Monday, April 4, 2011

Causes of Tuberculosis and Treatment

Introduction about tuberculosis: 
In an age when  we believe that we have the tools to conquer most diseases,the ancient scourge of tuberculosis(tb) still causes 2 million deaths a year worldwide-more than any other single infections organism-remainding us that we still have a long way to go.Even equipped with drugs to treat TB effectively,we haven't managed to eradicate this deadly infection.
From where this disease is effected:
         Mycobacterium tuberculosis, the bacteria that causes tuberculosis, has been around for centuries. Recently, fragments of the spinal columns from Egyptian mummies from 2400 B.C.E. were found to have definite signs of the ravages of this terrible disease. Also called consumption, TB was identified as the most widespread disease in ancient Greece, where it was almost always fatal.
        But it wasn't until centuries later that the first descriptions of the disease began to appear. Starting in the late seventeenth century, physicians began to identify changes in the lungs common in all consumptive, or TB, patients. At the same time, the earliest references to the fact that the disease was infectious began to appear.
        In 1720, the English doctor Benjamin Marten was the first to state that TB could be caused by “wonderfully minute living creatures.” He went further to say that it was likely that ongoing contact with a consumptive patient could cause a healthy person to get sick. Although Marten's findings didn't help to cure TB, they did help people to better understand the disease. The sanitorium, which was introduced in the mid-nineteenth century, was the first positive step to contain TB. Hermann Brehmer, a Silesian botany student who had TB, was told by his doctor to find a healthy climate. He moved to the Himalayas and continued his studies. He survived his bout with the illness, and after he received his doctorate, built an institution in Gorbersdorf, where TB patients could come to recuperate.
        They received good nutrition and were outside in fresh air most of the day. This became the model for the development of sanitoria around the world.In 1865, French military doctor Jean-Antoine Villemin demonstrated that TB could be passed from people to cattle and from cattle to rabbits. In 1882, Robert Koch discovered a staining technique that allowed him to see the bacteria that cause TB under a microscope.

        Until the introduction of surgical techniques to remove infected tissue and the development of x-rays to monitor the disease, doctors didn't have great tools to treat TB. TB patients could be isolated, which helped reduce the spread of the disease, but treating it remained a challenge.
Transmission of disease:
       Some diseases, such as influenza, are contagious or infectious, and can be transmitted by any of a variety of mechanisms, including coughs and sneezes, sexual transmission, by bites of insects or other carriers of the disease, from contaminated water or food, and so forth.Other diseases, such as cancer and heart disease, are not considered to be due to infection, although microorganisms may play a role.
Latent TB Infection:
Pulmonary tuberculosis, or TB of the lungs, is the most common form of TB. TB can also attack the spine, bones and joints, the central nervous system, the gastrointestinal tract, the lymph system, and the heart.

            Only 5 to 10 percent of healthy people who come in contact with TB bacteria will ever get sick. The vast majority of them will live with dormant TB bacteria in their bodies throughout their lives, because their immune systems are able to fight the bacteria and stop them from growing. People with latent TB don't feel sick, don't have symptoms, and can't spread TB. However, the bacteria remain alive in the body and can become active later. They have what are called latent infections.

          TB is spread through the air, not through handshakes, sitting on toilet seats, or sharing dishes and utensils with someone who has TB. However, casual exposure is not sufficient for someone to get TB.

          If at some point in their lives their immune system is weakened, the once-dormant bacteria may begin to grow again and cause active tuberculosis. Sometimes, doctors will recommend that people with latent TB infections take medicine to prevent development of active disease. The medicine is usually a drug called isoniazid (INH), which kills the TB bacteria that are in the body. Usually the course of treatment is six to nine months. Children and people with HIV infection, however, sometimes have to take INH for a longer period of time.
1)A bad cough that lasts longer than two weeks.
2)Pain in the chest.
3)Coughing up blood or sputum.
4)Weakness or fatigue.
5)Weight loss.
6)Loss of appetite.
9)Sweating at night.
Treating TB:
        Most of the time TB can be cured with antibiotics. If you have TB, you will need to take several drugs. This is because there are many bacteria to be killed. Taking multiple drugs also helps to prevent the bacteria from becoming drug resistant and, thus, much more difficult to cure.

        If you have TB of the lungs, or pulmonary TB, you are probably infectious. This means that you can spread the disease by coughing or sneezing. Fortunately, after a couple of weeks of taking medicine, most people are no longer infectious and they begin to feel better. Usually they can return to life as usual. But that doesn't mean all the bacteria are killed. People often have to take TB medicine for six to nine months before all the bacteria are killed.
Why Is It Important to Take TB Medicine for So Long?
        TB bacteria die very slowly. Even when patients start to feel better, the bacteria are alive in their bodies. They have to keep taking medicine until all the bacteria are dead, otherwise they can get sick again and infect others.

       Another danger of not completing the whole course of therapy is the rise of drug-resistant TB. If you stop taking your medicine and some of the bugs are still alive, they may become resistant to the drugs you were taking, so that if you get sick again, you will need different drugs to kill the bacteria because the old ones won't work. These additional drugs, called second-line drugs, must be taken for a very long time, sometimes up to two years, and their side effects can be quite serious.

       The only way to get better is to take your medicine as prescribed by the doctor. Most public health officials advocate Directly Observed Therapy (DOTS), which is when a health-care worker meets with the patient every day, or several times a week, to be sure they take their medicine. Sometimes they meet at the patient's home or at a hospital or TB clinic. Some DOTS programs provide medicine that can be taken only two or three times a week instead of every day. In addition to ensuring that the patient takes their medication as prescribed, the health care worker also monitors side effects.

       DOTS works and it is used in many countries. It is the World Health Organization's recommended method for successfully treating TB.Patients with active TB who have to go to the hospital may be put in special rooms with negative air pressure. This keeps TB from spreading from room to room, or out into hospital hallways. People who enter the rooms will wear special facemasks to protect themselves.

Social significance of disease:
      The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions as diseases of post-traumatic stress disorder, also known as "shell shock"; repetitive motion injury or repetitive stress injury (RSI); and Gulf War syndrome have had a number of positive and negative effects on the financial and other responsibilities of governments, corporations, and institutions towards individuals, as well as on the individuals themselves.
Multi-Drug-Resistant TB (MDR-TB):
    When TB patients don't take their medicine properly, the TB bacteria may become resistant to certain drugs. This means the drugs can no longer kill the bacteria. Drug resistance is most likely to occur when people …
Have spent time with someone with drug-resistant TB.
Don't take their medicine regularly.
Don't take all their medicine.
Develop TB after they've taken TB drugs before.
Come from areas where drug-resistant TB is common.
      Multi-drug-resistant TB (MDR-TB) is a form of tuberculosis that is resistant to two or more of the first-line drugs used to treat the disease. When the bacteria resist the antibiotics used to attack them, they relay that ability to new bacteria that is produced. People with multi-drug-resistant TB must be treated with special second-line drugs. These drugs don't kill the bacteria as well as the first-line drugs, and they often cause more severe side effects.

         If a person with MDR-TB spreads the disease to someone else and that person comes down with active disease, it will be multi-drug-resistant from the beginning. In the early 1990s, there were several outbreaks of multi-drug-resistant TB in New York City hospitals that were caused primarily by the spread of one strain, strain W, that went from patient to patient to patient. This strain was resistant to between seven and nine drugs. A large number of these patients died, and many health-care workers now have latent infections with this highly resistant strain.

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