Tuberculosis and Smoking ( Sam

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TUBERCULOSIS&

SMOKING

By

J12B27/901

WAMUBIRIGWE SAMUEL

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Introduction

This is a systemic mycobacterial disease caused byMycobacterium tuberculosis,but also occasionallyM. Bovis.

Its also known as Kochs disease.

Tubercular decay has been seen in Egyptian mummies datingas far as 3000-2400BCE.

Phthisis (Greek word for consumption), Hippocrates identified

it as most widely spread disease at around 460 BCE.

In most cases it affects the lungs i.e. Pulmonary tuberculosis(PTb). It can also spread outside the lungs resulting in extra-pulmonaryTB

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The absolute number of TB cases has been falling since2006, rather than rising slowly as indicated in previousglobal reports*

About 13% of TB cases occur among people living withHIV*

Its estimated to have an infection rate of 22%. A personwith active TB, but left untreated goes on to infect 10-15

other people annually.

Until 50 years ago, there were no medicines to cure TB.Strains of TB resistant to all major anti-TB drugs have alsoemerged

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* Global Tuberculosis control report 2011


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Tuberculosis is spread from infectious patients tosusceptible individuals bydroplet infection. A person onlyneeds to inhale a small number of the bacilli to be infected.

Approx. 1/3 of the worlds population is infected

The mycobacterium can survive in dry conditions outside

the body and can not be affected by weak disinfectants

Fortunately not all people that are exposed to the bacteriaprogress to develop clinical disease, since they develop

active natural immunity to the disease.

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Epidemiology


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Ugandas TB profile as of 2010

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ESTIMATES OF BURDEN2010

Number(thousands)

Rate(per 100 000 pop)

Mortality (excluding HIV) 5.1 (3.37.3) 15 (9.922)

Prevalence (incl HIV) 64 (32100) 193 (95306)

Incidence (incl HIV) 70 (5685) 209 (168254)

Incidence (HIV-positive) 38 (3046) 112 (91136)

Case detection, all forms (%) 61 (5176)

POPULATION 2010 (MILLIONS) 33


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However tuberculosis may flare up, and the person develops

clinical disease when this immunity is compromised orgenerally depressed .i.e.During famineOld ageHIV infection

ChemotherapyInfantsDiabeticsUse of immunity suppressing drugs

People with HIV and TB infection are much more likely todevelop TB.

Its assumed that 5-10% of people that are infected with TBbut without AIDS develop the disease compared to the 30%

of those with AIDS

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PresentationThe way TB presents varies greatly according to the

system or the organ affected i.e.Bones, joints (skeletal TB)

Lungs (pulmonary TB) Kidneys

Ovaries (female reproductive organs)

Abdominal cavity (peritonis/gastrointestinal TB)

Meninges (Potts disease)Heart and blood vessels

The signs and symptoms of tuberculosis can be easily

understood from the clinical history of the disease

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Early signs and symptomsProductive cough

Positive tuberculin test

Night sweats

Weight loss

Fatigue

Late signs and symptomsLoss of appetite

Enlargement of the lymph nodes(in the neck and other areas)

Difficulty breathing

Blood stained sputum (haemoptysis)

Chest pain

Symptoms of other organs involved

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Diagnosis

Diagnosis of tuberculosis may be made by;Radiology (X-rays)

Microscopic examination

Tuberculin test (Manteux test)

Blood testingMicrobiological culture of bodily fluids

Medical history and physical examination

However new TB tests have been developed that are fastand accurate i.e.

Polymerase chain reaction

Amplified mycobacterial TB direct test (MTD Gen-Probe)

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Risk factors for tuberculosis HIV/AIDS

Over crowding

Poor ventilation

Malnutrition

Alcoholism

Diabetes mellitus

Low income groups

Employees in high risk congregate groups

Immunity suppressing drugs

Health workers with infected clientelle

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PreventionThe Bacillus Calmette Guerin (BCG) vaccine was first

used in the 1920s, and tests have found it to be veryvariable in its ability to protect people from infectionin modern settings

A drug called isoniazid (INH) can be used as apreventive therapy for those who are at high risk of

becoming infected with tuberculosis

The WHO recommends that HIV positive people withlatent tuberculosisbe offered isoniazid (INK)

preventive therapy as needed

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A TB patient should also be

advised not to spit anywherecarelessly

Over crowding and poor

ventilation in homes shouldbe avoided

Early diagnosis and treatment

Isolation

Nutrition

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A patient with TB covers her mouth in an attemptto stop the spread of the disease
http://www.avert.org/media-gallery/image-420-a-tb-patient-covers-her-mouth-to-prevent-spreading-the-disease


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Through the Health Sector Strategic Plan III (HSSPIII 2010/11-2014/15), the govt of Uganda came up with the followingstrategies and interventions to reduce the morbidity, mortalityand transmission of tuberculosis;

Expand and consolidate high-quality DOTS services in all districtsby 2010

Expand and strengthen TB/HIV collaborative activities, addressMDR-TB and other challenges in special settings and populations

Contribute to the Strengthening of health systems

Engage all care providers in TB care

Empower people with TB and the communities to participate in TBcare

Build capacity for TB control

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Tuberculosis in children

Over 250000 children 10yrs and below develop TB and100000 will continue to die from TB each year

Tuberculosis and malnutrition often go together, and achild with TB may present as failure to gain weight, lossof energy, and coughing for more than 3 weeks

In children, it is difficult to diagnose TB due to the

problems associated with collecting their sputumspecimens

Hence its usually made primarily basing on diseasehistory, clinical signs and symptoms, and a tuberculinskin test, though not considered a confirmatory test

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WHO guidelines for diagnosis of TB in children

History of contact with a suspect or confirmed case of pulmonary TB

One with loss of weight, cough, fever, and does not respond toantibiotic therapy for acute respiratory disease

With abdominal swelling, hard painless mass and free fluid

With signs suggesting meningitis or disease in the central nervoussystem

Painless firm or soft swelling in a group of superficial lymph nodes

A child that does not return to normal health after measles orwhooping cough

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TreatmentAntibiotics are used to kill the mycobacteria. It serves two

purposes; to cure the patient and to prevent spread toothers

The Directly Observed Treatment Short course(DOTS)strategy, was recommended by WHO in order to decreasethe TB epidemic

As of 2010, a combination of four antibiotics Isoniazid,Rifampicin, Pyrazinamide, and Ethambutol are being used

Thiacetazole was scrapped from the list due to its

dangerous side effects

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Other drugs that may be used to treat TB include:AmikacinEthionamideMoxifloxacinPara-aminosalicylic acid

Streptomycin

When people do not take their TB medications asrecommended, the infection becomes much more difficult

to treat

Medicines used to treat TB may cause side effects likechanges in vision, orange or brown-colored tears andurine, body rash etc including liver problems

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Public health importance of tuberculosis

Its fatal

Its curable

Its a highly infectious disease

There is free treatment for TB

Loss if working days

Stigma due to association with AIDS

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As part of the DOTS strategy, a patient with tuberculosis takes daily doses of pills during supervised

treatment

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http://www.avert.org/media-gallery/image-419-a-tb-patient-taking-medication


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SMOKING

A local artiste wastes his lungs (Courtesy of the Red Pepper publications)

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Smoking is often referred to merely as a bad habit thatsimply requires adequate willpower to conquer effectively

A more practical model describes smoking as a chronicrelapsing condition that often requires ongoing medicaland behavioral treatment

In 2009, cross-sectional study among 2,789 students in 19high schools in Kampala district revealed that 17.5%

reported to have smoked tobacco, 37.9% were trying orstarted smoking before the age of 10, and 5.3% currentlysmoke (Kidimu Gilbert The New Vision May 29 2011)

Tobacco dependence (smoking)is listed as a disease in the

International Classification of Diseases (ICD 9)

Introduction

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Why do people smoke?To relieve stress

To build confidence

To feelwarm

To pass time

To express happiness

To find a sense ofbelonging

To build self esteem

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Risks associated with smokingSmokers not only increase their risk oflung diseases, including lung

cancer, but they also increase their risk of other illnesses like heartdisease, emphysema, stroke, and oral cancer

Body odour/smell

Reduced sense of smell and taste

Irritation of the eyes, nose, and throat

Chest discomfort

Coughing

Chronic bronchitis, a long-term inflammation of the bronchi (largeairways), is characterized by coughing productively over a long period

of time, etc...

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Secondhand smoke

Secondhand smoke is that which is exhaled bysmokers, and also smoke emitted from the burningend of a lit cigarette, cigar, or pipe and is inhaledby another person

It can also be referred to as involuntary or passivesmoking to the non smoker

However, there is also third hand smokewhich isthe residue of chemicals exhaled onto surfaces andthe smokers clothes (Simon Chapman, Professor of

Public Health, University of Sydney)

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Common symptoms associated with exposure to

second hand smokeirritation of the eyes, nose, and throat

coughing

excessive phlegm (mucus in the airways)chest discomfort or pain

Loss of appetite

Children and infants exposed to tobacco smoke aremore likely to experience ear infections, asthma, andare at a higher risk for Sudden Infant Death Syndrome(SIDS)

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PreventionThrough health promotion messages against smoking

Community out reaches to the young people

Strict government policies against smoking and tobaccouse

Providing smoking sections in public places

Encouraging good health practices to relieve stress

Counseling, and support groups

Nicotine replacement products

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Benefits of quitting smoking

Decreased risk of lung disease

Decreased risk of heart disease

Decreased risk of developing cancers

Reduced cigarette stains on fingers and teeth

Reduced occurrence of a hacking cough

Elimination of cigarettes smell on clothing and hair

Improved sense of smell and taste

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Smoking related diseasesMost people who decide to quit smoking do sobecause theyrealise how much damage it brings totheir health. This is a reasonable concern, because halfof smokers die from smoking-related diseases andailments i.e.

Heart attacks

Emphysema

Cancer, particularly lung cancer, cancers of the

larynx and mouth, and pancreatic cancer

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Caries (tooth decay)

Atherosclerosis

Coronary heart disease

Lupus

Strokes

Acute Myeloid Leukemia

Chronic bronchitis

Osteoporosis

Raynaud's disease

Cataracts

Tuberculosis

Leukoplakia

Less oxygen to the brain

Colds

Lowered immune response

Sleep difficulties

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Smoking related illnesses cont

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Smoking related illnesses

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Symptoms of smoking-related lung

diseasesConstant chest pain

Wheezing

Recurring lung infections

Bloody or rust-coloured sputum

Hoarseness, swelling of the neck and face

Pain and weakness in the shoulder, arm, or hand

Unexplained fever

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TreatmentSince smoking is habit and a chronic relapsing

condition, its treatment is aimed at rehabilitatingthe patient and also towards the smoking relatedillnesses i.e.

Taking up a daily exercise oractivity to relieve stress

Nicotine replacement therapy

(patches, gum, lozenges)

Counseling

Supportive environments

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Public health importance of smoking

It brings a bad smell on the smokers clothing and body

Cigarettes cause staining of the fingers and teeth

It can also cause behavioral disturbances and concentration problems of

hyperactivity (ADHD) in children (Hillel R. Alpert, researchers from Harvard School ofPublic Health's Center for Global Tobacco Control)

Its associated with increased severity of asthma, lower respiratory tractinfections in infants

It raises the risks of getting heart attacks, strokes, and cancers

Smoking during pregnancy is associated with premature births,miscarriages, still births and excessive bleeding

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ReferencesCommunicable diseases by Erick Nordberg

http://www.avert.com/

http://www.health.kompas.com/

http://www.who.int/media centre

Our Bodies, Ourselves for the New Century, by

Boston Womens health book collection

http://www.wikipedia.org/

http://www.bettermedicines.com/

The New Vision , May 29 2011

A.D.A.M medical encyclopedia

Global TB control report 2011

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Tuberculosis and Smoking ( Sam

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