TuberculosisThe Differences and Similarities of Pneumonia and TuberculosisPneumonia and tuberculosis have been plaguing the citizens of the worldfor centuries causing millions of deaths. This occurred until the creation anduse of antibiotics become more widely available. These two respiratoryinfections have many differences, which include their etiology, incidence andprevalence, and many similarities in their objective and subject indicators,medical interventions, course, rehabilitation and effects.To explore the relationship between pneumonia and tuberculosis we willexamine a case study. Joan is a 35 year old women who was feeling fine up tilla few weeks ago when she develop a sore throat. Since her sore throat she hadbeen experiencing chest pain, a loss of appetite, coughing and a low fever soshe went to visit her doctor.

Her doctor admitted her to the hospital withbacterial pneumonia and after three days of unsuccessful treatment it wasdiscovered that she actually had active tuberculosis. This misdiagnosis showsthe similarities between the two diseases and how easily they can be confused.PneumoniaPneumonia is a serious infection or inflammation of the lungs withexudation and consolidation. Pneumonia can be one of two types: lobar pneumoniaor bronchial pneumonia.

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Lobar pneumonia affects one lobe of a lung whilebronchial pneumonia affects the areas closest to the bronchi (O’Toole, 1992).In the United States over three million people are infected with pneumonia eachyear; five percent of which die.EtiologyThere are over 30 causes for pneumonia however there are 4 main causeswhich are bacterial, viral, mycoplasma and fungal (American Lung Association,1996). Bacterial pneumonia attacks everyone from young to old, however”alcoholics, the debilitated, post-operative patients, people with respiratorydisease or viral infections and people who have weakened immune systems are atgreater risk” (American Lung Association, 1996). The Pneumococcusis bacteria,which is classified as Streptococcus pneumoniae, causes bacterial pneumonia andcan be prevented by a vaccine. In 20 – 30% of the cases the infection spreadsto the blood stream (MedicineNet, 1997) which can lead to secondary infections.Viral pneumonia accounts for half of all pneumonia cases (American LungAssociation, 1996) unfortunately there is no effective treatment becauseantibiotics do not affect viruses.

Many viral pneumonia cases are a result ofan influenza infection and commonly affect children, however they are notusually serious and last only a short time (American Lung Association, 1996).The “virus invades the lungs and multiplies, but there are almost no physicalsigns of lung tissue becoming filled with fluid. It finds many of its victimsamong those who have pre-existing heart or lung disease or are pregnant”(American Lung Association, 1996). In the more severe cases it can becomplicated with the invasion of bacteria that may result in symptoms ofbacterial pneumonia (American Lung Association, 1996).

During World War II mycoplasma were identified as the “smallest free-living agents of disease in humankind, unclassified as to whether bacteria orviruses, but having characteristics of both” (American Lung Association, 1996).Mycoplasma pneumonia is “often a slowly developing infection” (MedicineNet,1997) that often affects older children and young adults (American LungAssociation, 1996).The other main cause of pneumonia is fungal pneumonia. This is causedby a fungus that causes pneumocystic carinii pneumonia (PCP) and is often “thefirst sign of illness in many persons with AIDS and can be successfullytreated in many cases” (American Lung Association, 1996).In Joan’s case bacterial pneumonia was suspected because her immunesystem was weakened by her sore throat and her signs and symptoms correlatedwith pneumonia.Tuberculosis (TB)Tuberculosis was discovered 100 years ago but still kills three millionpeople annually (Schlossberg, 1994, p.

1). Cases range from race and ethnicity.In 1990 the non-Hispanic Blacks had 9, 634 cases while the American Indians andAlaskan Natives had 371 cases (Galantino and Bishop, 1994). It is caused bybacteria called either Mycobacterium tuberculosis or Tubercle bacillus.Tuberculosis can infect any part of the body but is most often found in thelungs where it causes a lung infection or pneumonia.EtiologyThere has been a resurgence of TB due to a number of factors that include:1. the HIV / AIDS epidemic, 2.

the increased number of immigrants, 3. theincrease in poverty, injection drug use and homelessness, 4. poor compliancewith treatment regiments and; 5. the increased number of residents in long termfacilities (Cook & Dresser, 1995).The tuberculosis bacteria is spread through the air however transmission willonly occur after prolonged exposure.

For example you only have a 50% chance tobecome infected if you spend eight hours a day for six months with someone whohas active TB (Cook & Dresser, 1995).The tuberculosis bacteria enters the air when a TB patient coughs,sneezes or talks and is then inhaled. The infection can lie dormant in aperson’s system for years causing them no problems however when their immunesystem is weakened it gives the infection a chance to break free.

Types of TB TreatmentsTypes of treatment will depend on whether the patient has inactive oractive tuberculosis. To diagnose active TB the doctor will look at the patients’symptoms, and outcomes of the skin test, sputum tests, and chest x-rays. Aperson has active tuberculosis when their immune system is weakened and theystart to exhibit the signs and symptoms of the disease. They also have positiveskin tests, sputum tests and chest x-rays. When this occurs the treatment ismore intense.

The disease is treated with at least two different types ofantibiotics in order to cure the infection. Within a few weeks the antibioticswill build the body’s resistance and slow the poisons of the TB germ to preventthe patient from being contagious. An example of treatment would be short-course chemotherapy, which is the use of isoniazid (INH), rifampin, andpyrazinamide in combination for at least six months (Cook ; Dresser, 1995). Thedrugs need to be taken for six to twelve months or there may be a reoccurrence.Failure to take the antibiotics consistently will result in a multi-drugresistant TB (MDR TB) which “is much harder to treat because the drugs do notkill the germs. MDR TB can be spread to others, just like regular TB” (AmericanLung Association, 1996).Inactive tuberculosis is when a person is infected with the tuberculosisbacteria, but their immune system is able to fight the infection, therefore onlyshowing a positive skin test and a negative x-ray and sputum test.

The patientmay be infected but they are not contagious which means the doctor will start apreventative treatment program. This program includes the use of the drugisoniazid for six to twelve months to prevent the TB from becoming active in thefuture.Once the treatment for Joan’s pneumonia was unsuccessful it wasrediagnosed because she remembered her exposure to TB when her grandfathercontracted it when she was seven years old. She has been unaware that she hasbeen caring the infection in a dormant state for 28 years. Due to her sorethroat, which weakened her immune system, her TB became active therefore she wasgiven a new treatment plan. This plan included the use of isoniazid, rifampin,and pyrazinamide.

Objective and Subjective IndicatorsTuberculosis and pneumonia have similar objective and subjectiveindicators because they both cause infection of the lungs. Because of thesessimilarities in the indicators Joan’s case was easily misdiagnosed without theinformation of the TB exposure.The subjective indicators are chest pain, headaches, loss of appetite,nausea, stiffness of joints or muscles, shortness of breath, tiredness andweakness. The patient has to be able to tell the doctor these symptoms in orderfor the correct diagnosis to be made because of the overlap between the twodiseases.The objective indicators include coughing, chills, fever, night sweatsand blood-streaked or brownish sputum. These signs will be observable by thedoctor.

Medical InterventionsThe diagnostic procedures for pneumonia and tuberculosis is also similar.The usual procedure is for the doctor to get a previous medical history alongwith a history of possible exposure and onset of symptoms. From there aphysical examination will occur.

The doctor will listen to the patients chestfor crackles. After that, tests such as the CBC blood test, x-rays, blood andsputum test, biopsy or a bronchoscopy can confirm an infection of the lungs. Atuberculosis specific test is the Mantoux test which is a skin test thatconfirms the presence of the TB bacteria in the patients system.A conservative treatment would include antibiotics such as penicillinand isoniazid (INH) that would treat the infection in the lungs. Orbronchodilators may be used to help keep the airways open.

Other treatments mayinclude a proper diet or bed rest.There are not many choices when it come to surgical management forpneumonia or tuberculosis. In fact there is usually only one that is often used.That surgery is thoracentesis and it is used to remove the pleural effusionfrom the lungs.

The CourseThe course of pneumonia and tuberculosis can vary from person to person.In general the course begins with the development of symptoms and the visit tothe doctor. After the visit to the doctor tests and examinations will occur toconfirm the presence of pneumonia or tuberculosis. Once the infection has beenconfirmed medication may be prescribed along with possible bed rest. A promptrecovery can occur if:1. they are young, 2.

their immune system is working well, 3. the disease iscaught early and; 4. they are not suffering from other illnesses.Most patients will be able to respond to the treatments and begin to improvewithin a couple of weeks.Throughout the treatment medical evaluation, drug monitoring andbacteriology is completed.

They will check the sputum twice monthly for TBuntil the smear is negative and the patient is asymptomatic which usually occurswithin the first three months (Galantino and Bishop, 1994). For both diseasesthey will also watch the patient for drug side effects, resistance andcompliance.In Joan’s case the TB infection was caught too late to use preventivetreatments but once it turned active it was discovered after two weeks.Bio-Psycho-Social EffectsThere are many secondary biological effects from pneumonia andtuberculosis. Tuberculosis and Bacterial Pneumonia can enter the body’s bloodsteam and cause damage or further infection to any part of the body, whichincludes the kidney, joints, bones, liver, brain, reproductive organs or urinarytract. Other secondary problems that may arise from either disease includeanemia, pleurisy, lung abscess, pulmonary edema, chronic interstitial pneumonia,acute respiratory failure, empyema, slowing of the intestines or hyponatremiawhich is low blood sodium (National Jewish Center for Immunology and RespiratoryMedicine, 1989).

The patient may also suffer from psychological and social problemsthroughout the course of the disease. In extreme cases patients may be unableto participate in physical, recreational, or normal day activities which maycause social deprivation or depression. However most patients can expect tokeep their jobs, stay with their families throughout the treatment and leadnormal lives.In Joan’s case she was hospitalized so had become socially deprived andwas becoming very depressed.

This is in part due to the fact the her treatmentwas ineffective for the first three days from the misdiagnoses.Goals and Interventions for the Pneumonia or Tuberculosis PatientTo facilitate the recovery of patients who have pneumonia or TB therewill be interventions from the Physical Therapist, Respiratory Therapist andSocial Worker. Each profession will have roles in motivating , supporting andincreasing the functional capability of the patient. The most common objectivesof treatment include:1.

to decrease discomfort, 2. to facilitate the exchange of oxygen and carbondioxide in the lungs, 3. to prevent atrophy from the increased bed rest, and 4.to prevent social withdrawal.

Rehabilitation Goals and Interventions1. Maintain or increase muscle strength during decreased activity-provide a progressive resistive exercise program-promote weight bearing activities, engage in recreationalactivities and self care activities2. Maintain or increase mobility of soft tissue and joints during bed rest anddecreased level of activity- provide passive and active range of motion-recreational activities combining aerobic, stretching, andstrengthening3. Develop, improve, restore or maintain coordination- practice skills with walking, dressing, hygiene and standing4.

Promote psych-social adaptation to disability and prevent social withdrawal- educate to adapt lifestyle- get involved in support groups and social interactions- body positions that decrease discomfort- Social Worker may help here5. Alleviation of chest pain and aid in respiration- use chest physio, oxygen treatments and respiratoy therapy- teach effective breathing techniques and postural drainage tokeep airways open6.Prevention of reoccurrence- preventive therapy that includes education on proper dietJoan was referred to see a Physical Therapist, Respiratory Therapist andSocial Worker. Her goals where to decrease her discomfort, education to adapther lifestyle and in different body positions that will promote easier breathing.The Social Worker was also there to encourage her to join a support group tohelp her cope with the restraints from her disease.Every year millions of people throughout the world are affected by thepneumonia and tuberculosis disease. These two respiratory infections havesimilarities and differences.

These similarities stem from the fact that bothdiseases attack a persons lungs causing inflammation and consolidation. In facttuberculosis is a chronic infection that can affect the lungs and causepneumonia. Since both infections cause consolidation indicators like coughing,chest pain and shortness of breath are found in pneumonia and tuberculosis.

Theproblem with these similarities, as was seen in Joan’s case, is that it can beeasily misdiagnosed when the proper tests are not used. The differences in thetwo infections are mainly just in their etiologies. For pneumonia there areover 30 different causes but the four main categories are bacterial, viral,mycoplasma and fungal while tuberculosis is only caused by a bacteria calledTubercle bacillus. Fortunately pneumonia and tuberculosis can be kept undercontrol with the use of antibiotics and the earlier that the infection is caughtthe better chance of a prompt recovery.

ReferencesAmerican Lung Association. (1996). Pneumonia Online. Available URL:http://www.lungusa.org/noframes/learn/lung/lunpneumonia.

htmlAmerican Lung Association. (1996) Tuberculosis Online. Available URL:http://www.

lungusa.org/noframes/learn/lung/luntb.htmlCook, Allan R., ; Dresser, Peter D. (Ed.).

(1995). Respiratory diseases anddisorders sourcebook (6). Detroit: Omnigraphics Inc.Galantino, Mary Lou., ; Bishop, Kathy Lee.

(1994, February). The new TB. PTMagazine. P.

53-61MedicineNet. (1997). Diseases ; treatments: pneumonia Online.

AvailableURL: http://www.medicinenet.com/mainmenu/encyclop/ARTICLE/Art_P/pneumon.htmNational Jewish Center for Immunology and Respiratory Medicine.

(1989). MedFacts Pneumonia Online. Available URL: http://www.hjc.

org/MFhtml/PNE_MF.htmlO’Toole, M. (Ed.). (1992). Miller-Keane encyclopedia and dictionary ofmedicine, nursing, and allied health.

Toronto: W.B. Saunders.Schlossberg, David. (Ed.).

(1994). Tuberculosis (3rd ed.). New York:Springer – Verlag.

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