Lower respiratory infections

Pneumonia

Pneumonia is the most common and most serious type of lung infection. It can be caused by a virus that is inhaled or by bacteria that gets in through the mouth. Pneumonia causes the alveoli to fill with liquid that blocks the exchange of oxygen in the lungs. The lack of oxygen combined with the spread of infection can cause death.

Pneumonia caused by bacteria is spread from person to person through secretions from the nose, mouth, and throat. Symptoms may include high fever, chills, severe chest pain, and a cough that produces mucus. Bacterial pneumonia can come on gradually or suddenly. It often follows what appears to be an ordinary respiratory infection.

Bacterial pneumonia can develop 4– 14 days after an apparent recovery from the flu, especially in people with heart disease. Fever returns, along with a cough that produces mucus. This disease can progress rapidly from flu to serious pneumonia, and it often causes death. Pneumococcal pneumonia is the most common type of bacterial pneumonia. It can be prevented with immunization and hand washing. Pneumonia caused by a virus resembles the flu at first, with fever, dry cough, headache, muscle pain, weakness, and shortness of breath. Careful hand washing can help prevent its spread.

Tuberculosis

Tuberculosis (TB) is an airborne infectious disease that is caused by an organism known as mycobacterium tuberculosis that gets into the lungs. TB is spread through casual contract. It is spread when the contact takes place in confined spaces and in poorly ventilated areas that increase the risk of exposure. It can also be spread on mucous droplets of an infected person through talking, laughing, singing, yellow breathing or coughing.

The organism, mycobacterium tuberculosis, is a bacterium. It is carrier on drops of moisture in the air. When the droplets are inhaled, they travel inside the lungs where they start to multiply. Once the TB germ has entered the body, the person now has TB INFECTION (inactive TB). You cannot get TB by touching the person with TB or from their drinking glasses, clothing, shaking their hand or sitting on the same toilet seat. The immune system traps TB with its white blood cells. The white blood cells try to destroy the bacteria to help keep the person from getting sick. These germs go into a “sleeping state”. The infected person usually feels fine at this point. But often, when person is tired, run down, or the immune system is compromised by other diseases such as HIV, pneumonia, cancer, or diabetes, the germ breaks out of the capsules and begins to multiply. At his point, the person has TB DISEASE (active

TB).

Types of TB

TB Infection (inactive TB) – This means that the person has the TB germ, but doesn’t look or feel sick. They cannot give another person TB. A TB skin test, given to someone who has inactive TB, will test positive. Sometimes, a doctor will prescribe preventative treatment. A single medication is given, usually for 6 months, but can be given for up to one year. Only about 5‐ 10% of inactive TB cases become active TB.

TB Disease‐ (active TB) ‐ With active TB, the person usually feels sick. The person will have a cough for 3 weeks or more, feel weak, have a fever, have weight loss, and low appetite. They may have night sweats, or cough up blood. Sometimes, they have chest pains while coughing. This person IS contagious unless he or she is taking TB medications as directed by a physician. Treatment for active TB requires more than medication. The therapy usually lasts between six months and a year. After one to two weeks, the person is no longer contagious. TB patients who are prescribed medication (but stop taking them before they should, are at very high risk for a stronger form of TB). This form is resistant to the normally prescribed medications. Stronger drugs are taken for a longer period of time required to kill this type of TB. Without treatment, the disease will become worse. If TB is in the lungs, it may produce phlegm, mucous, and or blood. TB can get into other parts of the body as well, including the liver, kidneys, spine, bones and abdominal cavity. TB disease in other parts of the body has different symptoms than with TB in the lungs. Symptoms depend upon the part of the body that is infected. A positive PPD requires a chest x‐ray for complete diagnosis. The chest x‐ray will show any damage to the lungs. Phlegm from a persistent cough can also be tested for TB. The test requires 3 different specimens. They must be obtained first thing in the morning after the patient has brushed their teeth and rinsed their mouth. A deep cough is needed to produce the phlegm, which is put into a sterile container and tested. If TB bacilli are present in the lungs or throat, they can be exhaled into the air by breathing or coughing. Others can breathe in the bacilli and become infected. This is the reason that TB patients are isolated and visitors are required to wear masks.

Background on TB

Before the 1940’s TB was a common disease. TB was the leading cause of death in the United States. It has been estimated that one in seven deaths were caused by TB. Unfortunately, a cure was found and TB was significantly reduced in the United States when it seemed we had won the war against tuberculosis, it is now becoming a serious health threat again. During the mid-1980’s, cases of TB began to increase, especially among the HIV positive population. New, drug resistant strains of TB have also been found. The World Health Organization estimates 1.7 billion people are infected with tuberculosis. Healthcare workers are often exposed to diseases without their knowledge. This is important for everyone who works in healthcare to understand TB. Understanding symptoms and precautions is the only way to prevent getting or giving the disease. Knowledge takes the fear out of the unknown. TB is more common among older people, especially males, foreign borne individuals and individuals who are also infected with HIV. Anyone with a compromised immune system is at a greater risk of contracting TB. In 2001, 1,145 cases of TB were reported in Florida, which made FL the 4th highest TB State in the US. 43% of the TB cases were reported in 2001 were from people outside the United States. In 1995, it was only 15%; 23% of the reported Florida TB cases in 2001 were HIV positive.

People born in foreign countries may have been vaccinated with BCG. BCG is a vaccination for TB. This vaccination is not widely used in the United States, but is given to infants and small children in

foreign countries where TB is high. BCG does not always protect the individual from TB. A PPD test should not be given to people who have been vaccinated with BCG. BCG causes a false positive result. These individuals need to have a chest x‐ ray to determine their TB status. (Just in case you’re interested ... BCG vaccine was named after the French scientists named Calmette and Guerin. The “B” stands for Bacillus.)

Symptoms of Tuberculosis

Just because a person has a cough or is tired, does not mean they have TB. TB is suspected when the symptoms last longer than three weeks, if the person has had a “positive” PPD, or if they have had a recent exposure to TB. Many other diseases, including HIV, have some of the same symptoms, so a visit to the doctor is always recommended for accurate diagnosing. Respiratory symptoms lasting more than three weeks should be evaluated, especially if they are accompanied by one or more of the following:

o Fatigue (tired all the time)

o Malaise (generally “feeling bad”)

o Loss of appetite

o Weight Loss (not planned)

o Fever

o Night Sweats

o Prolonged Coughing

o Coughing Up Blood

o Chest Pain

Testing

A simple TB skin test can identify those people who are either currently infected with the disease or have been exposed to it. A chest x‐ray can then determine if the disease is present. The CDC considers the following individuals at high risk for TB and recommends a TB skin test.

o Persons with signs or symptoms of tuberculosis

o Persons who have had contact with a person with active TB

o Persons with an abnormal chest X‐ Ray suggestive of TB

o Persons who inject drugs

o Persons with poor or compromised immune systems

o Groups at high risk of recent infection of TB (recent immigration from other countries, employees and residents of nursing homes, hospitals, prisons, and mental institutions)

The tuberculin test that gives the most accurate result is the Mantoux test, often call “PPD” named for the serum that is used. (Purified Protein Derivative). The serum is injected just below the skin, usually on the forearm, and then checked in 48‐72 hours for results. If the area is red and raised, (6‐10mm) it could be an indication of exposure to TB or active TB. The PPD is not 100% accurate. False positives and false negatives may occur. However, there is no better diagnostic test available. This skin test is a screening tool and is the traditional method of diagnosing individuals infected with mycobacterium tuberculosis.

Treatments

The type of treatment the individual will receive will depend on whether they have TB infection of TB disease. TB infection (Inactive TB) is usually treated with a drug called “INH”, also known as Isoniazid. INH kills the TB bacteria that are in the body. If the person takes this medication as prescribed, it will usually keep them from getting the TB disease. Treatment is 6‐12 months. Side effects include loss of appetite, nausea, vomiting, yellowish eyes skin, fever, abdominal pain, and tingling in hands or feet. Alcohol can increase the side effects and can contribute, to liver problems with these drugs, so while taking this medication, drinking alcohol not allowed.

Multi‐drug therapy is required for TB Disease (active TB) and can include the use of Rifampin. Rifampin can turn urine orange. It may even turn tears or saliva orange. Rifampin will stain contact lenses, so persons taking this drug must wear their glasses until the treatment is over. Rifampin also causes sensitivity to the skin so a good sunscreen should be used. Rifampin may interfere with birth control pills. Alternate birth control methods must be used during the treatment. Alcohol should not be used while taking this drug.

Other drugs used include Pyrazinamide and Ethambutol. Streptomycin may also be given by injection. TB does not normally require hospitalization. Treatment can usually be given on an out‐patient basis through a doctor’s office.