Etiology of Disease and the Practitioner:

Treatment of Communicable and Infectious Diseases

(Continued)

  The interaction between body systems is a variable factor between life and death. In life, there are natural and physical defenses. In death, the body becomes a hostile media of opportunistic microbes. Some are supportive to life processes during life but may be detrimental following life processes. Dried sputum may become airborne causing secondary negative conditions in the living.

  Our concern is a condition of abnormal vital functions involving any structure part or system. The interrelation between systems should be of paramount concern to all embalmers. It is not always a concern surrounding the embalmer. It includes the support systems of personnel together with specific education concerning the duties and responsibilities when handling the dead body for final disposition.

  As previously stated, tuberculosis is an infectious disease which has been a common concern among embalmers for years. With continuing education, government intervention and OSHA regulations, many concerns have been addressed. However, many more will evolve as time passes. The idea is to keep it simple and build on that which exists. It seems logical to begin with mycobacterium tuberculosis complex organisms which consist of five species: M-tuberculosis, M. bovis, M. africanum, M. ulcerans and M. microti.

  Mycobacterium tuberculosis causes all cases of human tuberculosis in developed countries. M-tuberculosis is a facultative intracellular parasite. Humans are their only natural reservoir. The microorganism is a non-spore forming non-volatile bacillus with a cell wall which has a high content of lipid indicating its virulence. Primary tuberculosis occurs in the individual whose resistance is low due to stress within the work environment and who has no pre-existing immunity. Tubercular bacilli are spread via the thoracic duct into the circulatory system and seed multiple organs which include bone marrow, liver, spleen, kidneys and meninges.

  In the past, M. bovis was a frequent cause of human tuberculosis usually acquired by the ingestion of milk contaminated with M. bovis. With pasteurization of milk it has been largely eliminated. M. africanum is a rare cause of human tuberculosis found in Africa. M. ulcerans is the causative bacilli of necrotizing cutaneous ulceration in Africa and Australia. M. microti is an animal pathogen.

  Of concern to the embalmer is the accumulation of various fluids. Liquefaction necrosis is one of the most harmful host responses in tuberculosis. The liquefied caseum is an excellent culture medium for tubercle bacilli. Their extensive multiplication extracellularly creates cavitation within the lungs thus producing potential purge during and after the embalming treatment. During life, normal healing may encapsulate the specific areas within which viable tubercle bacilli often persist. The healed fibro calcific granulomas, which are always present, are potential for breakdown (rupture) of these lesions and release of the bacilli into the environment.

  Part 16 will introduce extra-pulmonary tuberculosis.