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Sample Essay on The Most Common Causes of Septicemia and Their Agent and Treatment

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Sample Essay on The Most Common Causes of Septicemia and Their Agent and Treatment

       Introduction

The incidences of TB infections are today, increasing in patients that have tested HIV positive. The existence of TB is traced to many years in the ancient history of humanity. However, its occurrence alongside HIV patients today has raised more interests in the study of the association between HIV infection and TB. Such interests are guided by that fact that TB is the commonest opportunistic disease found in patients tested positive for HIV-1 infections. Certain studies Zwang, et al., (2007) and Severe et al., (2010) have estimated the rate of TB infection in patients tested positive for HIV-1 at 5-15 percent per year following the infection. This is compared to 5-10% TB cases reported per year among patients who test negative for HIV-1 infection. Besides, the research also highlights that HIV-induced immune suppressions often modify the potential expressions of TB. The most fascinating fact here is that during the initial stages of HIV immune suppressions, the TB patients express similar symptomatic evidence as those that are not infected with HIV-1 hence making it hard to distinguish the presence of HIV-1 in the patients. Long termed progression of the immune suppression, however, leads to dissemination and the extra-pulmonary TB becomes even more frequent and persistent. Besides, the occurrence of TB alongside HIV-1 in patients is increasingly becoming more complex following the rising incidences of MDR-TB hence prompting the need to investigate the association between the two conditions in this paper. The main objective of this research is to determine the relationship between HIV-1 and TB in co-infected patients. The research will be informed by the CD4 counts in the patients selected from a local population in Brazil.

1.1              PROBLEM STATEMENT
1.1.1     THE MAIN PROBLEM

            The co-occurrence of Mycobacterium tuberculosis and HIV in HIV-1 patients raises serious complications in the treatment process. The relationship between the two co-occurring conditions make it very difficult for the doctors and scientists to provide treatment for TB following the fact that it’s a curable disease as opposed to HIV. Finding the necessary cure for TB patients who have been co-diagnosed with HIV-1 has been a difficult ordeal to doctors. It is, therefore, necessary to investigate the association between the two conditions with an aim of finding the best cure for the curable TB despite the presence of HIV.  

1.1.2     THE SUB-PROBLEM

            The co-occurrence of TB and HIV has raised concerns in determining an appropriate cure for the curable TB condition. Persistent TB in HIV-1 patients has inhibited the process of its curation using the available drugs. By determining the nature of the relationship between TB and HIV in co-infected persons. Finding the right management and cure of the disease is expected to be achieved.

1.2              PURPOSE OF THE STUDY

The purpose of this study is to find out the manner of association between HIV-1 and TB infections in co-infected persons. The researchers monitored the nature of the association between the two conditions based on the CD4 counts of the patients for a period of one year. A total of 803 patients were monitored for a period of two years (between January 2013 and December 2014). The rate of TB, HIV-1 seropositivity rate was then determined to infer the association between the two co-occurring conditions in the patients

1.3              SIGNIFICANCE OF THE STUDY

This study aims at drawing the connection between the occurrences of TB in patients testing positive for HIV-1. The findings of the research shall be suitable for informing decision making on the co-occurrence of HIV-1 and TB in co-tested patients regarding the best treatment procedures to be adopted. Besides, the study will also establish the right stage at which the diseases can be treated with ease. Based on the findings, medical practitioners can deduce the right medical assignment for the patients. The study will also contribute to adding the knowledge of the existing body of research regarding the best medical practices to be adopted under such circumstances.

1.4              HYPOTHESIS
The study shall be guided by the null and alternative hypotheses stated as follows;

H0: There is no significant relationship in clinical presentation of TB, HIV-1 co-infection in HIV patients based on the CD4 counts

H1: There is a significant relationship in clinical presentation of TB, HIV-1 co-infection in HIV patients based on the CD4 counts

2        Literature Review

Mycobacterium tuberculosis is the etiological agent of the TB condition which has continued to cause havoc and discomfort among various patients, raising tension in the public health sector across the world. Research has been conducted to try and develop an everlasting cure for the disease. However, despite almost a century of intensive research into the matter, very little progress has been made in an attempt to eliminate the disease from the face of this world. It continues to affect roughly up to one-third of the world’s population. The relationship between TB and HIV infection has been suspected due to the commonality in the co-occurrence of the disease among co-tested patients. Despite the significant reduction realized in the infection trends and commonality of TB across the world within the last two decades, an estimated population of up to 1.8 million cases are reported every year (Dheda et al., 2010). Out of these, about 1.3 million deaths are caused as a result of TB infection (Gandhi et al., 2006). Many deaths and persistent cases are reported among patients also suffering from HIV-1 thus raising questions about the relationship between the two diseases.

Patel et al., (2009) for instance conducted a study to which developed Mycobacterium tuberculosis adhesions. The adhesions were targeted as potential biomarkers for use in anti-tuberculosis therapeutics and diagnostic targets. It was realized that the adhesions can play a key role in bacterial aggregation and biofilm formation during host-pathogen interactions. Such studies have only succeeded in developing relevant treatments for tuberculosis without interfering with the effects of HIV. However, the fact that the TB occurrence in HIV-1 tested patients raises more questions than answers regarding the influence that HIV-1 has on the occurrence and persistence of TB in co-tested patients.   

Severe et al., (2010) attributed the occurrence of TB in HIV-1 infected patients to the weakening of the immune systems of the concerned persons, in their study, Severe et al., (2010) mentions that the progression of TB in HIV-1 patients is due to the increase in immune expression as well as an increase in CCR5 and CXCR4 co-receptors expression in the CD4 cells. However, researches appear to be unclear or rather silent with respect to whether TB affects HIV RNA levels. Some studies, on the other hand, have gone ahead to investigate such relationships without making clear associations between the co-occurring status of the two diseases. Elevated HIV RNA levels have however been found in RB co-infected patients. This was postulated to be attributed to the activation of latent HIV, especially in macrophages and besides, dysregulated cytokines. One study, on the other hand Dheda et al., (2010) has asserted the reduction in HIV RNA levels in TB co-infected patients as well as in vitro data further suggesting the presence of an inhibitory effect on HIV replication in macrophages. 

3        Research Methodology

The information used in this research was generated from the ST Luis Hospital located in southern Brazil. The study adopted a retrospective methodology and looked at the cases relating to adult active TB among adults treated in the respiratory unit of the hospital between January 2013 and December 2014. The information was drawn from the patients’ medical reports, TB booklets, and HIV clinical records as well as from inpatients reports. Out of these reports, the demographic characteristics, clinical presentations, diagnostic methods such as sputum examination, tissue or blood culture of the M. Tuberculosis and biopsy, CD4 counts, as well as HIV-1 conditions were recorded for further analysis.  HIV serology testing was done using the ELISA method and confirmation carried out using the Western Blot. Absolute CD4 lymphocyte counts were then quantified. All analysis was done using SPSS version 13.0 for chi-square test at a confidence level of 95%. CD4 counts of ≤ 200 cells/ mm3 were considered severe immune suppression. 65% of the patients diagnosed with TB confirmed their HIV-1 statuses just after their diagnosis with TB.   

4        Data Analysis and Result

A total of 104 (12.3%) out of 803 patients treated for TB also had HIV-1 co-infected at the rate of 12.83%. The majority of the patients treated for HIV-1/TB co-infection were of the age between 35-59 years. The mean CD4 count was found to be 63.69 for patients with severe immune suppression (see Table 1).  Only 20.1%of the patients diagnosed with TB patients had CD4 severe immune suppression (CD4 counts of ≤ 200 cells/ mm3).

Table 1: characteristics of HIV-TB co-infected patients

Patients’ descriptions

Total population (N)

Percentage

Total number of tested HIV-1 and TB co-infections

103

12.83

Gender category

Male

93

88.6

Female

14

12.8

Age category

12- 34 years

27

26.4

35-59 years

70

69.3

Over 60 years

6

6.4

Patients’ HIV status

Confirmed

39

37.8

Recently confirmed

66

63.2

There was no positive correlation between TB infections with CD4 counts (P = 0.004). However, patients with severe immune suppression were found to be more likely to develop severe atypical chest radiographs
5        Discussion

The seropositivity diagnosis as per the results (12.83%) is almost similar to that of Thailand in 1998. The clinical manifestation of TB in HIV patients was dependent on the stage of HIV-1 infection as well as the associated level of immunodeficiency in the body of the patients. During the early stages of HIV-1 infections, the symptomatic expression of TB is similar to those present during the pre-HIV era hence the delusion of association. Severe immunodeficiency was associated with increased persistence of HIV-1 symptoms that resemble those of pulmonary as well as extra- pulmonary diseases. The traditional occurrence of TB in HIV-1 patients was only seen in patients with severely suppressed immune systems (CD4 counts of ≤ 200 cells/ mm3). The CD4 counts in HIV-1 patients do not relate to the occurrence of TB. The majority of the HIV-1/TB co-infected patients also had extended, subtle and varying symptoms such as low weights, fever, night sweats among others.     

6        Conclusion and Recommendation

TB cases have been very common, especially with the dawn of HIV. There has been a growing concern over the effects of HIV on TB and the vice versa, since the two diseases commonly co-occur in various individuals. The relationship between TB and HIV infection is undetermined despite the co-occurrence. Patients with TB should not be alarmed of HIV infection. However, low CD4 counts express similar characteristics of TB and must be confirmed through medical tests. Further research should be conducted in the association between HIV and TB infection in co-tested patients. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                7 References

Dheda, K., Warren, R., Zumla, A. et al. (2010). Extensively drug-resistant tuberculosis: epidemiology and management challenges. Infect Dis Clin North Am, 24 (3), 705-25.

Gandhi, N., Moll, A., Sturm, A. et al. (2006 ). Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet, 368 (9547), 1575-80.

Patel, N., Swan, K., Li, X. et al. (2009). Impaired M. tuberculosis-mediated apoptosis in alveolar macrophages from HIV+ persons: potential role of IL-10 and BCL-3. J Leukoc Biol, 86 (1), 53-60.

Severe, P., Juste, M., Ambroise, A. et al. (2010). Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med, 363 (3), 257-65.

Zwang, J., Garenne, M., Kahn, K. et. al. (2007). Trends in mortality from pulmonary tuberculosis and HIV/AIDS co-infection in rural South Africa (Agincourt). Trans R Soc Trop Med Hyg, 101 (9), 893-8.

 

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