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Anglais médical - Tout sur la tuberculose

Publié le 06/12/2012

Régulièrement, cette rubrique animée par Virginia Allum, auteur et consultante EMP (English for Medical Purposes), vous permettra, exercices à l'appui, de parfaire votre anglais médical au travers de situations de soins concrètes. Bon travail à tous !

N'hésitez pas à vous servir du dictionnaire en ligne Wordreference.
Vous trouverez à la fin de cet article les corrections des exercices qui vous sont proposés téléchargeables au format pdf.

Talking about tuberculosis and secretions

Before you start, think about the following questions

What sort of disease is tuberculosis?
What parts of the body can TB affect?
What symptoms would you expect in a patient who has TB?
Why is the treatment of TB difficult?

Before you start, review these terms

secretion	liquid that moves out of a duct or a cell
saliva	Also called spittle or spit; watery secretions in the mouth that help lubricate food while chewing
sternutation	Called a sneeze ; sudden expulsion of secretions from the nose and mouth
tussis	Called a cough; reflex used to expel secretions from the lungs and the airways
sputum	Also called phlegm or expectoration: secretions from the airways that are coughed up through the mouth
to expectorate	to cough up sputum
haemoptysis	coughing up of blood ;from haemo = blood and –ptosis = to spit
diaphoresis	profuse sweating; from dia = through and –phoresis = movement using a particular medium

Now, read the following text

Tuberculosis is a mycobacterial infection that mainly affects the lungs but can also affect the bones and nervous system. TB is spread by droplet infection in saliva or sputum that is transmitted in the sneezes or coughs of a TB sufferer. It used to be called consumption because of the effect it had on the body; the disease seemed to consume the body leaving sufferers emaciated and weak.

According to World Health Organization (WHO) there were 8.7 million new cases of TB in 2011 and 1.4 million deaths caused by TB in the world. After the introduction of antibiotics TB became less common, however, worryingly the disease is still increasing in certain ethnic minority communities and in poorer communities in urban centres. TB also tends to coexist with HIV and AIDS because HIV weakens the body’s immune system making infection with TB more likely.

Tuberculosis often develops slowly in the body as the TB bacteria are very slow moving. Symptoms may not appear for many months or even years after infection with the TB bacteria. Around one-third of the world’s population is thought to be infected with latent TB. The body’s immune system is not able to kill the bacteria, but instead builds a defensive barrier around the infection.

If the immune system is not able to kill the infection it spreads slowly to the lungs and is known as active TB. The symptoms of active TB include:

a persistent cough
haemoptysis
weight loss
nocturnal diaphoresis

The standard antibiotic regime for tuberculosis must be taken every day for as long as six months to ensure that all bacteria are eradicated. Drug-resistant TB which is on the increase requires a minimum of 18 months of treatment. Drug-resistant TB may develop when the standard course is not completed or when some of the drugs in the regime are omitted. This is more often the case in the poorest of countries where TB drug regimes are too expensive or not easily accessible. Some of the drugs may be sent to family members in a misguided attempt to help them.

Some forms of TB are prevented by vaccination with the BCG vaccine, however, it is believed that the only hope for complete eradication of the disease is with the new vaccines currently being researched and tested

Activity 1

Match the terms 1 – 14 with their meanings a – n

1. mycobacteria	a) a substance made from a weakened form of a disease that is used to prevent the same disease
2. droplet infection	b) night sweats
3. saliva	c) a chronic cough that continues even after treatment
4. sputum	d) a disease that has outward symptoms that can be used in diagnosis
5. immune system	e) a disease that does not respond to treatment with a particular drug
6. latent disease	f) coughing up blood-stained sputum
7. spread	g) a type of rod-shaped bacteria
8. active disease	h) watery secretions from the mouth that help when chewing food
9. persistent cough	i) administration of a vaccine as an injection or a medicine to prevent a disease from developing
10. haemoptysis	j) infection that is spread in a sneeze or a cough
11. nocturnal diaphoresis	k) a dormant disease with no outward symptoms
12. drug-resistant	l) transfer an infection from one person to another
13. vaccination	m) also called phlegm, secretions that are coughed up
14. vaccine	n) the system of the body that protects the body against infection

Activity 2

Look at the questions at the beginning of the unit and answer them using information in the text to help you

1. What sort of disease is tuberculosis?

a. a disease of the tubercles of the bone
b. a serious bacterial disease that is highly contagious
c. a muscle wasting disease

2. What parts of the body can TB affect?

a. TB usually affects the lungs but may also affect the bones and brain
b. the lungs only
c. salivary glands

3. What symptoms would you expect in a patient who has TB?

a. weight gain and mild cough
b. weight loss and increased sweating
c. weight loss, cough with blood-stained sputum and night sweats

4. Why is the treatment of TB difficult?

a. finding the correct antibiotic is difficult
b. treatment is not available in all countries
c. treatment must be followed for a long time and drug-resistance is increasing

Koch bacillus (bacille de Koch)

Activity 3

Before you start, review these terms

TB	Tuberculosis
MDR-TB	Multi-resistant TB = TB that is resistant to several drugs including the two of the most powerful anti-TB drugs, isoniazid and rifampicin
XDR-TB	extensively drug resistant tuberculosis = TB that is resistant to ï¬rst- and second-line TB drugs

TB cases increasingly resistant to all drugs, study warns

Thursday 30 August 2012
Researchers find 6.7% of drug-resistant tuberculosis patients have a form of the disease that may take years to treat. Cases of tuberculosis that are resistant to virtually all drugs currently available to treat the disease are increasing at an alarming rate around the world, according to a study.

The paper, in the Lancet medical journal, shows that nearly half (47%) of TB cases that were already resistant to the two basic antibiotics used as standard treatment were also resistant to one of the second-line drugs that doctors try when the standard combination fails. The problem was worst in Latvia, where 62% of multi-drug-resistant TB (MDR TB) was not susceptible to at least one second-line drug.

Drug-resistant tuberculosis has spread around the world and has now been identified in 77 countries, but many of the worst-hit have inadequate laboratory diagnostic capacity and poor data collection so the exact prevalence is difficult to know. The survey, by the US Centres for Disease Control and Prevention, found that XDR TB was most likely to develop when treatment for MDR TB had not been properly completed. It found that the risk of XDR disease was more than quadrupled in previously treated patients. Previous treatment with second-line drugs was consistently the strongest risk factor for resistance to these drugs.

Read the excerpt below and answer the questions that follow

1. The best summary of paragraph 1 would be:

a. There is a global increase of TB that is resistant to treatment with the standard medication regime.
b. TB that is resistant to standard treatment takes a long time to treat and is, unfortunately, increasing in prevalence around the world.
c. TB is a disease that can be difficult to treat especially if a drug-resistant form develops

2. The best summary of paragraph 2 would be:

a. Just under 50% of TB cases are cases that do not respond to the treatment used when initial TB drugs fail to treat the disease
b. Resistance to drug treatment is a significant problem in around half of all TB cases.
c. Around half of patients that are resistant to first-line TB drugs are also resistant to one of the second-line TB drugs; this figure reaches around 60% in Latvia.

3. The best summary of the third paragraph would be:

a. Accurate data is not available on the numbers of cases of Extensively drug resistant tuberculosis (XDR-TB) which is often a result of poor compliance with Multi-resistant TB (MDR-TB) drug regimes.
b. Laboratory diagnosis in 77 countries has shown that the risk of XDR-TB in previously treated TB patients has increased four-fold in recent times.
c. A US survey identified statistical errors in the information collected by 77 of the world’s laboratories.

Activity 4

Read the article below from the Nursing Research magazine and then complete the activity that follows.

Efficacy of nurse case-managed intervention for latent tuberculosis among homeless subsamples.
Nurs Res. 2008 Jan-Feb;57(1):33-9.
Nyamathi A, Nahid P, Berg J, Burrage J, Christiani A, Aqtash S, Morisky D, Leake B.

Source
Audrienne H. Moseley Endowed Chair in Community Health Research, School of Nursing, University of California, Los Angeles, CA 90095-1702, USA. anyamath@sonnet.ucla.edu

Abstract

Background :
The efficacy of a nurse case-managed intervention was evaluated in subsamples of participants with one of the following characteristics: female gender, African American ethnicity, recruited from a homeless shelter, a history of military service, lifetime injection drug use, daily alcohol and drug use, poor physical health, and a history of poor mental health.

Objective :
To determine whether a validated nurse case-managed intervention with incentives and tracking would improve adherence to latent tuberculosis infection treatment in subsamples of homeless persons with characteristics previously identified in the literature as predictive of non-adherence.

Methods :
A prospective 2-group site-randomized design was conducted with 520 homeless adults residing in 12 homeless shelters and residential recovery sites in the Skid Row region of Los Angeles from 1998 to 2003.

Results :
Daily drug users, participants with a history of injection drug use, daily alcohol users, and persons who were not of African American race or ethnicity had particularly poor completion rates, even in the nurse case-managed intervention program (48%, 55%, 54%, and 50%, respectively). However, the intervention achieved a 91% completion rate for homeless shelter residents and significantly improved latent tuberculosis infection treatment adherence in 9 of 12 subgroups tested (odds ratios = 2.51-10.41), including daily alcohol and drug users, when potential confounders were controlled using logistic regression analysis.

Discussion :
Nurse case management with incentives appears to be a good foundation for increasing adherence to 6-month isoniazid treatment in a variety of homeless subgroups and, in particular, for sheltered homeless populations. However, additional social-structural and environmental strategies are needed to address those at greatest risk of non-adherence.

Complete the summary of the article. Use words in the box below to help you

incentives ; treatment ; adherence ; latent ; homeless ; drug ; users ; nurse-led

A study of the effectiveness of (1) _______________________ management of homeless people with (2) _______________________ tuberculosis was conducted over a five year period in (3) _______________________ shelters in Los Angeles. The subjects of the study were female, African American, former IV (4) _______________________ and in poor physical and mental health.
The aim of the study was to determine whether nurse-led clinics would be able to encourage the completion of drug (5) _______________________ for the prevention of latent TB infections.
The results of the survey seem to suggest that increased (6) _______________________ to a 6-month treatment regime was achieved in homeless clients by using nurse-led management which included (7) _______________________ to encourage clients to complete the drug treatment.

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Virginia ALLUM
Author and Consultant in English for Medical Purposes
United Kingdom