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Introduction

Despite decades of efforts to manage it, tuberculosis (TB), which is caused by Mycobacterium tuberculosis, remains a global health challenge. In recent years, the emergence of drug-resistant strains, specifically Multi-Drug Resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, has added a new layer of complexity to the fight against this deadly pathogen. Mycobacterium tuberculosis (TB) is a serious hazard to public health that requires a thorough understanding of the infecting agent, host, environmental, and government policies that contribute to its transmission (Gagneux, 2018). This essay will investigate these issues while critically evaluating the relevant research in order to better understand the challenges faced by MDR/XDR TB and viable containment measures.

Role of Agent (Mycobacterium tuberculosis) in Infection

Mycobacterium tuberculosis, the tuberculosis causative agent, is a pathogen with specific characteristics that contribute to its capacity to produce and sustain infection within the human body (Gagneux, 2018).

Mechanism of Infection: Mycobacterium tuberculosis spreads predominantly through respiratory transmission, which is a very efficient and persistent form of infection (Ryndak & Laal, 2019). When an infected individual coughs or sneezes, tiny respiratory droplets containing the bacterium can be inhaled by others, leading to new infections (Sia & Rengarajan, 2019). When M. tuberculosis enters the respiratory system, it principally attacks the alveoli of the lungs (Gagneux, 2018). These microscopic droplets can be swallowed by susceptible persons in close proximity, increasing the spread of new illnesses (Ryndak & Laal, 2019). The ability of the bacterium to preferentially infect the alveoli is essential, as these little air sacs provide an excellent environment for the disease to establish itself (De Martino et al., 2019). 

Presence of waxy cell wall: One of the striking characteristics of M. tuberculosis is its characteristic waxy cell wall, which is rich in mycolic acids (Sia & Rengarajan, 2019). This intricate structure acts as a robust protective shield, providing resistance to desiccation, oxidative stress, and immunological defenses (Gagneux, 2018). Particularly, the bacterium is resistant to several common antibiotics and its high concentration of mycolic acid protects it from drying out. It also contributes to the ability of M. tuberculosis to survive for extended periods outside the host, increasing the likelihood of transmission in the environment (Behr et al., 2019). 

Granuloma Formation: Granulomas tend to develop as a result of M. tuberculosis infection (Pagán & Ramakrishnan, 2018). The immune cells, mainly macrophages and T lymphocytes, surround the bacteria in these structured structures (Behr et al., 2019). As per the works of Cohen et al., (2022) it can be said that Granulomas serve as a defense mechanism as well as a home for M. tuberculosis. They indicate the host's attempt to control the infection and prevent the pathogen from spreading throughout the body (Ryndak & Laal, 2019). However, Granulomas can also be a source of ongoing infection since the bacteria that reside within them are still active (Pagán & Ramakrishnan, 2018). This duality adds to tuberculosis's chronic and latent character, enabling the bacterium to elude the immune system's efforts to eradicate the illness (Behr et al., 2019).

Drug Resistance Development: An additional factor in the context of M. tuberculosis is its ability to develop resistance to antibiotics. This is a critical factor contributing to the emergence of MDR and XDR tuberculosis (Gagneux, 2018). Resistance can arise from spontaneous mutations, particularly in genes associated with medication targets, or by horizontal gene transfer from other resistant strains (Gagneux, 2018). This development of resistance undermines the effectiveness of first-line drugs, necessitating the use of more toxic, expensive, and less effective second-line and third-line drugs (Singh et al., 2020).

Disease Progression and Symptoms: Mycobacterium tuberculosis can spread to other organs and tissues as the illness advances, by creating extrapulmonary tuberculosis (Sia & Rengarajan, 2019). The symptoms of tuberculosis can vary and may include a persistent cough, fever, night sweats, weight loss, chest pain, and fatigue (Sia & Rengarajan, 2019). In serious circumstances, it can cause significant lung damage as well as other issues, impacting not just the respiratory system but also the individual's overall health (Singh et al., 2020).

Host and environmental factors

Host Immune Status

Based on the views of Sia & Rengarajan, (2019), it is acknowledged that the immune system is crucial in establishing an individual's susceptibility to M. tuberculosis infection and disease progression. A strong immune response can effectively control the illness and prevent it from spreading (De Martino et al., 2019). However, various factors can impair the immune system's ability to regulate the bacterium such as Immunosuppressive Medications, HIV Co-Infection, Aging, and Malnutrition (De Martino et al., 2019). Certain medical treatments like immunosuppressive drugs or corticosteroids used for conditions like post-organ transplant or autoimmune diseases can weaken the immune response, thereby increasing the risk of TB reactivation (Ryndak & Laal, 2019). In addition, by the views of Esmail et al., (2018), it is acknowledged that the HIV/AIDS patients are more susceptible to M. tuberculosis because the infection impairs immunity, making the bacterium challenging to control. Moreover, malnutrition weakens the immune system, which increases a person's susceptibility to M. tuberculosis (Esmail et al., 2018). Adequate nutrition is required to maintain immune function and resistance to the bacteria (Singh et al., 2020). However, in context to aging, it can be said that the immune response of aged people becomes less effective which makes them vulnerable to tuberculosis infection (Olmo-Fontánez & Turner, 2022).

Environmental Factors

Several environmental factors impact significantly the acquisition and spread of M. tuberculosis.

Ventilation: Lowering the concentration of infectious aerosols in interior areas can minimize the risk of transmission. This can be achieved through proper ventilation and exposure to fresh air (Escombe et al., 2019).

Over-crowding: Person-to-person transmission of tuberculosis is facilitated by crowded living situations. In confined spaces, close contact with an infectious individual increases the risk of infection (Coleman et al., 2022).

Socioeconomic Factors: Poverty, limited access to healthcare, and inadequate nutrition can all raise a person's risk of tuberculosis (TB) and hinder diagnosis and treatment (Bhargava et al., 2020).

Healthcare Settings: Nosocomial transmission of tuberculosis can occur in healthcare facilities, particularly in settings with inadequate infection control measures (Escombe et al., 2019).

Therefore, recognizing the impact of host immune status and environmental factors is crucial for public health initiatives to control the acquisition and spread of M. tuberculosis.

Potential Policy Responses

Countries and regions have different government policies and public health measures to prevent the acquisition and spread of Mycobacterium tuberculosis, which reflects the local epidemiological context and available resources. Some of the country-specific policies and their actions are discussed. 

Australia has a comprehensive approach to tuberculosis (TB) control. The country follows guidelines and recommendations provided by the World Health Organization (WHO) and has established a National Tuberculosis Advisory Committee to guide its policies (AG Health, 2020). Free access to the healthcare services is provided by the country for those diagnosed with TB (Coorey et al., 2022). In addition, regular screening is recommended in the country for high-risk groups like recent immigrants from high-prevalence countries and healthcare workers (AG Health, 2020). Moreover, Australia invests in public health campaigns to raise awareness about TB, its transmission, and the importance of early diagnosis and treatment (AG Health, 2020).

The National Tuberculosis Surveillance System was established in the United States to track and monitor TB cases nationwide (Woodruff et al., 2015). The local health departments are in charge of locating patients, screening them, and ensuring that they complete their treatment (Filardo et al., 2022). The U.S. Centers for Disease Control and Prevention (CDC) provides guidelines and resources for TB control (CDC, 2022). Moreover, the comprehensive TB program in South Africa focuses on TB-HIV co-infection. They offer free antiretroviral therapy (ART) to individuals with TB and HIV, and have expanded the use of GeneXpert technology for more accurate and rapid TB diagnosis (McLaren et al., 2018). Also, the National Tuberculosis Control Program (RNTCP) has been implemented by the Indian government to offer free diagnosis and treatment for TB patients (Khanna et al., 2023). They have also introduced active case-finding campaigns, such as "Nikshay Poshan Yojana," which provides financial support to the patients with tuberculosis to ensure treatment completion (Begum et al., 2020).

Therefore, it can be said that these country-specific policies encompass early detection, treatment adherence, infection control, as well as public awareness to prevent the acquisition and spread of tuberculosis.

Treatments for Mycobacterium tuberculosis

The prevention and treatment of tuberculosis (TB), which is caused by Mycobacterium tuberculosis, is fundamental. The conventional treatment for drug-susceptible tuberculosis involves a combination of antibiotics over an extended period (Caminero et al., 2018). The primary drug regimen for drug-susceptible TB typically includes a combination of four first-line antibiotics: Ethambutol (EMB), Rifampin (RIF), Isoniazid (INH), and Pyrazinamide (PZA) (Jhun & Koh, 2020). This regimen is administered for six to nine months, with the first two months being the intensive phase, followed by a continuation phase (Sia & Rengarajan, 2019). Treatment with a single medicine, such as INH, is occasionally indicated for persons with latent TB infection, where the bacteria are dormant and not causing symptoms (Caminero et al., 2018). Moreover, Directly Observed Therapy (DOT) involves healthcare workers or trained individuals to directly observe patients taking their medications, thereby ensuring treatment adherence (Holzman et al., 2018). Additionally, regular monitoring of patients during treatment is essential to evaluate their response as well as detect any adverse effects (Gagneux, 2018). In addition, it can be said that the Bacille Calmette-Guérin (BCG) vaccine is used in some countries, primarily to prevent severe forms of TB in children (Setiabudiawan et al., 2018). However, the medications for tuberculosis possess adverse effects like liver toxicity, peripheral neuropathy, and gastrointestinal issues (Sia & Rengarajan, 2019). So, it is necessary to monitor and manage these adverse effects.

Discussion

Throughout the essay, the critical information associated with Mycobacterium tuberculosis impacting the individual’s health is discussed. In accordance to authors Ryndak & Laal, (2019), it is realized that Tuberculosis is not just medical problem, it is tied inherently to the socioeconomic conditions. The authors De Martino et al., (2019) highlighted that socioeconomic factor such as poverty, limited access to healthcare, and inadequate nutrition increase the risk of tuberculosis and hinder diagnosis and treatment. Addressing these determinants is integral to effective control. The government policies must extend beyond the healthcare sector, involving poverty alleviation, improving living conditions, along with ensuring access to quality nutrition. So, the global countries need to develop certain policies that go beyond the traditional healthcare framework and encompass broader societal and economic dimensions. This includes poverty alleviation programs to uplift marginalized populations, improving living conditions to reduce overcrowding, and facilitating better ventilation (Coleman et al., 2022). In addition, the healthcare systems should be integrated with social support services so as to address the multifaceted challenges posed by tuberculosis. This ensures access to quality nutrition through food security initiatives. On the other hand, it is acknowledged from the views of Ryndak & Laal, (2019) that the governments must also invest in education and communication strategies to change public perceptions regarding the disease, reducing stigma as well as promoting early diagnosis.

Moreover, the authors Behr et al., (2019) also underscore the fact that the international cooperation is imperative in tackling the disease tuberculosis, especially drug-resistant strains. Collaborative efforts, as exemplified by initiatives like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, should serve as models for future cooperation. To advance the fight against this disease, the future research and development efforts should focus on creating innovative diagnostic tools and treatments, that includes novel vaccines to prevent TB (Singh et al., 2020). As countries develop policies for the future, it is also crucial that they integrate these holistic and multidisciplinary approaches to address the complex web of challenges associated with Mycobacterium tuberculosis. 

Apart from this, it is realized from the works of Jhun & Koh, (2020) that tuberculosis treatment, particularly for drug-resistant forms, is a complicated and time-consuming process. From the works of Caminero et al., (2018) it is realized that first-line medications are effective for drug-susceptible TB, whereas second- and third-line treatments are more hazardous and less effective for MDR and XDR TB. It is also understood that adverse impact management and continuous patient monitoring are important (Gagneux, 2018). So, in order to better address this issue, the future research should focus on developing safer, more effective, and accessible treatments for MDR and XDR TB. Advances in personalized medicine, including the identification of genetic markers associated with drug resistance, can aid in tailoring treatments to individual patients (Caminero et al., 2018). Therefore, it can be said that by advancing these areas of study, it can be possible to achieve more favorable outcomes in the fight against drug-resistant tuberculosis caused by Mycobacterium tuberculosis.

Conclusion

Throughout the essay, it is observed that Mycobacterium tuberculosis poses a complex challenge to global health. The transmission and control of Tuberculosis are greatly impacted by the interaction of the infectious agent, host characteristics, environment, and government policy. The socioeconomic determinants, international collaboration, and multidisciplinary approaches are essential to address the multifaceted nature of the disease. In the future, creative research, better therapies, and tailored medicine may provide hope in the fight against drug-resistant tuberculosis. By understanding these complexities and working together, we can strive for the ultimate goal of reducing this persistent global health threat.

References

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