Pulmonary TB very commonly occurs in which of the following people?

NHM MP Staff Nurse - 2015

Medical Surgical Nursing

Easy

Appeared in: NHM MP Staff Nurse - 2015

Explanation

HIV infection is the most potent risk factor for the progression of latent TB to active disease.
HIV targets and destroys CD4+ T-cells, which are essential components of the cell-mediated immunity required to control Mycobacterium tuberculosis.
Individuals with HIV are 25-30 times more likely to develop active TB compared to those without HIV.
In a person with HIV, the lifetime risk of TB activation (around 10%) becomes an annual risk, highlighting the rapid progression of the disease in an immunocompromised state.

Option A: While smoking is a significant risk factor that doubles the risk of TB and worsens outcomes, the magnitude of risk is substantially lower than that associated with HIV infection.
Option B: Living in a village or farming are not direct medical risk factors for TB. The risk in such populations is often due to associated socioeconomic factors like poverty, malnutrition, and crowded living conditions, not the occupation or location itself.
Option C: Advanced age is a risk factor due to a weakening immune system (immunosenescence). However, asthma is not a primary risk factor for TB unless the patient is on long-term, high-dose corticosteroids, which suppress the immune system. Even then, the risk is not as profound as with HIV.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Risk factors for Pulmonary Tuberculosis (TB) as background academic context rather than a clinical decision trigger.
Nurses must practice bidirectional screening: screen all TB patients for HIV and all people living with HIV (PLHIV) for TB at every clinical encounter.
Key TB screening questions for a person with HIV include asking about current cough, fever, weight loss, or night sweats (the 'four-symptom screen').
Managing co-infection requires careful coordination of Anti-Retroviral Therapy (ART) and Anti-Tuberculosis Treatment (ATT) to improve outcomes and manage potential drug interactions and Immune Reconstitution Inflammatory Syndrome (IRIS).

How to Approach the Question

First, identify the core of the question: it asks to identify the group with the highest risk for developing pulmonary TB.
Analyze each option by considering its effect on the immune system or exposure to the TB bacterium.
Option A (Smoking): Affects lung health and immunity, a known risk factor.
Option B (Farming): A socioeconomic factor, not a direct biological risk.
Option C (Elderly with asthma): Age is a risk factor (weakened immunity), but asthma is not a primary one.
Option D (HIV infection): Directly attacks and destroys the immune system.

Concept Tested & Keywords

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