Pulmonary tuberculosis

ICD-9: 011.xx

REPORTABLE DISEASE

Description

Pulmonary tuberculosis (TB) is a slowly developing bacterial lung infection characterized by progressive necrosis of lung tissue. An inflammatory response begins with phagocytosis. Growths of inflamed, granular-appearing tissue (granulomas) form and, when they calcify, leave lesions that may be visible on an x-ray. The lymph and blood generally are affected.

Pulmonary TB is a common cause of death in the world. The arrival of nearly 400,000 immigrants and over 50,000 refugees per year from overseas contributes to the rise of TB in the United States. The incidence of TB also is increasing due to homelessness, substance abuse, and HIV infection – all related to individuals who are less likely to receive adequate medical attention. In general, TB is more common among elderly persons, the urban poor, and members of minority groups.

READ:   Infectious mononucleosis

Etiology

Pulmonary TB is caused by Mycobacterium tuberculosis. The infected individual’s immune system usually is able to wall the bacteria into a tubercle or tiny nodule. The bacteria can lie dormant for years and then reactivate and spread when conditions are favorable. The disease is transmitted in aerosol droplets exhaled by infected individuals. Note: Although the lungs are the organs most commonly infected, the bacteria can infect other parts of the body as well.

Signs and Symptoms

Pulmonary TB may be asymptomatic. The onset generally is insidious. When symptoms are present, they are often vague and may include cough, lassitude, malaise, fatigability, night sweats, anorexia, afternoon fever, weight loss, pleuritic chest pain, hemoptysis, and wheezing.

READ:   Lung abscess

Diagnostic Procedures

Anteroposterior x-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis

FIGURE. Anteroposterior x-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis. (Centers for Disease Control and Prevention, 1972.)

A thorough physical examination, chest x-ray or CT scan, bronchoscopy, and positive tuberculin test often confirm the diagnosis. The tuberculin test of choice is the Mantoux test, which consists of an intradermal injection of a purified protein derivative (PPD) of the tuberculin bacillus. The TB skin test cannot determine if the disease is active. This determination requires sputum analysis (smear and culture) in the laboratory. The sensitive PCR (polymerase chain reaction) test can detect the genetic material of the bacteria, usually within a few days. The bacteria may be identified in the sputum, urine, body fluids, or tissues of the client. Pulmonary and pleural biopsies may be ordered.

READ:   Croup

Treatment

Drug therapy is indicated in every case of pulmonary TB. There are many TB drugs, however, and these can be used in a number of different ways. To prevent the development of resistance, TB drugs are administered in combinations of two or more (usually four) in most instances. Prolonged use of about 6 months is essential. Bed rest and isolation are indicated until the person is strong enough to resume activities.

Complementary Therapy

A whole-foods and nutritious diet combined with vitamin supplements can be helpful. Enhancing the body’s immune response with fresh air, rest, light exercise, and relaxation will prove beneficial.

CLIENT COMMUNICATION

READ:   Cor pulmonale

Teach clients to cough and sneeze into tissues and to properly dispose of all secretions. Remind them of the importance of taking all their medications. Teach family members about the infectious nature of the disease and proper medication regimen. Individuals exposed to someone with pulmonary TB disease should contact their primary care provider or local health department about getting a TB skin test.

Prognosis

The prognosis for an individual with active pulmonary TB is good if the disease is detected early and if the client follows the prescribed regimen of drug therapy. However, if strains of bacteria are resistant to two or more of the major antituberculosis agents, mortality rates increase.

READ:   LEGIONELLA PNEUMONIA (LEGIONNAIRES DISEASE)

Prevention

Preventive measures include proper infection control, tuberculin testing of persons known to have been in close contact with infected persons, and treatment of individuals reacting to the tuberculin testing. Generally, a person with a positive tuberculin reaction is put on 1 year of isoniazid prophylactically. Use of the bacille Calmette-Guerin (bCG) vaccination should be considered only for very select persons who meet specific criteria and in consultation with a TB expert.

Pulmonary embolism ICD-9: 416.2 Description A pulmonary embolism is a mass of undissolved matter in the pulmonary artery or one of its branches. It is the most common pulmonary complication among hospitalized individuals with about 250,000 incident cases occurring annually. It is not considered a disease itself but is a complication of venous thrombosis. It is potentially lethal. Etiology FIGURE. Embolism. (From Thomas, CL : Taber’s Cyclopedic Medical Dictionary, ed 21. FA Davis, Philadelphia, 2005, p 744, with permission.) A pulmonary embolism generally originates in the pelvic veins or deep lower extremity veins and travels through the circulatory system until it blocks a pulmonary artery. At high risk for pulmonary emboli are individuals immobilized with chronic diseases, those in body casts, persons with congestive heart failure or neoplasms, and postoperative clients. Also at risk are pregnant women; women taking oral contraceptives; and individuals with venous diseases, such as var...
LEGIONELLA PNEUMONIA (LEGIONNAIRES DISEASE) ICD-9: 482.84 Description A Legionella infection is an acute bronchopneumonia disease. There are two forms of the disease: Legionnaires disease and Pontiac fever. Legionnaires disease is named after an epidemic outbreak of the illness that killed 34 people and sickened more than 200 attending an American Legion convention in Philadelphia in July 1976. The disease may be mild and self-limiting, as in the case of Pontiac fever, or may produce a pneumonia severe enough to be fatal. According to the Centers for Disease Control and Prevention (CDC), between 8000 and 18,000 people are hospitalized with Legionnaires disease each year in the United States. Etiology Legionella infection is caused by the gram-negative bacillus Legionella pneumophila. Other closely related bacteria within the genus Legionella also can produce outbreaks of the disease that are clinically indistinguishable from classic Legionnaires disease. The Legionella bacteria thrive primarily in warm aquatic environm...
Sleep apnea ICD-9: 770.81 Description Sleep apnea is potentially dangerous and occurs when individuals’ breathing at night repeatedly stops and starts. The condition often is accompanied by snoring loud enough to disturb partners. There are three forms: obstructive sleep apnea in which the throat muscles relax, central sleep apnea in which the brain does not send the proper signals to the muscles that control breathing, and complex apnea, which is a combination of both. It is more common in males and in older adults. Etiology In obstructive sleep apnea, when the muscles in the back of the throat relax, the airway narrows, and breathing temporarily stops. The brain senses the inability to breathe and causes the individual to awaken and take a breath. This occurrence may happen as many as 30 times per hour all night long. Repeated incidences cause the oxygen level in the blood to fall. Because sleep is so disturbed (even though most do not recall waking up to breathe), individuals may feel...
EPIGLOTTITIS ICD-9: 464.31 Description Epiglottitis occurs when the epiglottis covering the windpipe swells and blocks the flow of air into the lungs. It is life-threatening. Etiology Infection with Haemophilus influenzae type b (Hib) is the most common cause, followed by burns from hot liquids and direct injury to the throat. Other bacteria and viruses that cause epiglottitis are pneumococcus; streptococcus A, B, and C; Candida albicans; and varicella zoster. Swallowing a foreign object and smoking crack cocaine and heroin may also cause epiglottitis. Signs and Symptoms Onset of symptoms is sudden. Likely symptoms include sore throat, painful swallowing, fever, drooling, hoarseness, dyspnea, and cyanosis. Diagnostic Procedures Once the airway is open and the condition is stable, the throat is examined with a flexible fiberoptic tube. A blood test and throat culture are likely taken to establish the cause of any infection. Treatment The first priority is to establish a c...
Pneumonia ICD-9: 486 Description Pneumonia is an acute inflammation of the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli of the lung. The inflammation may be either unilateral or bilateral and involve all or a portion of the affected lung. Pneumonia once was the leading cause of death in the United States, but modern antibiotics greatly lessened the incidence of the disease. However, pneumonia still affects close to 4 million people each year and causes death for almost 60,000 individuals yearly in the United States. People ages 65 and older and those with depressed immunity are at greater risk. Pneumonia is often further identified as follows: Lobar pneumonia—Affects one or more lobes of the lung Bronchopneumonia—Also known as lobular pneumonia; bacterial form of the disease Interstitial pneumonia—Characterized by progressive scarring of both lungs Etiology Pneumonia may be caused by microorganisms, such as bacteria, viruses, fungi, protozoa, or rickettsiae. Vira...