Etiology of Disease and the Practitioner: Treatment of Communicable and Infectious Diseases (Continued)
This article will deal with extra-pulmonary tuberculosis (EPT).
Primary tuberculosis was, at one time, a major concern to the funeral community due to lack of communication and sanitary precautions. Individuals worked in poor conditions for long hours, living conditions were close, and nutritional habits were poor, making them susceptible to the bacilli.
In reality, how many times, now or in the past, have you embalmed remains with no knowledge as to the cause of death, thereby being exposed during the removal of a body from the place of death? During handling of the body in cases of pulmonary infections, the major concern is the inhalation of droplet nuclei which are found on various instruments, and surfaces such as table tops and floors.
During the hematogenous phase, a transition may progress into a disseminated scattered area. At this time, the lymphohematogenous phase creates a situation where organ particles are spread into cellular tissue. Extra pulmonary tuberculosis in the aged is generally assumed to be the result of seeding. Most remains have predisposing conditions including immunosuppressive treatment (particularly the use of steroids), HIV infection or chronic illness. This includes renal failure, connective tissue diseases and diabetes mellitus. All of these influence tissue fixation and must be a consideration in total preservation and disinfection. It is the seeding which creates the potential hazard in handling the dead remains. Pathological lesions, tiny gaseous granulomas which resemble millenary seeds become millenary tuberculosis if not identified and are usually fatal within one year.
Many organs are affected with extra-pulmonary disease due to hematogenous seeding of a particular organ system. These include the central nervous, pericardium, genitourinary by way of the peripheral lymph system. Sometime years later, the asymptomatic latent period follows the hematogenous seeding of the extra pulmonary organ system. This may be a potential source of infection to the embalmer due to accidental cuts or needle punctures. Likewise, conditions like tuberculosis meningitis, tuberculosis pericarditis, and renal tuberculosis may be latent for years.
Other forms of isolated organ tuberculosis exist but are not relevant to the embalming process. However, the possibility exists they may cause skeletal tuberculosis of the spine (Post’s Disease), granulomatous hepatitis and tuberculosis peritonitis which may be a concern following an autopsy.
As embalmers, we must be aware of the possibility of the drug resistant population of the tubercle bacilli and other microorganisms. Prevention of infection is our primary responsibility and function as funeral service practitioners.
It is not what we see but what we don’t see or understand that we, as embalmers, must be constantly aware of and with which we should be concerned at all times. What affects the body affects the mind and what affects the mind affects the body.
During the hematogenous transition process, a transition may occur changing this tissue and causing it to break off and relocate into the tissue of another organ. Because malignant tumors have no enclosing capsule, cells may escape and be transported by the lymphatic circulation or the bloodstream to other organs. These organs can be far from the primary tumor. This process is referred to as being metastatic.
Part 17 will be a continuation of various different microorganisms.