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Objective of the paper

Describe about the Multidrug- Resistance Tuberculosis for Bacterial Infection.

Background information

Tuberculosis (TB) is known to be a bacterial infection that spreads from one person to another through the air according to Ngosa & Naidoo (2016). TB is primarily caused by Mycobacterium tuberculosis that normally affects the respiratory system organ called the lungs as well as other body parts like the kidney, the spine, or the brain. Even though TB is curable and treatable in most cases, people with TB can die if they do not get proper treatment. The disease occurs in two forms, i.e., active and latent forms. Active TB actively produces symptoms that can easily be transmitted to other individuals. On the other hand, latent TR occurs when an individual is not producing the symptoms and have no TB bacteria in the sputum as a result of body suppressing the growth and spread of the bacteria. As a result, Virenfeldt et al. (2014) point out that people with latent TB do not usually transfer the infection to other people unless in the failure of the immune system. In case if the failure, the growth, and spread of the bacteria cannot be suppressed resulting to active TB making the person contagious. For this reason, latent TB is said to go dormant and can be reactivated in the later stages of infection as pointed out by Neil and William (2011).

In the treatment of TB, multi-drug treatment tends to be used for active TB patients. Depending on the public health or state regulations, a patient can use the drugs under the supervision of a healthcare professional or a physician. The Global Tuberculosis Report (2015) refers to the program as a Direct Observed Therapy aimed at preventing erratic treatment procedures that can result in the failure of the treatment process. With acquired resistance and continued risk transmission of the bacteria to the medication, a patient develops a resistant to the drugs used, a condition called multidrug-resistance (MDR) Tuberculosis. This paper presents a detailed analysis of MDR Tuberculosis as a re-emerging communicable disease. It focuses on the role of the causative agent of the disease, the host, as well as the environmental factors that favor the spread of the infection. It also examines a literature analysis on the potential policy responses that have been put in place so as to help in managing the infection. The paper then concludes with a brief summary of the major issues presented in the literature analysis.

Analysis and discussion of the paper objectives

The resistant of the multi-drugs used occurs when these drugs are mismanaged or misused by a patient. For instance, it occurs when a patient does not fully complete the dosage of the treatment prescription, when a wrong treatment is prescribed by the healthcare providers and a wrong length of time for taking the drugs or gives a wrong dosage. Other cases are reported that occurs when the drug supply is not available or when the drugs prescribed are of poor quality. On the other hand, Virenfeldt et al. (2014) point out that MDR-TB is common in individuals who do not regularly take the TB medicine and patients who develop TB disease after a previous infection and use of TB drugs. It also occurs in people who come from areas where drug-resistance is commonly reported or even in individuals who spent time with individuals reported to have drug resistance to TB infections.

Human being is the host of the Mycobacterium tuberculosis. The point of entry of the TB bacteria into the body of the host is via the respiratory tract through the respiratory droplet nuclei infection that is small in size to pass through into the lower respiratory tract Villegas according to (2016). Once inside the lungs of the body, the bacterium has four potential fates. First, the organism can start multiplying immediately and start growing within the lungs after infection causing a primary condition of the disease known as primary tuberculosis. Secondly, the immune system of the host can be effective and will initially respond by killing the bacterium. In such cases, the patient has no chance of developing the infection shortly. Thirdly, it may become dormant and do not cause any disease making the patient develop a latent infection that can only manifest when the tuberculin skin test of the patients turns out to be positive. Fourthly, the latent organism starts growing resulting in the occurrence of the clinical disease called reactivation tuberculosis according to Ngosa & Naidoo (2016).

In healthy hosts with the latent form of TB infection, Banna et al. (2016) in their study report that 5 % to 10% have a chance once in a lifetime of developing active TB disease. On the other hand, many compromised hosts with reduced immune system such as HVI patients have 7% chance of TB development once the latent infection is established. It hence makes apparent the importance of the body of the host in fighting infections as denoted by Villegas et al. (2016). In such a state, it is vital that the host is tested to know the form or level of the infection so as to initiate the right prescription of the appropriate drugs. It is at this point that the MDR develops depending on the response of the patient towards the dosage and treatment process.   When the wrong drugs are prescribed, or the patient does not finish the recommended days of treatment, the body becomes resistance to the multiple drugs used for treatment, a condition that leads to the development of MDR tuberculosis Ahmed et al. (2016).

Role of the agent in the body if the host

Many studies suggest that there is minimal difference between the risk of transmission of MDR-TB and other forms of tuberculosis. Singhal et al. (2016) point out that the spread of the infection is dependent on many environmental factors mainly the number and concentration of TB patients together as well as the presence of individuals with a higher risk of infection. The possibility of getting the infection increases with the time that uninfected individual spends in the same room with an infected person.  In their study, Neil and William (2011) denote that the risk of spreading the disease increases with the concentration of the TB bacteria mainly in places with poor ventilation such as hospitals, prisons, houses, etc. However, many researchers and publications suggest other environmental potential risk factors that may lead to the increased risk of getting an infection.

According to Masini et al. (2016), getting exposed to smoke is a risk factor that can greatly affect the spread of MDR-TB. Even though the proposed links between getting exposed to smoke and TB is currently defensible, the mechanism that underlines the idea is still unclear. Some scientists also speculate that smoking of cigarette boosts the infection of TB as it impairs the ability of cilia of the lungs to clear the presence of TB bacteria in the respiratory track. In such cases, Bastos (2016) point out that the body can naturally produce carbon monoxide to initiate apoptosis process that can lead to B latency. However, in cases of cigarette smoking and burning of biomass in places with less oxygen, apoptosis process declines drastically due to excess exposure to carbon monoxide and can prevent TB-infected cells from flourishing.

Excessive use of alcohol is a behavioral factor, it is also said to increase the infection and progression risks. Excessive use of alcohol empires immune response and invite risky social interactions that can foster the transmission of TB. In their study, Sung-Ching et al. (2016) points out that the risk of TB is elevated in individuals who consume over 40 grams of alcohol every single day. Cases are also reported where TB patient stops taking their drugs as a result of excessive alcohol making them forget the need to take the drugs every single day. The TB drugs are as well very strong and require the body to have enough energy. As a result, patients with limited food supply suffer from malnutrition, a factor that as well causes patients to stop taking the drugs or forego the TB drugs and buy food despite the fact that they are TB patients (McLaren, Schnippel & Sharp, 2016).

Environmental factors

In the process of managing the spread of this communicable disease in various parts of the country, different policies have been designed to help different health practitioners and patients to manage the infection. As mentioned earlier, resistance to drugs occur as a result of several factors, some of which may be federal challenge such as the availability of sufficient drug supply. As a result, several research and publications have adopted different potential policies to help in managing the spread of the infection. These include;

Schmidt (2013) points out that TB drugs are widely available in many pharmaceutical shops globally thus encouraging self-treatment and purchase of inadequate combinations and quantities of medications. In the process of drug subscriptions, the individuals prescribing the drugs contrary to the national TB programs may fail to abide by the recommended regimens while other patients may only purchase part of the prescribed medication as a result of financial constraints. These procedures occur as a result of poor prescription and dispensation monitoring and regulation of the drugs. According to Singhal et al. (2016), the regulations may exist but are poorly and insufficiently enforced. This policy is hence aimed at voluntarily engaging private and public providers with the national programs for TB. It is hence a forceful approach aimed at restricting the right of prescribing and dispensing the drugs to national TB programs or even to providers who have been accredited by the program. It is a measure that has seen to effectively work in countries like Tanzania, Ghana, Syria, and Brazil as it promotes the awareness of patients on poor subscription and the health threats that can occur as a result of substandard medication according to Nathanson et al. (2016).

According to the Global Tuberculosis Report (2015), only 18% of newly reported cases of tuberculosis were treated with fixed-dose combinations of the tuberculosis drugs in 2015. This was despite their potential of reducing the risk of developing drug resistance and logistic advantages. Ngosa & Naidoo (2016) also reports a documentation of the use of poor-quality and counterfeit anti-tuberculosis drugs that can easily lead to amplification and development of drug resistance despite the fact that there is still no accurate estimation of the scale of the problem. For effective prevention and management of MDR-TB, this policy is aimed at achieving or securing affordable and quality-assured anti-tuberculosis drugs to as to ensure a TB management process that meets the international quality standards for different federal states globally. However, Nathanson et al. (2016) assert that achieving this policy has not been easy for the past four years since particular concerns and reports for increasing the scale of MDR-TB management is as a result of the insufficiency in the supply of quality-assured, second-line anti-TB drugs. For this reason, Singhal et al. (2016) recommend that building a second-line anti-TB drug with improved quality in meeting the increased volumes requires an accurate forecasting of the market demand. For the policy to be successfully implemented, it is necessary for national authorities to expedite the enrollment of more patients under properly managed medical care conditions.

Potential policy responses

In their review, Ghebremariam et al. (2016) point out that the inadequate measures of controlling MDR-TB infection have led to continuous transmission of both XDR and MDR TB in congregate settings and health care settings. The same review reports that no state with a high burden of TB has put in place systematic measures that reduce the transmission of the disease not only globally, but even at community levels.  Health care professionals working with TB patients, as well as clinical settings with limited resources, are substantially at a higher risk of the infection than the general population Schmidt (2013).  Therefore, healthcare settings that admit TB patients need to implement TB control measures complementing with the general measures of controlling infection, especially those targeting airborne infections.  This policy thus aims at promoting community-based treatment management for the TB infected patients. As a result, if this policy, some federal states such as Australia do not only consider TB as a communicable disease but as an occupational hazard as well. The control of MDR-TB in such countries hence requires engagement with some stakeholders all across the healthcare system to promote a collaborative action that will ensure the process of treating TB becomes a priority not only to clinical organizations but with the public as well (McLaren, Schnippel & Sharp, 2016).

In his study, Dejene et al. (2016) point out that the transmission of the MDR-TB occurs mainly in communities as evidenced by the high MDR-TB frequencies among the previously untreated patients within the communities of some countries. In countries that face limited resources patients suffering from MDR or XDR TB first undergo a tow unsuccessful treatment course as well as a first-line antituberculosis medication before qualifying to be treated using second-line drugs. However, Ngosa & Naidoo (2016) also reports that many countries have policies permitting the treatment process for MDR-TB only after its diagnosis is confirmed, a process the takes several months when conventional procedures are followed. The resulting effect is sustaining the patients within the communities as these conventional procedures are followed, a process that exposes more people to the infection.

The aim of this policy is thus to initiate a prompt diagnosis as well as treatment of MDR-TB to reduce the case reproduction number of MDR-TB strains below the replacement rate. With complexities involved in treating the disease or caring for patients with the infection such as poorly tolerated drugs and lengthy days of therapy, Banna et al. point out that community-based or clinic-based care can be feasible and effective. However, Ghebremariam et al. (2016) point out that the feasibility for outpatients can only be effective with the availability of primary care facilities social support networks, and qualified health care providers who can promote adheres to the prescribed treatment process. Putting strategies in place for this policy hence requires a critical selection of suitable models taking into account the individual right and needs of the MDR-TB patients as asserted by Sung-Ching et al. (2016).


On the verge of preventing the MDR-TB from spreading, it is necessary that any patient diagnosed with TB completes the medication process as prescribed by the physician or the health care provider. Such a patient should not miss any dose or even stop the process of treatment at early stages. In the case of any trouble with the medication process, it is advisable that an individual informs the physician of the challenges faced. For instance, when a patient is traveling a long distance, he needs to ensure he has sufficient supply of the drugs he can use while in the journey so as to ensure he does not miss any dosage. The healthcare providers as well have the responsibility of ensuring a quick diagnosis of any reported case, follow the recommended treatment guidelines, monitor the response of the patients towards the treatment process, and ensure a complete therapy process. Preventing exposure to MDR-TB also requires people to avoid exposing themselves to known MDR TB patients in crowded or closed places such as prisons, hospitals, or even homeless shelters.

A medical practitioner working with TB patients should also consult the occupational health experts or the infection control for advice on the administrative as well as environmental procedures and strategies to avoid infection. The procedures and strategies are like using individual respiratory protective devices that help in reducing the risks of infection. Despite the environmental factors that promote the spread of the infection, different policies can be strategically adopted to help in the management of MDR-TB. Abolishing barriers in finances, financing care, and control programs, engaging all medical providers, TB management, and care optimization, restricting availability or drugs, and ensuring the access of quality-assured anti-TB drugs are some of the measures that can be adopted to help in controlling the spread of this communicable disease.


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