Common Course of Treatment for TB Patients
Normally, healthy immune systems can suppress and outright kill TB, but TB has a special quality to it that allows it to resist our defenses once it flourishes: it can mutate. This makes treating TB time consuming.
Isoniazid and Rifampin, Ethambutol, and Pyrazinamide are commonly used TB antibiotics. They are used in 6-9 month course regiments. Twelve month regiments are not unheard of in patients that are dealing with a drug resistant strain of the disease. HIV patients must undergo course regiments for a year or more.
If improperly dosed any regular TB strain can develop a resistance to future antibiotic efforts. Treatment must be aggressive early on or it can work against the patient.
Note: Antibiotics do not necessarily kill all TB bacterium in the body; its purpose is to kill growth long enough for the immune system to remove it naturally. This takes longer in HIV patients due to the lack of white blood cells available to kill TB bacteria.
Care Tips for TB
TB is dangerous, but can be circumvented by precaution and knowledge of the disease. It can only be passed through moisture droplets in the active state; latent infections do not pass the condition. You cannot get TB from sharing food, toilet seats, shaking hands, utensils or plates. That said the latent state can still be very concerning.
TB doesn't present any symptoms in its dormant state, and in healthy people treatment may not be sought because the disease may be suppressed by the immune system. To find out if you have TB get a Mantoux skin reaction test.
Mantoux Skin Test
The Mantoux skin test involves injecting 0.1ml of tuberculin purified protein derivative (PPD) in the inner surface of the forearm. Within 48-72 hours you will be asked to come back to have your skin elevation read. If you have a positive reaction (usually an elevation of 15mms or more) you are infected with TB. In high risk patients, such as those with HIV, infection is indicated on a reading of 5mm-10mms. For assurance purposes, two visits are necessary to read the skin in the event of a false reading.
In some cases TB diagnosis may rely on a chest x-ray. X-rays are able to do this because the body naturally heals as TB impacts the body, leaving calcified buildups, or scars, which can be read on a chest reading.
Health care facilities find that it is convenient to have medical workers get TB skin tests approximately every 6 months (preferably before starting work). High risk patients may have themselves tested 1-2 times a year in order to prevent latent TB infection from progressing to the active state.
Vaccines for TB exist, but offer mixed results for most patients. They are often used specifically for special risk populations, such as HIV and TB patients, and within reason some health workers dealing with TB patients. This vaccine is called Bacille Calmette-Guérin or BFG for short. This is highly recommended when patients have both soniazid and rifampin drug resistance (two of the most common medications used for TB strains). Positive TB tests can occur from a vaccination, as skin tests are typically measured by the injected substances reaction (vaccines use trace elements of a bacteria or virus to spur antibodies).
TB patients have to deal with medications that are less ideal as a result of a co-infection, and side effects can cause discomfort. For instance, Rifampin turns urine, saliva and tears orange (soft contact lenses may not be advised as they can get stained), and can lessen the capability of contraceptives, such as birth control pills and implants.
Major side effects include:
- Lack of appetite
- Vomiting Yellowish skin
- Skin rashes
- Aching joints
- Enhanced bruising
- Hearing loss
- Abdominal pain
Information on how TB will impact your patient's life is crucial as there may be a time when active TB forces them to be separated from family members. Your patient may also be irritated by the amount of medication it takes to eliminate TB. If this is the patient's first time with TB, it is ideal to tell them that taking medication correctly within the first 6 months is often the fastest route to get better, but as TB is stubbornly resistant, it can take as much as 9-12 months if not followed correctly. They can help themselves by eating better, staying active, practicing good hygiene and doing things they love. Care must be taken that the patient's items don't leave their room without a procedure to accommodate it.
Particular care must be considered for HIV patients, as their complication treatments can cause them to feel helpless, and nauseous. TB treatments can last a year or more in this group.
In the Event of Active State Infection
Isolation is not unheard of for TB patients, as the disease is very communicable. Legally, health departments need to know that patients have TB, and a proper isolation policy must be enforced. Patients, as a result, may end up isolated at home, or in an appropriately equipped medical facility. It takes about 2-4 weeks with proper antibiotic treatment to downgrade TB to its harmless dormant state. The patient may end up being separated from friends and family.
The CDC recommends particular respirators such as the N95, N99, or N100 particulate respirators. This provides a barrier for the nose and mouth. At home, it is appropriate to open windows, as it will move air stagnated with TB elsewhere.
Personal Protective Equipment Considerations
Equipment standards should address HIV and TB equally, like any other opportunistic infection.
- Use a 60% alcohol sanitizer or better if you're not washing hands.
- Prevent yourself from touching items with contaminated gloves. The patient can harbor trace infectious material on their hands, and body.
- Hold clothes away from you.
- Rules and procedures should address endoscope isolation; otherwise trace TB bacteria may be passed from patient to patient. One endoscope should be designated, left and sterilized before and after use in the patient's isolated room. TB is treated differently than HIV in this regard because TB is more communicable than HIV (TB can remain in the air), and only requires speaking, as opposed to blood and bodily fluid exposure which a worker can prepare for.
- You can sterilize endoscopes by cleaning and sterilizing them with a 2% glutaraldehyde solution for 20 minutes (test studies found no trace of Hep C using this method). This is an acceptable method for removing TB.
- Basic facemasks were once thought effective, but they only provide a degree of protection (bacterium can slip through still).
- Cleaners, such as Lysol, with 99.9% guarantees, can be used to combat TB in commonly used surface spaces.