Running head: Epidemiology paper: Tuberculosis
Epidemiology Paper: Tuberculosis
Grand Canyon University
October 5, 2014
Epidemiology Paper: Tuberculosis
“Tuberculosis (TB), a multisystem disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. In addition, the prevalence of drug-resistant TB is increasing worldwide. TB is caused by M tuberculosis, a slow-growing obligate aerobe and a facultative intracellular parasite. The organism grows in parallel groups called cords (as seen in the image below). It retains many stains after discoloration with acid-alcohol, which is the basis of the acid-fast stains used for pathologic identification. Humans are the only known reservoir for M tuberculosis. The organism is spread primarily as an airborne aerosol from an individual who is in the infectious stage of TB (although transdermal and GI transmission have been reported). Classic clinical features associated with active pulmonary TB are as follows: cough, weight loss/anorexia, fever, night sweats, hemoptysis, chest pain, and fatigue. For initial empiric treatment of TB, patients are started on a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is known to be fully susceptible, ethambutol (or streptomycin, if it is used as a fourth drug) can be discontinued” (Herchline, 2014).
“Tuberculosis (TB) is one of the world’s deadliest diseases: 1) One third of the world’s population is infected with TB, 2) In 2012, nearly 9 million people around the world became sick with TB disease. There were around 1.3 million TB-related deaths worldwide, 3) TB is a leading killer of people who are HIV infected. A total of 9,582 TB cases (a rate of 3.0 cases per 100,000 persons) were reported in the United States in 2013. Both the number of TB cases reported and the case rate decreased; this represents a 5.4% and 6.1% decline, respectively, compared to 2012” (cdc.gov, 2014).
The Commission on Social Determinants of Health identifies social determinants of health as conditions that make social stratification recognizable in the society. The following are structural determinants of the epidemiology of tuberculosis: fast urbanization and growth of population, global socioeconomic inequalities, and elevated levels of population mobility. The said conditions are the causes of unequal distributions of the key social determinants of TB which are poor housing and environmental conditions, food insecurity and malnutrition, and geographical, cultural and financial barriers to accessing healthcare. As a result, the distribution of population of TB mirrors the social determinants distribution, which, in turn, imposes an effect on the four stages of TB pathogenesis: “exposure to infection, progression to disease, late or inappropriate diagnosis and treatment, and poor treatment adherence and success” (Hargreaves, et al, 2011). The social determinants mentioned above are key risk factors for TB. As an example, overcrowded homes, workplaces and communities, and poor ventilation increase the risk of non-infected persons getting exposure to TB infection. Other factors that could increase susceptibility to TB infection are malnutrition, hunger, and poverty. In addition, these also affect the severity of the clinical outcome of the disease. “Individuals with TB symptoms such as a persistent cough often face significant social and economic barriers that delay their contact with health systems in which an appropriate diagnosis might be made, including difficulties in transport to health facilities, fear of stigmatization if they seek a TB diagnosis, and lack of social support to seek care when they fall sick” (Hargreaves, et al, 2011).
The epidemiologic triangle is a...
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