The Differences and Similarities of Pneumonia and Tuberculosis

Pneumonia and consumption have been plaguing the citizens of the world for centuries, causing numerous deaths. This continued until the production and use of antibiotics became more widely available. These two respiratory infections have many differences, including their etiology, incidence, and frequency, as well as many similarities in their objective and subjective indicators, medical interventions, course, rehabilitation, and effects.

To explore the connection between pneumonia and tuberculosis, we will examine a case study. Joan, a 35-year-old woman was in good health until she developed a sore throat a few weeks ago.

Since then, she has experienced chest pain, loss of appetite, coughing, and a low-grade fever, so she decided to visit her doctor. Her doctor admitted her to the hospital with bacterial pneumonia, but after three days of unsuccessful treatment, it was found that she had active tuberculosis. This misdiagnosis demonstrates the similarities between the two diseases and how easily they can be confused.

Differences in Pneumonia and Tuberculosis Pneumonia

Pneumonia is a severe infection or inflammation of the lungs with exudation and consolidation. It can be of two types: lobar pneumonia or bronchial pneumonia. Lobar pneumonia affects one lobe of a lung, while bronchial pneumonia impacts the areas closest to the bronchi (O'Toole, 1992). In the United States, over three million people contract pneumonia each year, five percent of whom pass away.

Etiology

There are more than 30 causes for pneumonia; however, there are four main reasons which are microbial, viral, mycoplasma, and fungal (American Lung Association, 1996). Bacterial pneumonia attacks everyone from the young to the old. Nonetheless, alcoholics, the debilitated, post-operative people, individuals with respiratory diseases or viral infections, as well as people who have compromised immune systems, are at higher risk (American Lung Association, 1996). The Pneumococcus bacteria, which is categorized as Streptococcus pneumoniae, cause bacterial pneumonia and can be prevented by a vaccine. In 20-30% of the cases, the infection spreads to the bloodstream (MedicineNet, 1997), which can lead to secondary infections.

Viral pneumonia accounts for half of all pneumonia cases (American Lung Association, 1996). Unfortunately, there is no effective treatment since antibiotics do not affect viruses. Many viral pneumonia cases are a result of an influenza virus and generally affect children, but they are not typically serious and only last for a short time (American Lung Association, 1996). The "virus invades the lungs and multiplies, but there are almost no physical signs of lung tissue becoming full of fluid. It finds many of its victims among those who have pre-existing heart or lung diseases, or are pregnant" (American Lung Association, 1996). In more severe cases, it can be complicated with the invasion of bacteria, which may cause symptoms of bacterial pneumonia (American Lung Association, 1996).

During World War II, mycoplasmas were identified as the 'smallest free-living agents of disease in mankind', unclassified as either bacteria or viruses, but having characteristics of both (American Lung Association, 1996). Mycoplasma pneumonia is 'often a slowly developing infection' (MedicineNet, 1997) that commonly affects older children and young adults (American Lung Association, 1996).

The other primary source of pneumonia is fungal pneumonia. It's caused by a fungus that causes pneumocystic carinii pneumonia (PCP) and is often 'the first sign of disease in many individuals with AIDS and ... can be successfully treated in many cases' (American Lung Association, 1996).

In Joan's case, bacterial pneumonia was suspected since her immune system was weakened by her sore throat, and her symptoms correlated with pneumonia.

Consumption (TB)

Consumption, discovered 100 years ago, still eliminates 3 million people every year (Schlossberg, 1994, p. 1). Cases range across race and ethnicity. In 1990, non-Hispanic Blacks had 9,634 instances, while American Indians and Alaskan Natives had 371 cases (Galantino and Diocesan, 1994). The disease is caused by bacteria, either Mycobacterium tuberculosis or Tubercle bacillus. Although tuberculosis can infect any part of the body, it is most frequently found in the lungs, where it manifests as a pulmonary infection or pneumonia.

Etiology

There 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. the rise in poverty, injection drug use, and homelessness, 4. inadequate compliance with treatment regimens, and 5. the increased number of residents in long-term facilities (Chef & Dresser, 1995).

The tuberculosis bacteria are spread through the air. However, transmission will only occur after prolonged exposure. For example, you only have a 50% chance to become infected if you spend eight hours a day for six months with someone who has active TB (Chef & Dresser, 1995).

The tuberculosis bacteria enter the air when a TB patient coughs, sneezes, or talks and are then inhaled. The infection can lie dormant in an individual's system for years, causing them no problems. However, when their immune system is weakened, it gives the infection a chance to break free.

Sorts Of TB Therapies

The type of treatment certainly depends on whether the person has dormant or active tuberculosis. To diagnose active TB, the physician assesses the patients' symptoms and the results of the skin test, sputum tests, and chest X-rays. A person is said to have active tuberculosis when their immune system is weakened and they begin to display the symptoms of the disease. Positive results in skin tests, sputum tests, and chest X-rays further confirm this. In such cases, the treatment is more intense.

The disease is treated with at least two different types of antibiotics to combat the infection. Within a few weeks, the antibiotics bolster the body's immunity and subdue the toxicity of the TB bacterium, preventing the individual from being contagious. An example of a treatment strategy would be short-course chemotherapy, which involves the use of Isoniazid (INH), Rifampin, and Pyrazinamide in a combination for at least six months (Cook & Dresser, 1995). The medications must be taken consistently for six to twelve months to avoid a recurrence. Failure to take the antibiotics regularly can lead to multi-drug resistant TB (MDR TB). This form of TB is much harder to treat as the drugs do not kill the bacteria. MDR TB is also capable of transmission to others, similar to regular TB (American Lung Association, 1996).

Dormant tuberculosis is when a person is infected with the tuberculosis bacterium, but their immune system successfully battles the infection. The only indications are a positive skin test and negative X-ray and sputum test results. Although the patient may be infected, they are not contagious, which means the doctor will initiate a preventative treatment program. This regimen comprises the administration of Isoniazid for six to twelve months to prevent the TB from becoming active in the future.

When the treatment for Joan's pneumonia was unsuccessful, her condition was rediagnosed. She remembered being exposed to TB, contracted by her grandfather when she was seven years old. She had been carrying the dormant infection for 28 years without realizing it. A sore throat weakened her immune system, resulting in her TB becoming active. Therefore, she was given a new treatment plan incorporating Isoniazid, Rifampin, and Pyrazinamide.

The Resemblances of Pneumonia and Consumption

Objective and Subjective Indicators. Consumption and pneumonia have comparable objective and subjective indicators, as they both cause infection of the lungs. Because of these similarities in the symptoms, Joan's situation was easily misdiagnosed without the information on TB exposure.

The subjective signs include chest pain, headaches, loss of appetite, nausea, joint or muscle stiffness, shortness of breath, fatigue, and weakness. The patient must convey these symptoms to the doctor for an accurate diagnosis due to the overlap between the two conditions. The objective symptoms consist of coughing, chills, fever, night sweats, and blood-streaked or brown sputum. The doctor will be able to identify these symptoms.

Clinical Interventions

The treatment approaches for pneumonia and tuberculosis are quite similar. Typically, the doctor begins by obtaining a previous medical history, along with a record of potential exposure and onset of symptoms. Following this, a physical examination is conducted during which the doctor listens to the patient's chest for crackles. Then, tests such as the CBC blood test, X-rays, blood and sputum tests, a biopsy, or a bronchoscopy can confirm a lung infection. A tuberculosis-specific test is the Mantoux test, which is a skin test that verifies the presence of the TB bacteria in the patient's system.

Standard treatment usually involves antibiotics such as penicillin and Isoniazid (INH) to treat the infection in the lungs. Bronchodilators may also be used to help keep the airways open. Other treatments might include a proper diet or bed rest. When it comes to medical management for pneumonia or tuberculosis, there are few options. In fact, there is typically only one common procedure. This procedure called thoracentesis, is used to remove pleural effusion from the lungs.

The Course

The course of pneumonia and consumption can differ from one person to another. In general, the program begins with the development of symptoms and a visit to the doctor. After this visit, tests and examinations will take place to confirm the presence of pneumonia or tuberculosis. Once the infection has been confirmed, medication may be prescribed along with possible bed rest. A prompt recovery can occur if: 1) they are young, 2) their immune system is working well, 3) the disease is caught early, and 4) they are not suffering from other health issues. Most patients will be able to respond to the treatments and start to improve within a few weeks.

Throughout the treatment, medical analysis, medication management, and bacteriology are completed. The patient's spit will be checked twice monthly for TB until the smear is negative and the patient is asymptomatic; this typically happens within the first three months (Galantino and Bishop, 1994). For both conditions, the medical team will also monitor the patient for medication side effects, resistance, and compliance.

In Joan's case, the TB infection was caught too late for preventive treatments. However, once it turned active, it was discovered after two weeks.

Bio-Psycho-Social Effects

There are numerous additional biological results from pneumonia and consumption. Tuberculosis and microbial pneumonia can enter the body's bloodstream, causing damage or further infection to any part of the body. This includes the kidneys, joints, bones, liver, brain, reproductive organs, and urinary system. Secondary problems that may arise from either disease include anemia, pleurisy, lung abscess, lung edema, chronic interstitial pneumonia, acute respiratory failure, empyema, slowing of the intestines, or hyponatremia, which is low blood salt (National Jewish Center for Immunology and Respiratory Medicine, 1989).

Clients may also face emotional and social challenges throughout the course of the disease. In severe cases, individuals may be unable to participate in physical, recreational, or daily activities, leading to social deprivation or depression. However, most patients can expect to maintain their jobs and stay with their families during the treatment, leading normal lives.

In Joan's case, hospitalization resulted in social deprivation and severe depression. This was partly due to the fact that her treatment was ineffective for the first three days due to a misdiagnosis.

Objectives and also Interventions for the Pneumonia or Consumption Person

To assist in the recovery of individuals who have pneumonia or TB, there will certainly be interventions from the Physiotherapist, Breathing Therapist, and Social Worker. Each profession will have roles in motivating, supporting, and enhancing the functional ability of the individual. The most common goals of treatment include: 1. reducing pain, 2. facilitating the exchange of oxygen and carbon dioxide in the lungs, 3. preventing atrophy from extended bed rest, and 4. preventing social withdrawal.

Recovery Goals and Interventions

• Keep or boost muscular tissue strength during reduced activity - provide a progressive resistance workout program - promote weight bearing activities, participate in recreational activities and self-care activities.
• Maintain or boost movement of soft tissue and joints during bed rest and decreased levels of activity - give passive and active ranges of motion - engage in recreational activities incorporating cardio, stretching, and strengthening.
• Develop, enhance, restore, or maintain coordination - practice skills with walking, dressing, hygienic tasks, and standing.
• Promote psych-social adjustment to disability and prevent social withdrawal - educate in adjusting lifestyle - get involved in support groups and social interactions - demonstrate body positions that reduce pain – A Social Worker may provide assistance.
• Reduction of chest discomfort and aid in respiration - use chest physio, oxygen treatments, and respiratory therapy - teach effective breathing techniques, and postural drainage to maintain open airways.
• Prevention of reoccurrence - preventative care that includes education on proper diet. Joan was referred to see a Physiotherapist, Breathing Specialist, and Social Worker. Her goals were to reduce her pain, educate herself to adapt her lifestyle and learn about various body positions that will promote easier breathing.

The social worker was likewise there to motivate her to join a support group to assist her in managing the restrictions from her illness.

Final thought

Annually, countless individuals throughout the globe are impacted by pneumonia and tuberculosis. These two respiratory infections have similarities and differences. These similarities originate from the fact that both diseases attack a person's lungs, causing inflammation and consolidation. In fact, tuberculosis is a chronic infection that can affect the lungs and trigger pneumonia. Since both infections cause consolidation, indications like coughing, chest pain, and shortness of breath are found in both pneumonia and tuberculosis.

The issue with these similarities, as was seen in Joan's case, is that they can be easily misdiagnosed when the appropriate tests are not used. The differences in the two infections are primarily in their etiologies. For pneumonia, there are over 30 different causes, but the four main categories are bacterial, viral, mycoplasma, and fungal, while tuberculosis is solely caused by a bacterium called Tubercle bacillus. Fortunately, both pneumonia and tuberculosis can be controlled with the use of antibiotics, and the earlier the infection is caught, the better the chance of a quick recovery.

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