Infectious Disease Called Tuberculosis

Infectious disease called Tuberculosis

Summary

Tuberculosis is an infectious disease caused by mycobacteria that is called mycobacterium tuberculosis. The vector through which it is transmitted from person to person is air. The lungs are the most affected organs. Its symptomatology is usually nonspecific, but hemoptysis makes us suspect and start with the diagnosis and subsequent treatment. Worldwide it causes serious morbidity and mortality at all ages and sexes. Prevention is decisive in people who live with infected patients. The treatment that will be administered to patients will be the combination of a series of antibiotics.

Introduction

Tuberculosis (TB) is a transmissible disease caused by a bacterium called mycobacterium tuberculosis. Its propagation is produced by close contact between an infected person and another healthy. When the TB patient expels (when he speaks, coughs, sneezes …) drops that are suspended in the air, the inhalation of those bacilli will be sufficient to get infected. The mainly affected body zone is the lungs, but it can also be spread and implemented in other organs and tissues of the organism.

Common symptoms of pulmonary TB are: intense productive cough (sometimes accompanied by blood), thoracic pain, weakness, weight loss, fever and sweat.

There are two types of transmission: people with active TB, who are those capable of spreading, and people with latent TB, who are not sick and are not able to infect others, are carriers.

This condition can be prevented and cured if appropriate measures are taken and an early diagnosis is made. Otherwise, if its natural evolution follows and the disease is established without timely treatment could be deadly (1, 2).

TB is considered a world epidemic, among the top ten causes of death, the main as a pathology that infects through a single agent (even being superior to HIV/AIDS) and the cause of important morbidity.

According to the World Health Organization, in recent years, the figures of TB people have remained stable at 10 million. In 2018, the number of deaths from TB in people co -infected with HIV was 251.000, exceeding this amount, deaths per tb in HIV-negatives, reached 1.2 million.

As for affectation according to sex and age, 57% affects men, followed by women with 32%, and, finally, children (under 15 years old) in 11%.

In response to the geographical location, the greatest number of cases per TB was registered in the development regions, the most affected Asia being the most affected with 44%. However, Europe represents 3% world (3).

There is a vaccine called BCG, discovered in 1921, composed of an attenuated strain of Mycobacterium bovis, being the only one available in Spain and that comes from the original strain of the Calmette-Guerin bacillus. It is highly effective in the prevention of severe forms of TB such as meningitis and miliar TB, but against moderate forms it shows an unpredictable immunity. Widely used in countries where TB is endemic.

The World Health Organization recommends that ‘‘ The best prevention of TB, due to the limited objective of the BCG vaccine, is the identification and treatment of infected people ’’ (4) (4).

For there to be a contagion of an infected person to a healthy. But in addition to the above, other risk factors will influence. These include: the amount of bacilli present in the patient, the age of infection, and the duration and proximity during the exposure. Undoubtedly, healthy people who are living with those affected will have more probability than those who do not.

There are two methods for the diagnosis of TB infection: the tuberculin (PT) test and the determination of the production of gamma interferon (IFN-gamma).

The method of choice to detect the spread of TB is the PT. It is a cutaneous test, known as Mantoux test, in which a reaction is stimulated inside the dermis.

The technique consists of injecting through the intradermal pathway into the ventral face of the 0.1 ml forearm of the Purified Protein derivative liquid of the TB (PPD). Once administered, a lump will appear in the arm, which is called Habón, which will decrease its elevation slightly.

The result of the procedure is considered valid during the first week, it will be interpreted in the first 48-72 hours. At the time of reading, we will measure (in millimeters) with respect to the longitudinal axis of the forearm, the transverse diameter of induration. For this, an object (for example a rule) will be passed through the skin, as many times as necessary to delimit the area, and where it stops when it comes into contact with the elevation, it will be the point that we will take into account when measuring.

In Spain, the test will be considered to have a positive result when:

In people who have not been administered the BCG vaccine, induration is greater than or equal to 5 mm.

In which if they have been vaccinated with the BCG, its interpretation is complex when interfering with the test. Therefore, it will be an antecedent that will not be taken into account in people with great possibility of getting sick. Induration will have to be greater than or equal to 5 mm, in people they are frequent and narrow contacts with infected patients or be a carrier of residual injuries of TB and evolutionary and bacteriological follow -ups that discard the pathology.

In people with immunosuppression situation (HIV, transplanted …) any induration will be considered.

There is an effect called thrust or booster that can lead to errors in the interpretations of the result by being able to understand as a conversion of TB and yet be the result of the realization of the PT. This test does not raise. For all these reasons, it will be a factor of great importance to consider in people who are monitored with the consequent control tests. When this effect is manifested, the test must be repeated after 7 or 10 days and this second reading will be taken as a definitive result, thus concluding if it is a false negative.

On the other hand, the IFN-GAMMA arose as a need to respond to cases in which the PT has limitations. It consists of detecting in blood a cytonin called Gamma Interferon, which is released when stimulating T cells with specific TB antigens that are not present in the BCG vaccine. This test shows a series of advantages with respect to the PT, among which it stands out: ability to discern between vaccinated patients and those who have been infected by other bacteria, avoid false negatives and booster effect, the results are easily interpretedAnd without the continuous visit to consultation. However, its economic cost is higher than the PT.

Tuberculous disease will be developed by infected people who present more risk factors. In this way, those that have been recently infected and those that their immune system are weakened (5) will be more exposed (5).

It is usually classified into two large groups: pulmonary and extrapulmonary. According to the area of the organism that is affected we will find a series of clinical manifestations (6).

Pulmonary TB can occur in isolation or simultaneous to a pleural TB. Frequently infected show symptoms of several weeks of evolution such as productive cough, sometimes accompanied by blood, chest pain, fever, weakness, sweating and weight loss, among others. However, it can manifest in an nonspecific or even in patients who do not present symptoms. Diagnostic studies will begin when the patient presents hemoptysis and/or respiratory symptoms of more than 2 or 3 weeks. In pleural TB, the symptomatology of a pleural spilling, normally unilateral (5) will be characteristic (5).

Regarding extrapulmonary TB, we find different locations:

MILIAR: It is one of the most serious and progressive forms of TB. It occurs when the disease moves through the blood and lymphatic system and affects multiple organs and tissues of the organism, among which are: liver, spleen, lung, lymph nodes, meninges, bone marrow and adrenal glands. A typical lesion that can be observed on the surface of the lungs are the so -called ‘‘ millet seeds ’’ (reduced size nodules and with a whitish tone).

Pericardial: It usually appears concomitant to another affected area, which has been extended, or by blood dissemination.

Laryngea: it is the most contagious location. It can manifest next to a pulmonary TB, and sometimes it can be confused with a neoplasm when presenting as masses in the vocal cords and larynx. Your fundamental symptom is dysphonia.

Gastrointestinal: Any area of the digestive system can be affected, however, it is most frequently located in the Ileocecal. Causes the inflammation of the mucous tissue with the consequent formation of abdominal masses, being able to develop fistulas and ulcers. It usually manifests itself through progressive and chronic nonspecific symptomatology, although abdominal pain is characteristic.

Cutaneous and soft tissue: it is the one that causes the least cases. The most typical lesion is the tuberculous granuloma. In general, they are granulomatous inflammations, which can be accompanied by necrosis and vasculitis to a lesser or greater extent.

Osteoarticular: it frequently manifests in the knees, column and hip, the pain being the representative symptom. We will observe abscesses in the most serious cases.

Central nervous system: the most frequent presentation is meningitis, but brain abscesses or tuberculoms may also appear. It is a serious form of TB, registering high figures for morbidity and mortality despite the beginning of treatment. Sometimes leave sequels.

Genitourinary: Initial semiology is polaquiuria, pain when urinating and hematuria, being able to present renal cramps. Women can present infertility as well as abdominopélvicos pains. On the other hand, the male organs that can often be affected will be the prostate, the epididymis and the testicles (6).

The different tests that can be carried out in a patient with TB suspected are divided into 3 groups:

Image techniques such as simple radiographs, computerized tomography and magnetic resonance. Its use allows us at first to locate structural alterations in the body and discern the types of injuries and if they correspond to an active or residual TB.

Microbiology techniques are made up of: baciloscopy (faster and simpler method by using staining techniques. A minimum of 3 sputum samples belonging to 3 successive days), mycobacteria culture (its indication is usual by overcoming the sensitivity of bacilloscopy, that is, the ability to detect infected people. Allows to detect the bacteriological species and assess the most appropriate antibiotic. However, it presents a great inconvenience and that is that the growth of pathogens is slow, delaycan be valued due to its limited universal practice).

Other procedures: histology (analysis of a tissue sample of the affected organ. In extrapulmonary TB its use is frequent. The representative lesion is granulomatous inflammation with or without necrosis presence. After taking the biopsy, the culture will be performed) and determination of adenosine heartbreak (known as ADA, is an enzyme that produces the monocytes and macrophages in inflammatory response processes and that is directly related to TB when we detect it in large quantities. Its use is usual in the pleural form) (5).

The treatment that those infected with this pathology must take is formed by a series of antituberculous drugs. The importance of early and intensive beginning as well as the continuation of the treatment will benefit both the patient and the society around him. In this way, the patient’s morbidity and mortality will be reduced by decreasing the amount of bacilli present in his body and therefore his infegiosity. The first choice therapeutic regime has a total duration of 6 months. In the first 2 rifampicin, isoniazid, etambutol and piracinamide, and the following 4 months are maintained. However, the treatment should always be individualized to each patient, adapting the doses, duration and drugs according to the present medical situation. The most frequent adverse effects due to medication are gastrointestinal alterations, hepatoto xicity and cutaneous manifestations (such as rash). During the patient’s follow -up, we must ensure that he does not present side effects, and in case they made it make the relevant modifications, so that they can achieve adherence to successful treatment and with it its total recovery (5, 7).

Methodology

This work has arisen from the need to know the information with greater evidence and current affairs about tuberculosis. To do this, a bibliographic review has been carried out in different databases and national and international organizations.

Multiple searches have been made on the following supports: Academic Google, Dialnet Plus, Scielo, Spanish Society of Pneumology and Thoracic Surgery (Sepa), World Health Organization (WHO), Centers For Disease Control and Prevention (CDC), European Lung Foundation (ELF), European Respiratory Society (ERS) and Spanish Association of Pediatrics (AEP).

To limit the results we wanted to obtain, the following criteria have been used: years between 2010 and 2020, languages (English and Spanish) and the Boolean and operator. Of the total of 30 articles and documents that were consulted, 7 were selected for the development of the subject.

Conclusions

Tuberculosis is an infectious pathology that continues to affect a large proportion of people in the world. The priority must be its early detection in order to reduce the high morbidity and mortality figures.

The role of health professionals will be fundamental in the education of the patient with tuberculosis. We must motivate the patient to actively participate in their process. With this we can avoid infection to other people, achieve their adherence to treatment and, ultimately, their complete recovery.

Bibliography

1. Centers For Disease Control and Prevention (CDC). Basic data on tuberculosis [Internet]. 2016 Jun. [Accessed January 18, 2020]. Available at: https: // www.CDC.GOV/TB/ESP/TOPIC/BASICS/DEFAULT.htm
2. World Health Organization (WHO). DESCRIPTIVE NOTE OF TUBERCULOSIS [Internet]. 2019 Oct. [Accessed January 18, 2020]. Available at: https: // www.quien.INT/ES/NEWS-OOM/FACT-SHEETS/DETAIL/TUBERCULOSIS
3. Global Tuberculosis Report 2019. Geneva: World Health Organization;2019.
4. European Respiratory Society (ERS). Pulmonary diseases and information: tuberculosis [Internet]. [Accessed January 18, 2020]. Available at: https: // www.Europeanlung.Org/Es/Pulmonary Diseases-E-Information%C3%B3N/Pulmonary Diseases/Tuberculosis
5. González-Martín J, García-García JM, Anibarro L, et al. Consensus document on diagnosis, treatment and prevention of tuberculosis. Arch Bronconumol. 2010;46 (5): 255-274.
6. Ramírez-LaPause M, Menéndez-Saldaña A, Noguerado-Asensio A. Extrapulmonary tuberculosis, a review. Rev Esp Sanid Penit. 2015;17: 3-11.
7. PASCUAL-PAREJA JF, CARRILLO-GÓMEZ R, HONTAÑÓN-ANTOÑANA V, Martínez Prieto M. Pulmonary and extrapulmonary tuberculous disease treatment. DIRECT INFECC MICROBIOL CLIN. 2018;36 (8): 507-516.