Introduction ... 3
Elements in the chain of infection of tuberculosis ... 3
Reservoir: ... 3
Portal of Exit: ... 4
Means of Transmission: ... 4
Portal of Entry: ... 5
Susceptible Host:... 5
Nursing Management of Tuberculosis ... 6
Treatment Options ... 6
Role of Professional Nurses in TB management ... 7
Evidencebased Practice Nursing Intervention ... 8
References ... 10
In practice, evidence-based practice helps in developing appropriate control and
prevention measures of infectious diseases. However, effective intervention relies on an
informed understanding of the chain of infection. This is a paramount aspect in professional
nursing because it facilitates nursing management of a given condition with the focus of breaking
the chain through treatment and nursing management interventions.
In the case of tuberculosis, the chain of infection involves six key elements. These
elements are infectious agent, reservoir, portal of exit, means of transmission, portal of entry, and
Infectious agent: Etiological agent of tuberculosis in humans has been found to be a
bacterium known as Mycobaterium tuberculosis. M. tuberculosis is a pathogenic bacterium, and
it belongs to Mycobacteriaceae family. This bacterium exhibits unique microbiological
characteristics which are responsible for its pathogenicity. M. tuberculosis is a nonmotile
bacterium which thrives in environments with high oxygen levels. As such, it is considered as an
obligate aerobe. From the bacteriological staining, M. tuberculosis is considered as an acid-fast
bacterium. It possesses a complex cellwall which comprises of mycolic acids, a characteristic
that confer it with resistance to weak disinfectants. Genetic studies indicate that M. tuberculosis
consists of 167 strains which are responsible for 98.8% of tuberculosis cases in humans (Assam
et al., 2013).
Reservoir for M. tuberculosis is another human being in which the bacterium thrives.
Ordinarily, M. tuberculosis thrives in natural environments with high levels of oxygen. This is
why it prefers the mammalian respiratory tract. However, it is worth noting that M. tuberculosis
can infect different regions of the body. Apart from the respiratory tract, especially the lungs, this
bacterium infects the spine where it may cause lifelong disability.
Portal of exit for M. tuberculosis is through cough or sneeze through which the
etiological agent is propelled into air (World Health Organization, 2015). Biological analysis
indicates that sputum contains a high population of the bacilli. This is why diagnosis for
tuberculosis involves sputum analysis including acid-fast staining and microscopy to identify the
stained rods. In addition, bacterial culture techniques are useful in which sputum is cultured to
determine growth of the rods. Therefore, propulsion of sputum into the air through coughing,
spitting or sneezing serves as the portal of exit for tuberculosis.
Tuberculosis is known as an airborne disease because its transmission occurs through the
air. Ordinarily, the route of transmission of tuberculosis is direct from the reservoir person to the
new susceptible individual or host. Transmission occurs when a person with tuberculosis propels
respiratory droplets into the air through coughing or sneezing. In most cases, these are
microscopic droplets that can be propelled through singing, laughing and speaking. However, it
is worth noting that only persons with active tuberculosis can spread the bacteria (National
Institutes of Health, 2012). According to World Health Organization (2015), tuberculosis in
humans can exist in active or latent forms. It is reported that one-third of the global population is
infected with latent tuberculosis. These persons cannot transmit tuberculosis to other people.
This implies that only persons with active tuberculosis can spread it directly to other people,
especially those in damp and overcrowded environments which are characterized by limited
space such as small houses (Müller, 2011).
On the other hand, transmission of tuberculosis can occur when dust contaminated with
TB bacilli enter into the body of uninfected person. As such, dusty environments favor the
spread of tuberculosis (Müller, 2011).
Infection of tuberculosis occurs when uninfected person inhales respiratory droplets
which are propelled by a person suffering from tuberculosis into air. Therefore, inhalation serves
as the portal of entry into the body. Upon entry into the body, tuberculosis bacilli infect the
respiratory tract, primarily the lungs where they multiply and exert their pathology. However, it
is worth noting that tuberculosis cannot be transmitted from a pregnant mother to the fetus
because tuberculosis bacilli do not cross the placenta (Müller, 2011).
Humans serve as the hosts for tuberculosis. M. tuberculosis can infect all people
irrespective of gender, race and color. As such, the disease does not exhibit demographic
inequalities. However, tuberculosis exists in people in two distinct forms: inactive and active.
People with latent tuberculosis do not exhibit the pathology related to the disease. However,
latent tuberculosis can become active and this is manifested by the main signs and symptoms of
World Health Organization (2015) reports that, people with latent tuberculosis have a
10% risk of developing active tuberculosis. This risk is related to several factors which increase
an individual's susceptibility to tuberculosis. First, people with suppressed immune system are
highly susceptible to tuberculosis infection. For instance, HIV patients are highly susceptible to
tuberculosis in a situation referred to as co-infection. Babies are also more susceptible to
tuberculosis infection than healthy adults. Second, malnutrition increases the risk of getting
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- Patrick Kimuyu (Author), 2018, Treatment and Nursing Management of Tuberculosis, Munich, GRIN Verlag, https://www.grin.com/document/388520