observed therapy for improving medication efficiency. The current disorder is highly dangerous for people with weakened or immature immune systems or professionals that are involved in treating people with TB or directly dealing with them. It is particularly dangerous for the elderly, babies, infants, for people with HIV or other chronic conditions, health care providers, and nursing staff that treat and provide medical care to patients with TB. It is also unhealthy for the staff working in various shelters, jails, and other specific facilities when there is more likelihood to be exposed to TB. 

A Socio-Historical Perspective of TB and Evolution of the Tubercle Bacillus

Various stages of the human society’s development facilitated evolvement of different microorganisms and mycobacteria tuberculosis is one of them. M. tuberculosis has probably accompanied the humans for centuries. However, the etiological aspect remains unrevealed. Assumingly, the tubercle bacillus birth preceded the humans’ appearance. Agricultural development and village settlement are the initial source of getting the TB infection by people considering that the bacteria could be preserved in the ground and water. The tubercle bacillus as well as other “smallest beings in evolution's survival mutated and coalesced in order to thrive”. The tubercle bacteria can affect lots of earth life-forms such as birds, cattle, and environmental reservoirs as ground and water, including humans. Simultaneously, it can exist independently without any hosts though it can get activated and start progressing “by possessing something living”. Its mutations and adaptiveness to other alternatives forms of life from birds to humans indicate evolution of the TB-causing bacteria.

The tubercle bacillus has managed to survive and improve its properties during growing population density, predominantly outdoor living, and poor hygiene practice. Its viability enables it to reside in different, even unfavorable environmental conditions and locations. It allows concluding that “nonhuman reservoir may become pertinent to human TB”. Mycobacteria tuberculosis preserves its stamina and potential aggressiveness even while being dormant. Being aerobic infection, growth, replication, and oxygen supplement are not obligatory factors for the current bacillus existence. Adaptability “to the immunologic environment it engages,” changing and sustained survival abilities in the metabolically passive condition, and mutation ability make the stated mycobacteria ineradicable. Thus, the indicated properties of mycobacteria tuberculosis also contribute to the spread of the infection. The causative agent of tuberculosis can get activated immediately upon infiltration into the bloodstream of low-resistant organisms and provokes development of highly contagious symptoms. Technical “inventions stimulated rapid growth in the industries and textiles and led to the Industrial Revolution”. Urbanization associated with fast industrialization and various modes of transport have allowed the M. tuberculosis to travel worldwide searching for new casualties. Favorable environmental conditions have turned tuberculosis into the epidemic disease. Over the past 400 years, the disease was spread by Europeans due to colonization, human traffic, massive migrations, and advanced transports. “Lacking immunity” to the unknown migrating diseases poured into the severe outbreaks and further decimation. Later, the disease attacked sub-Saharan Africa and the Pacific Islands. The epidemic outbursts slowly wane within a large population group as TB resistant individuals survive. Furthermore, variable transmission modes and poor health care provision increase the tuberculosis incidence. The simplicity of the infectious agent, its mobility, accessibility, and adjustability to various hosts illustrates its evolutionary growth. 

Social Determinants of Tuberculosis

Negative socio-economic factors are directly interlinked with social determinants of health.  Global economic inequality, population mobility, fast urbanization, and annual growth of the population affect TB epidemiological situation worldwide. The countries were not ready to deal with “the consequences of the urbanization process” being disabled to provide healthy living environment. Massive migration from TB low-prevalence countries to the ones with high TB incidence, wars and post-war situations, improper mass traffic, unemployment, and homelessness also facilitate the TB spread. Such social factors as inappropriate living conditions, unemployment, food insecurity, malnourishment, as well as “financial, geographic, and cultural barriers” for having access to appropriate professional health care may lead to the continuing epidemic of TB. Social determinants are particularly crucial for individuals with already present malfunctions or chronic infection, and with a chronic medical condition that makes them more vulnerable. Vulnerable groups include close surroundings of TB-affected persons, immigrants from TB-adverse countries, and disadvantageous groups with a high level of TB transmission, including the homeless, injection drug users, and HIV-infected people.

Dealing with TB-patients on a daily basis, health care providers and nursing staff in various specific facilities are at a constant risk of contracting the disease. Poor ventilation and overcrowding, unsanitary conditions, poor and insufficient nutrition, and inappropriate medication due to its expensiveness increase the contingency of being infected with TB. Babies, young children, and adults can get TB due to either immaturity of their immune system or compromised health status. Chronic diseases, HIV/AIDS, autoimmune disorders, chemotherapy, cancer status, and organ transplantation are factors favorable for tuberculosis acquirement. Poverty, absence or lack of adequate financial resources to satisfy daily needs, aging, and malnourishment “may increase susceptibility to tuberculosis” and, therefore, reduce resistance of the body and weaken the immune system. Certain social and economic obstacles prevent TB-affected persons from contacting health care providers due to prejudices, transportation difficulties, and improper social support. Furthermore, ignorance may lead to severe consequences. The above discussed social determinants create preconditions and environment favorable for the tubercle bacillus viability and subsequently influence the spread of tuberculosis.           

Social Changes after the TB Outbreaks

Recurrent epidemic outbursts of tuberculosis provoking numerous TB casualties and deaths have become a top priority and a challenge for researchers and scientists. After discovering the bacterial nature of the disease, the medical communities have combined their efforts in combating the infection. They have started working on developing the medication efficient for a competent TB management, raised demands to sanitary norms. Simultaneously, the society has become more cautious after discovering TB contagiousness and initiated development of the preventive strategy. Such social behavior is aimed at restricting the spread of the disease and its further elimination. Some measures include progressing social media, establishment of special organizations with the purpose to educate the population regarding tuberculosis and enhance disease surveillance, implementation of the preventive strategy to stop the spread of the studied disease and, consequently, keep it under control. Thus, the Centers of Disease Control and Prevention and the World Health Organization are examples of health care-oriented agencies that keep a track on tuberculosis incidence and mortality rate, countercheck efficacy of already existing medication involved in various treatment modalities, along with conducting further research on new advanced therapy and medication. Additionally, outbreaks of tuberculosis have urged development of TB-vaccine. Compulsory vaccination in the TB high-prevalence countries and annual TB skin tests reduce the quantity of TB-affected people and allow providing certain public safety. Further laboratory pharmaceutical research has allowed producing more efficient drugs that are crucial for the disease management.

Tuberculosis Threats

Tuberculosis epidemic or pandemic may threat the world population in case of an inappropriate social attitude to the disease. Delayed TB management, erroneous diagnosis, unawareness regarding the sickness, inaccessibility to the health care facilities, and absence of preventive measures and programs may increase TB infection rate worldwide. Furthermore, the indicated factors may be preconditions for further outbursts of tuberculosis that can impair the public health safety and involve considerable economic losses. Any outbreaks of the communicable diseases, including tuberculosis, substantially impact the society economically, socially, and even politically, whereas they “could result in increased deaths, economic hardship from lost work time, and loss of productivity”. Even nowadays, some progressive countries report their concern regarding the TB tense epidemiological situation despite the application of possible precautions. It is clear that without an effective TB prevention and control policy the disease infection rate would have disastrous results.

Approach to TB Issue by Various Health Care Organizations

The American Government along with the global community “share a vision of a world free from tuberculosis (TB)”. Such health care authorities as the World Health Organization, National Tuberculosis Controllers Association, Centers for Disease Control and Prevention, American Lung Association, Stop TB Partnership, American Thoracic Society, Mayo Clinic, and other medical institutes are health care agencies designed for preventing and eliminating various life-threatening communicable diseases, including tuberculosis. Their common mission is the provision of the public health safety by combating the TB disease and preventing it from relapse. The present agencies are eager to “ensure provision of inexpensive and efficacious drugs to countries that cannot afford them”.

They all seek to diminish the TB infection rate via monitoring the incidence, providing education, and carrying out further research, studies and surveillance. All involved stated organizations implement TB preventive “public health strategies” at state, regional, and territorial levels and contribute to the development of advanced treatment modalities and medications. However, advanced diagnostic tools, therapeutic agents, and improved vaccines are still required for fighting the discussed medical condition more efficiently. Weak points of such organizations are inaccessibility to adequate and trust-worthy information independently, non-availability of their branches in high-prevalence states, and lack of a possibility to countercheck the implementation of the designed TB-preventive programs. 

Conclusion

In conclusion, tuberculosis belongs to the most dangerous contagious diseases that can drastically affect the health condition and reduce life expectancy. It is primarily caused by Mycobacterium tuberculosis and can be transmitted via contaminated air. Tuberculosis medical management frequently requires a long-lasting multi-drug medication. Some socioeconomic determinants determine groups at risk that can be easily exposed to TB infection. Adequate social behavior can prevent or minimize the chances of contracting disease and, consequently, spreading the disease. Many health care organizations, clinics, and medical educational centers have a goal of combating tuberculosis by implementing certain preventive programs worldwide. They continue conducting researches to develop efficient remedies for tuberculosis management.

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