Department: Editor's Memo
I will never forget the young male admitted from the ED. He was burning with fever, drenched in sweat, talking incoherently, thrashing around in the bed, restrained, thin as a rail, and his face drained of color. I started my nursing career on a tuberculosis (TB) ward. That night I saw the face of TB at its worst—a man so near death that staff doubted he would make it to morning. Although TB wards are gone now, TB is still thriving. The World Health Organization (WHO) notes that TB is one of the 10 leading causes of death worldwide, and it is a leading cause of death in individuals coinfected with HIV.
In 2017, 10 million people became ill with TB and 1.6 million died from the disease.1 In the US, there were 9,105 reported cases of TB in 2017. Although all 50 states were included, 4 states accounted for more than 50% of the total cases: California, Texas, New York, and Florida. In 2016, there were 528 deaths attributed to TB infection, a 12% increase from 2015.2 One of the United Nation's Sustainable Development Goals is to end the TB epidemic by 2030 through integrated patient-centered care and prevention, bold policies, supportive systems, and intensified research and innovation.1,3
The nation's fight against TB
In the US, the CDC leads the nation's fight against TB. Strategies to eliminate TB are focused on interrupting TB transmission and aggressively addressing latent TB infection. State health departments have active TB control programs. Visit the CDC's site TB Personal Stories to read the stories and watch videos; all the patients mention the prominent role public health nurses fulfilled in their treatment and recovery.4 Many patients had missed diagnoses, and often, over 1 year had lapsed between symptom onset and diagnosis. Those infected with TB were treated for colds, bronchitis, and pneumonia with repeated courses of antibiotics. One patient even had an enlarged lymph node in her neck removed with no suspicion of TB, which led to infection in her eye (extrapulmonary TB). Another patient's chest X-ray was never reviewed, whereas another's was misread.
Not all the stories, however, point to errors in diagnosis. Many hail the persistence of the healthcare team in treating their disease, particularly those with multidrug-resistant TB, which is a major challenge worldwide. But genetic and culture-based lab methods show promise in detection of drug-resistant TB because having patients complete the full treatment course is critical in removing active disease.
World Tuberculosis Day: Increasing public awareness
The most common risk factors for TB include travel to or having been born in a country with high rates of TB, excessive alcohol use, diabetes mellitus, homelessness within in the past year, injection drug use, coinfection with HIV, and living in a correctional setting. Healthcare workers are regularly exposed to these populations and thus have increased risk of TB infection. Annually, the WHO designates March 24 as World Tuberculosis Day to increase public awareness about the global epidemic of TB and the ongoing efforts to eliminate the disease. Expand differential diagnoses in patients at higher risk for infection. Familiarize yourself with the signs and symptoms of TB and test appropriately, then assemble the team for management.
Jamesetta A. Newland, PhD, FNP-BC, FAANP, DPNAP, FAAN