List and describe the clinical manifestations, pathophysiology, clinical features and management of tuberculosis, lung abscess and fungal infections
Identify treatments and therapies used in the management of tuberculosis, lung abscess and fungal infections
Mycobacterium tuberculosis is a bacterial organism that is responsible for causing an infection of the lungs we refer to as tuberculosis or TB for short. M. tuberculosis is carried in airborne particles and are generated when an infected person coughs, sneezes, speaks or sings. M. tuberculosis is spread through the air from one person to another when a person who is not affected breathes in the bacteria from someone who is infected. M. tuberculosis can remain suspended in the air for several hours and can enter the body through the mouth or nasal passages without making an individual sick. This is referred to as latent TB infection (LTBI). This means that the bacteria is inactive or dormant in the body. When the bacteria are active they are multiplying and this is referred to as TB disease. The state of an individual’s immune system determines whether TB will remain dormant in the body or become active causing disease. If a healthy individual becomes affected by TB then the immune system is able to contain the organism.
Latent TB is not contagious and cannot be spread to other people, on the other hand, active TB is extremely contagious and can infect more then just the lungs. Once the bacteria enter the respiratory system and settle in the lungs it begins to grow and can move through the blood and affect other parts of the body such as the brain, kidneys and spine.
Infection occurs when a person inhales droplet nuclei containing tubercle bacilli which travels to the alveoli of the lungs. The tubercle bacilli are ingested by alveolar macrophages; the majority of these bacilli are destroyed. A small number multiply and are released when the macrophages die. If alive, these bacilli may spread by way of lymphatic channels or through the bloodstream to more distant tissues and organs. When the tubercle bacilli are ingested and surrounded by macrophages, the macrophages encapsulate or form a barrier shell, called a granuloma, to contain and keep the bacilli under control. Cavity formation also occurs within lung tissue and during the healing process, calcification and fibrosis develop in the affected areas. Fungal infections and disease result in the development of a restrictive pulmonary disorder due to the affect in the lung compliance (causes a decrease in lung compliance).
Exposure to TB is evaluated by completing a purified protein derivative (PPD) skin test. This test is done by injecting tuberculin under the skin using a small needle. The skin is then checked within 48 to 72 hours to see if there is a reaction. A positive PPD skin test will result in redness (erythema) and swelling (induration) of at least 6-10 mm in diameter at the site of injection. A TB blood test such as the QuantiFERON-TB test is used to determine latent or active tuberculosis by measuring the immune system’s reaction to TB bacteria. Another test is the acid-fast bacilli smear and culture and is performed on sputum to confirm the diagnosis of TB disease.
Some patients will not show any symptoms when infected with TB. This is due to an individual’s health and immune system. Others will present with symptoms such as malaise (weakness), fever, productive cough, hemoptysis, night sweats, and weight loss. The treatment for tuberculosis consists of a 6-month minimum regimen of medications which includes:
Ethambutol or Streptomycin
Fungal infections are less common than bacterial or viral infections and mainly affect people living in certain geographic areas as well as individuals with weakened immune systems. Many fungi are found in soil, dust, water or bird droppings and cause sickness when the aerosolized spores are inhaled. Spores become aerosolized when their natural habitat are disturbed. Three of the major types of fungal infections are: Histoplasmosis, Blastomycosis and Coccidioidomycosis. Most fungal infections are opportunistic because they occur predominantly in individuals whose immune systems are compromised.
It is recommended that patients with severe immunosuppression take antifungal medications to prevent infection. Amphotericin B was a commonly used and popular antifungal agent for most fungal infections. However, amphotericin B is very toxic and there are now new agents available to treat these infections.
For this assignment, you will provide detailed responses to the following questions and provide detailed responses to the case study.
Case Study #1
Daniel, a 30-year-old male, visits the Jackson County Health Department for a tuberculosis test because he is required to have one before he starts his new job at the Brice Nursing Home. He has a positive reaction to the test. He has no symptoms of TB and his chest x-ray findings are normal.
Should Daniel be considered a case of TB? (Why or why not)
Should Daniel be considered infectious? (Why or why not)
Provide detailed responses to the following questions.
Why is the recent traveling history of a patient important in the diagnosis of pulmonary infections?
Explain the difference between symptomatic and asymptomatic TB.
Submit your answers in at least 500 words on a Word document. You must cite at least three references in APA format to defend and support your position.
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