A FRAMEWORK FOR DESCRIBING TUBERCULOSIS INFECTION

Tuberculosis, a disease caused by the infection of Mycobacterium tuberculosis remains a global

health problem (1, 2). It is one of the ten leading cause of death globally particularly from a single
infectious agent, ranking above HIV/AIDS. Despite the fact above, tuberculosis can be cure with
effective diagnosis and appropriate treatment. The principles of public health provide an essential
framework for continuing investigate the cause and consequence of TB infection and also to
improve the tuberculosis prevention and control programs.

Health Condition or Risk Factor of Tuberculosis Infection

Mycobacterium tuberculosis is the etiological agent of tuberculosis (TB) infection. It is an airborne

pathogen, which is easily spread through the air from person to person. In general, the airborne
droplets from pulmonary TB patients can become contagious or have a progress to be an active TB
(3). In some case, people can develop the disease soon after becoming infected with TB bacteria
while others may become ill later after their immune system become weak. There are two
categories of TB risk factor, such as; people who have been infected with TB and those who are
immunocompromised due to HIV infection, diabetes mellitus, severe kidney failure and etc (4).

The Severity of Tuberculosis Infection

Tuberculosis is commonly a disease related to poverty. Despite the declining of TB incidence in

many countries, the disease continues to rise in several countries, particularly in Sub-Saharan Africa
where HIV is endemic (5). One of the risk factors of TB is HIV infection which can increase the
reactivating of latent TB and increase the progression of active TB after infection with latent-TB
(6). According to the annual report of World Health Organization (2016), approximately 1.4 billion
people died from TB in 2015 and approximately 0.4 million deaths from TB-associated HIV/AIDS.
Furthermore, around 10.4 million new cases are reported, 5.9 million among men, 3.5 million
among women, 1.0 million among children and 1.2 million among those who are infected with
HIV/AIDS (7). Moreover, the burden of TB infection is more severe in the Asia region compare to
the previous reports. the TB infection incidence rates in several Asian countries are more severe
than other regions (8).

Measuring the TB Infection

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Although TB infection is easily treated, there is an increasing global burden of tuberculosis
associated with HIV infection. There is a strong correlation between HIV-TB infection even since
the early stage of HIV infection. The situation become more complex since the recognition of multi-
drug resistant TB (MDR-TB) cases especially in the Eastern Europe and South Africa (9). Patient
with HIV-TB have high death rates and TB is the leading cause of death in HIV patients especially
in endemic countries. MDR-TB has also increased rapidly as a result of lack TB case management
and program management (10).

Those Who are at Risk for Developing Tuberculosis Infection

Babies and young children are the most at risk to develop TB infection. Although young children
are less likely to transmit the TB, the transmission from children still can be occurred (4). In
countries with a high incidence rate of TB infection, the risk for developing TB among children
who have contact with adult with TB positive is 30%-50%. Furthermore, other
immunocompromised people such as those who live with HIV/AIDS, diabetes, severe kidney
disease, cancer and malnutrition can easily develop TB infection as their body cannot effectively
defend the disease.

Determinants of Tuberculosis Infection

The determinants of TB infection such as; Firstly, susceptibility of the infected person. Those with
weakened immune system are more likely being infected with TB. The number of TB patients
increase drastically since the spread of HIV. This because HIV suppresses the immune system,
making it difficult to control TB bacteria. People with HIV are many times more likely to get TB
and to progress latent TB to be an active disease. Multi drug resistant strains TB arise when an
antibiotic fails to kill all the targeted bacteria. This causes the surviving bacteria to become resistant
to drug and other antibiotics. Secondly, the infectiousness of TB patients which related to the
number of tuberculosis bacteria expelled into the air. Thirdly, the environmental factors that affect
the spread Mycobacterium tuberculosis, including specimen handling, air circulation and
ventilation. Fourthly, duration, frequency and proximity of exposure. The longer duration of
exposure will increase the risk of TB infection the higher frequency of exposure can lead to the
increasing risk of developing TB and the closer of proximity also can increase the risk of TB
infection (4).

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Potential Prevention Strategies

TB prevention and control remains the global public health agenda, requiring multiple tools. The
World Health Organization has introduced a population level-intervention called DOTS (Directly
Observed Treatment, Short Course) as the internationally recommended TB Control Strategy. The
keys element of DOTS including, firstly, sustained political and financial commitment. Political
commitment is crucial for enhancing the national and international partnership to tackle the spread
of infectious agent. In addition, the adequate resources and finance together with good strategy
planning can help to cure the TB infection. Secondly, diagnosis by quality ensured sputum-smear
microscopy. Testing mucus from sputum is the highly effective method to diagnose the active TB.
Another test can be done through chest x-ray, Mantoux skin test and QuantiFERON TB-Gold test
(4). Strengthen laboratory network also can increase the validity of the laboratory result. Thirdly,
standardized short course anti-TB treatment given under direct and supportive observation (DOT).
It helps to minimize the burden of multidrug resistant TB cases and to improve the TB treatment.
Fourthly, a regular, uninterrupted supply of high quality anti-TB drugs. Finally, standardized
recording and reporting. It helps to monitor the performance of the program and to record each TB
patient (11).

In conclusion, although tuberculosis remains the leading cause of morbidity and deaths worldwide,
the implementation of directly-observed therapy short course (DOTS) has been effectively
controlled the disease infection.

REFERENCE