Nursing Care for HIV - Nursing of TB and HIV Coinfection

Authors: Dr. Kerrigan McCarthy; Stacie Stender, MSN, MSc ID, FNP
Editor In Chief: Ian M. Sanne, MBBCH, FCP(SA) (More Info)

Last Reviewed: July 8, 2016 (What's New)

Credit Information

inPractice® Africa’s Continuing Education Unit (CEU) provider, the South African Medical Association, does not offer CPD points for this individual module, but all participants who complete the module with a 70% pass rate will receive a participation certificate. To learn more on CPD credits and participation certificates, click here.

Introduction: The Natural History of Tuberculosis Transmission, Infection, and Disease

How Tuberculosis Is Spread

  • When someone has tuberculosis (TB) in his/her lungs, irritation from the infection causes the person to cough often
  • With the coughs, invisible droplets may be dispersed into the air
    • These droplets may contain Mycobacterium tuberculosis, the organism that causes TB[Fennelly 2004]
    • One cough can propel 3000 infectious particles into the air; a sneeze, 1 million[ZA NDOH TB 2014]
  • These droplets remain suspended in the air and fall slowly (12 mm/hour)
    • They can be inhaled by other persons because they remain in the air for an extended time
  • When inhaled, the bacteria travel into the alveoli (small air sacs) of the lungs
  • In the alveoli, bacteria enter immune cells (macrophages) of the body. Thus, TB infection begins

Latent Tuberculosis Infection

Tuberculosis Infection ≠ Tuberculosis Disease

  • After exposure to and infection with Mycobacterium tuberculosis, a person may develop “latent infection”
    • At these early stages, the infection does not produce symptoms and goes unnoticed
  • Features of latent infection include
    • The patient does not have symptoms of illness
    • A tuberculin skin test (Mantoux test) may be positive but only if the person has a functioning immune system
    • Mycobacterium tuberculosis remains dormant (but not dead) in the lungs in nodules[Adams 1976]
      • In many HIV-negative people, their immune systems may control tuberculosis for the rest of their lives with no sign of active tuberculosis

Active Tuberculosis Disease

  • Tuberculosis (TB) becomes activated when the immune system no longer is able to keep the TB infection controlled
  • The immune system can become weakened from the following diseases, among others
  • When this happens, Mycobacterium tuberculosis spreads rapidly into the surrounding lung tissue[Lawn 2005]
  • The infected person develops symptoms of TB such as cough, sweating at night, fever, loss of weight, and/or chest pain
  • This is active TB