Tuberculosis:

history, epidemiology,
pathogenesis, immunity
Lecturer: Ph.D
M.G.Dolynska
The magnitude of the problem
 Tuberculosis kills more than 3 million people per
year
 Tuberculosis produces 25% of all avoidable
deaths in developing countries
 Tuberculosis produces more death than any
other single infectious disease , so its the
deadliest one
 About the 1/3 of the world population are
infected by tuberculosis
 Tuberculosis uniqueness
 the most ancient among known infection
 the most ubiquitous infection
 infection which can coexist with the
human being without producing the
disease
 infection from which human being isn’t
able to deliver
 Main reasons for tuberculosis
reappearance as a global
challenge
 Drug-resistance
 HIV

 Social disturbances
 Types of Approaches to the
Epidemiology of Tuberculosis

o Descriptive epidemiology
o Etiologic epidemiology
o Predictive epidemiology
 Tuberculosis prevalence
 Low (less than 30 cases per 100000) −
Western Europe, USA
 Moderate (30-90 cases per 100000) −

Central Europe
 High (more than 90 cases per 100000) −

South Asia, Africa, former Soviet Union

 Estimated Number of Incident Tuberculosis
Cases in the World, by WHO Region, 1997

Southeast Asia
Western Pacific
Africa

Eastern Mediterranean
Europe
Americas

0 1 2 3 4
Number of cases (in million)
Dye C, et al. J Am Med Assoc 1999;282:677-86
 Afg
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istan
Annual Risk of Tuberculous Infection in
Low Income Countries of Five WHO Regions

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Risk of infection (%)

3 Africa

h
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Americas

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atBahran
Eastern Mediterranean

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Western Pacific
1

0
70 75 80 85

Cauthen GM, et al. WHO Document 1988;WHO/TB/88.154:1-34

 The Epidemiologic Situation of Tuberculosis
and Economic Realities

Annual risk of infection (%) Health

Country or area Current level Annual resource
decline availability

I Industrialized 0.01 – 0.1 > 10 Excellent

II Middle-income Latin 0.5 – 1.5 5 – 10 Good
America, West Asia, North
Africa
III Middle-income East and 1.0 – 2.5 <5 Good
Southeast Asia
IV Sub-Saharan Africa, 1.0 – 2.5 0–3 Poor
Indian subcontinent

Kochi A. Tubercle 1991;72:1-6

 Types of Approaches to the
Epidemiology of Tuberculosis

o Descriptive epidemiology
o Etiologic epidemiology
o Predictive epidemiology
 Mycobacteria types
1. M. causing tuberculosis
 M. tuberculosis (human)
 M. bovis.
 M. Africans.
2. Non-patogenous M.
 M.avium-intracellulare.
 M.smegmaticus.
 M. xenopi
 M. scrofulaceum.
3. M. causing leprosy
 M. leprae
Mycobacteria important properties

 mycolic acid in the cell wall producing

phenomenal resistance
 the intracellular type of the parasitizing
 The ways of the transmission:
 Inhalation (about 90%)
o Dusty

o Droplet

 Alimentary
 Contact
 Vertical
Risk of Infection Among Contacts as
a Function of the Proximity of Contact
 Number of Droplets produced by Different
Aerosol Producing Maneuvers
50000

40000
Number of droplets

C
oughingT
alkingS
inging
30000

20000

10000

Loudon RG, et al. Am Rev Respir Dis 1968;98:297-300

 Types of Approaches to the
Epidemiology of Tuberculosis

o Descriptive epidemiology
o Etiologic epidemiology
o Predictive epidemiology
 A
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L.Infection195;23:1-4
 Risk groups
Medical
 HIV-positive people

 Patient with diabetes mellitus

 Patient with malignancy

 Exposed by different types of the

immunosuppressive therapy
 People exposed by close contact with
bacterial expectorators
 Risk groups

Social
 Any kind of marginal population

(homeless, unemployed, substances

abusers)
 Refugees

 Health care workers

Immune response
Specific alveolar macrophages
transformation