SHOW 302: The Return of TB
Once called "consumption" or the "white plague," tuberculosis killed hundreds of thousands of people earlier in this century. By the mid-20th century, powerful drugs were developed to treat it, and the incidence of TB declined. In recent years, however, TB has made an unwelcome comeback. Not only is the disease making a comeback among certain high-risk populations, it is also developing multidrug-resistant strains that are extremely difficult to cure. FRONTIERS tracks down an active carrier and looks at what is being done to combat the current outbreak.
Activity: How Much Do You Know?
Notes & Discussion
Report From the Field: Bonnie Goyette, Senior Community Health Nurse, Fort Myers, Florida
the immune system
ACTIVITY: HOW MUCH DO YOU KNOW?
As you've seen on FRONTIERS, the key to preventing tuberculosis is early identification of active carriers. These two quizzes will test your knowledge of TB and other diseases. You might find it helpful to read the true-false questions before watching FRONTIERS; some answers can be found on the show.
TB: FACT OR FICTION...
- Tuberculosis used to be a serious problem in the U.S., but modern antibiotics have made it less of a threat today.
- Tuberculosis is caused by a virus.
- All of these populations are at a higher than normal risk for developing TB: prisoners, migrant farm workers, people with HIV infections and those who suffer from diabetes or cancer.
- A person who tests positive for TB is at higher risk for developing the disease.
- One thorough treatment of drugs effectively kills all of the TB bacteria in the body.
- Most people never need to have a TB skin test performed.
- Unless treated, TB can cause serious illness and death.
- People who test positive for the HIV virus will automatically develop TB.
- Multi-drug resistant strains of TB can never be cured.
- If people are diagnosed with TB, it's OK for them to stop taking the medication when the symptoms go away.
Read the clues below and identify the correct disease.
- This disease, caused by a virus, afflicted many thousands of people every year in the U.S. alone until a vaccine was developed in the 1950s. The virus attacked the nervous system, causing paralysis and breathing difficulties. The disease is under control in most parts of the world.
- This most widespread of all human diseases affects most people at some time in their lives and is spread by viruses released into the air by coughing or sneezing. Symptoms range from mild discomfort to fever, body aches and breathing difficulties. There is no treatment for the disease itself, though the symptoms can be relieved.
- This airborne infection primarily affects the respiratory system but can spread to other parts of the body. The risk of contracting it from a carrier is increased by conditions such as prison overcrowding.
- This anaerobic bacterium produces the toxin responsible for a lethal type of food poisoning. The bacteria is common in soil but in oxygen-free surroundings, the bacteria grows and releases several types of neurotoxins.
- This virus causes a disease that makes its victims vulnerable to serious illnesses or infections. Those infected may manifest a range of symptoms, from none to severe. Work continues on finding a cure, but several viruses are probably involved; the virus mutates frequently, making it very difficult to develop a vaccine.
- This acute, often fatal disease is caused by a virus transmitted from an animal to another animal or to humans, usually through a bite.
TB: FACT OR FICTION?
- F/TB is making a comeback
- F/bacteria causes TB
- F/some bacteria survive treatment and become more resistant
- F/certain populations are at higher risk; health-care workers and others in contact with active TB carriers should be tested (note: does your school district require a TB test)
- F/however, they will be at higher risk if exposed, and, if they are TB carriers, their weakened immune system will make them at risk for developing the disease
- F/some can be cured, though it requires diligence and time
- F/if treatment is stopped too early, surviving bacteria become stronger
- common cold
- This activity is designed to provide basic information and stimulate student interest in TB and specific diseases, as well as distinguish between bacteria and viruses. Answers to the true-false quiz will depend partly on information found in Show 302. The second part of the quiz could be set up like the game show "Jeopardy," if you wish.
NOTES & DISCUSSION
- It's estimated that about 10 to 15 million Americans (roughly 5% of the population) carry the bacterium that causes tuberculosis, which means they will test positive on skin tests. These carriers have a lifelong potential for developing TB, particularly if their immune system is weakened by other diseases. Although a person who is a carrier of TB may show no symptoms and cannot spread the disease, preventive treatment is usually advised to keep the bacteria from becoming active.
- Although TB is not a disease that affects only the poor and disenfranchised, people living in overcrowded conditions with poor ventilation are at higher risk. Ask students for suggestions on ways to help migrant workers and others on the move who are active carriers of TB to continue their medications for the recommended time of treatment. What does this story tell students about finishing medications prescribed when they are ill?
- What is the body's reaction when it is invaded by bacteria and viruses? Previous FRONTIERS guides have explored this question, including a simplified diagram illustrating what happens when viruses attack (for the segment on "Infant Heart Transplant" in Show 201), and an activity on culturing bacteria (for "Botulin Toxin" in Show 301).
- Organisms besides bacteria also develop resistances to substances that would ordinarily kill them. Some insects seem to have developed immunities to certain pesticides. Right now, billions of microscopic parasites (phylloxeras) are devouring much of the vineyards in western states. Although many of the grapevines were believed to have been resistant, the phylloxeras apparently mutated into a new strain that now threatens even the resistant roots. Experts fear the parasite will continue to mutate, making it extremely difficult to develop a toxic chemical to contain it.
- Look for news accounts of other diseases thought to be under control that are making a comeback (epidemics of measles, mumps; outbreaks of rheumatic fever, postpolio syndrome). Even the plague was not totally eliminated in the Middle Ages; about a dozen cases are reported in the U.S. each year. Caused by a bacterial infection, plague is highly fatal but is usually treatable. Some diseases, like smallpox, have been wiped off the face of the earth. In fact, the last remaining smallpox virus is scheduled to be destroyed in the near future.
REPORT FROM THE FIELD: BONNIE GOYETTE, SENIOR COMMUNITY HEALTH NURSE, FORT MYERS, FLORIDA
For Bonnie Goyette, who wanted to be a nurse since the age of three, working in a community health environment provides the perfect combination of challenge and personal satisfaction.
In community health, Goyette says, there is less focus on the dollar, an opportunity to make a positive impact on her patients' health and the chance to provide essential preventive care. Goyette gains satisfaction from knowing that many of her patients would not receive any health care without her clinic.
The clinic staff takes a personal interest in refugee families and assists them with a variety of services, whether it's explaining how to get a prescription filled, helping them get food stamps or even finding bus passes so they can travel to and from the clinic.
Goyette's latest challenge is the TB screening in Florida, as seen on FRONTIERS, where an extensive contact investigation was set in motion after an active case of TB was identified in a Red Cross shelter housing victims of a local flood.
Because so few of her patients speak English, Goyette must provide care using primarily nonverbal communication. She treasures the "tremendous bond that develops between me and my patients." They often come back to visit even after they've recovered from an illness and mothers make a special trip to the clinic just to show off their new babies.
Students who want to pursue a career like this one should know that it requires at least a bachelor's degree in nursing or a health-related field. Goyette also advises that a second language and knowledge of different cultures are helpful skills in dealing with the diverse patients one encounters. And it's evident from speaking with Goyette that respect and compassion for all types of people are also essential for a public health nurse.
Students should also know that the field of nursing is not for women only!
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