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Health Alert TUBERCULOSIS Henry Wouk .
PhotoTakeUSA. No part of this book may be reproduced or utilized in any form or by any means electronic or mechanical including photocopying. Title.marshallcavendish. The photographs in this book are used by permission and through the courtesy of: Peter Arnold Inc. Gideon Mendel for The International HIV/AIDS Alliance. Photo Researchers Inc. and practices change with time. author.With thanks to Adam J. for his expert review of the manuscript. RC311. including action that may seem to be indicated by the contents of this work. Anna Kern/Etsa. — (Health alert) Includes index. TDR. 56 Editor: Joy Bean Publisher: Michelle Bisson Art Director: Anahid Hamparian Printed in Malaysia 654321 . 24. 22. 45. Véronique Estiot. 52. Tuberculosis—Juvenile literature. Marshall Cavendish Benchmark 99 White Plains Road Tarrytown. 12. SPL. 5. 8. 28. Title page: Tuberculosis bacteria Photo Research by Candlepants Incorporated Cover Photo: SPL / Photo Researchers Inc. Bart's Medical Library. Bubbles Photolibrary. Jonathan (Contemporary Artist) / Private Collection. 42. Corbis: CDC/PHIL. recording. Hulton-Deutsch Collection. Tuberculosis—History—Juvenile literature. 13. WHO. ISBN 978-0-7614-4611-8 (e-book) 1. NY: HIP. Center for Immunotherapy of Cancer and Infectious Diseases and Department of Immunology. PhD. 49. 31. Innerspace Imaging. 19. Marcio Jose Sanchez. Summary: “Provides comprehensive information on the causes. Museum of History and Industry. 3. 38. Adam Gault. Henry. University of Connecticut Health Center. knowledge. The reader is advised that no action of a medical nature should be taken without consultation with a licensed medical practitioner. since individual circumstances vary and medical standards. Art Resource. Tuberculosis / by Henry Wouk. Adler. 16. 30. 25. 47.com. without permission from the copyright holders. AP Images: Ric Francis. Greg Baker. treatment. Associate Professor. and history of tuberculosis”—Provided by publisher. 18. This book is not intended for use as a substitute for advice. 54. cm. consultation. 41.9’95—dc22 2008021369 Front cover: An X-ray showing extensive tuberculosis in both lungs (in red). 33. The Image Works: Print Collector / HIP. 34. 26. The Bridgeman Art Library: Barry.: Manfred Kage. Bettmann.: Deni McIntyre. 37. Getty Images: 3D4Medical. New York 10591-5502 www. 11. Andy Crump. 2. 14.W94 2010 616.com: ISM. Jacques Boyer / Roger-Viollet. or by any information storage and retrieval system. Seattle Post-Intelligencer Collection. 44. and medical consultants disclaim all liability and cannot be held responsible for any problems that may arise from the use of this book. Alamy Images: Nick Gregory.us Text copyright © 2010 by Marshall Cavendish Corporation All rights reserved. p. Library of Congress Cataloging-in-Publication Data Wouk. or treatment by a licensed medical practitioner. 21. The publisher. I. 39.
Contents Chapter 1 Chapter 2 Chapter 3 Chapter 4 What Is It Like to Have Tuberculosis? What Is Tuberculosis? The History of Tuberculosis Treating and Living with Tuberculosis Glossary Find Out More Index 6 10 28 46 58 60 62 .
Then the doctor asked about other family members. During the day. His doctor agreed—at first. ten-year-old Jeremy had a cough that would not quit. Sometimes Jeremy coughed so hard that his chest hurt. Because the cough hung on for so long. Jeremy felt tired and did not have the energy to play with his friends or even to go fishing with his grandfather. WHAT IS IT LIKE TO HAVE TUBERCULOSIS? F or a couple of weeks. He began waking up in the middle of the night to find his pajamas drenched with sweat. His body shook with chills. including Jeremy’s grandfather. At first it was a nuisance. Jeremy’s parents thought he might have the flu. Grandpa Madden had been going to his doctor with the same complaint about a bad cough and 6 . His parents thought it was just a bad cold and it eventually would go away. Then other things started to happen in his body.
During one of his doctor visits. he knew that a person who had TB once could get it again. That summer Jeremy and Grandpa Madden had been sharing a bedroom at the family summer cottage for weeks at a time. The doctor had good reason to think that. If he did have tuberculosis. Fewer and fewer people come down with the disease because of special medicines and public health laws. The doctors immediately ordered the same tests for 7 . a tiny sample of fluid from his lungs showed he had the TB germs. Madden began to lose weight. He said that people rarely get TB these days. Even so. he had tuberculosis (TB). None of the doctor’s recommendations helped.WHAT IS IT LIKE TO HAVE TUBERCULOSIS? trouble breathing. But TB is still around. he worried he might have spread the disease to his grandson. Grandpa Madden remembered something. The cough got worse. He had chills and night sweats. At first Grandpa Madden’s doctor thought there was no need for an X-ray. Mr. and he recovered. When examined under a microscope. which are possible signs of TB infection. as Jeremy’s grandfather found out after an X-ray. He asked his doctor if he should get a chest X-ray to see if there was anything wrong with his lungs. Fortunately Grandpa Madden was treated for the disease. When he was about Jeremy’s age. The image showed white shadows. The number of TB victims is shrinking so fast that some experts predict the disease will soon be wiped from the face of the earth. a serious lung disease.
Healthy lungs. Although other family members were fine.Tuberculosis A doctor points to an X-ray of lungs stricken with tuberculosis showing the damaged portions as white areas. Jeremy and the rest of the family. appear as clear dark images. on the right. 8 . Jeremy had TB. Grandpa Madden’s hunch was right.
9 . which killed the bacteria. both grandfather and grandson felt better. Jeremy and his grandfather completely recovered. After six months. Jeremy and his grandfather had to take pills containing antibiotics. Within three weeks. Before long it was spring and they were having fun fishing together again. Every day for six months.WHAT IS IT LIKE TO HAVE TUBERCULOSIS? Fortunately there is a treatment for tuberculosis.
such as the brain. A person who repeatedly breathes the germ-loaded air can catch tuberculosis. The other type is active TB. One is latent TB. and the spine. People with this form of the disease do get sick. the TB germs will spread and eat away at lung tissue. Inside each droplet are TB bacteria. which means a person carries the TB germ but is not sick and cannot pass the germ on to other people. If the disease goes untreated. WHAT IS TUBERCULOSIS? T uberculosis is a disease in which bacteria may invade many parts of the body. The TB bacteria damage the lungs so much that it is difficult for a person to breathe. the kidneys. This damage 10 . When someone who is sick with TB coughs or sneezes. TB’s most common target is the lungs. and they can make other people ill as well. Once inside the body. he or she exhales clouds of tiny droplets. TB bacteria can work their way to the lungs. There are two main types of TB.
Each time you breathe in. close your eyes. Sit quietly. breathing takes place automatically. and excess body heat. gases such as carbon dioxide.WHAT IS TUBERCULOSIS? A microscopic snapshot shows the distinctive rod shapes of tuberculosis bacteria. and listen to your breathing. Each time you exhale. For healthy people. shows up on a chest X-ray. you breathe out things that the body needs to get rid of—germs. Soon the infected person will develop a cough and may have trouble breathing. your body takes in oxygen that it needs to survive. The lungs are organs that 11 .
To understand how important this is. watching Blood cells carry carbon dioxide from the body to the lungs. Your respiratory center automatically adjusts the rate of breathing when you run faster or work harder. But you can also override this system. This destruction weakens a person’s ability to take in oxygen and to rid the body of carbon dioxide. Whether you are running. Tuberculosis germs destroy lung tissue. your brain makes sure your body is breathing every second of every day. HOW THE LUNGS WORK A special part of the brain called the respiratory center controls the process of breathing. Your brain also keeps track of how much oxygen your body needs. which expel the gas from the body. you need to know a little bit about how these amazing organs work.Tuberculosis exchange bad air for good air as you breathe. television. 12 . or sleeping.
The back of the diaphragm is attached to the spine. This muscle fits like a dome under both lungs and lies between them and the ribs. The front of the diaphragm is attached to the sternum. 13 . Every healthy person has two of them. They need the air by themselves. the bone in the center of the chest. They sit on either side of the heart and are protected by the ribs. you can take a deep breath when you are getting ready to shout or to sing. The left lung is a little smaller than the right lung because it leaves a pocket for the heart to nestle in. Or you can choose to stop breathing completely for a few seconds when you are swimming underwater. Lungs cannot take in Lungs cannot take in air on their own. All the air that comes into the body goes into the lungs. called the diaphragm.WHAT IS TUBERCULOSIS? For example. They diaphragm muscle (in red. below lungs) to expand and need the help of a muscle contract them.
which look like tiny balloons. The trachea splits into two tubes called This colored X-ray shows how the body’s breathing bronchial tubes. and bronchial tubes form an eventually ending with tiny air sacs. These tubes are about as thick as a human hair. The diaphragm is making your chest cavity bigger. air comes in through your nose and mouth. Inside the lungs each bronchial tube subdivides. At the tips of the bronchioles are alveoli. Watch your chest relax. into smaller and smaller tubes called bronchioles. It flows down through the windpipe. they resemble grapes at the end of a branch. When you inhale. Notice how your chest expands. The trachea system is a series of smaller and smaller branches. Each bronchial tube leads to a lung. take a deep breath. upside-down Y. or trachea. Now breathe out. 14 . This draws in air. The diaphragm is squeezing out air from your lungs. like branches on a tree. Under a microscope.Tuberculosis To see how respiration works.
When someone talks for five minutes. you would see that they are packed with about six hundred million tiny bubbles. The lungs are so good at their job that a person can still survive with just one. And if the Lung Power From the outside. These vessels circulate oxygen to the rest of the body. carbon dioxide seeps into the alveoli as a waste product.400 times a year. they would cover a football field. or air sacs. coughs. If you could take a microscopic peek inside. When a person inhales.WHAT IS TUBERCULOSIS? The thin walls of the alveoli are lined with blood vessels. At the same time. which let the lungs slide easily against the diaphragm as they are squeezed with each breath. or even talks. 15 . or 2. the air travels all the way down to the end of the bronchioles. sings. 5. he or she sends out clouds of thousands of tiny drops of moisture. sings for only a minute. the human body breathes in and out about every fifteen seconds. the lungs look like two large pink sponges. THE INVADER WITH TWO INITIALS: TB Every time a person exhales. It seeps through the alveoli walls into the blood vessels. That equals 4 times a minute.102.760 times a day. On average. These are super-slippery layers of tissue. that individual sprays about three thousand droplets into the air. A pair of lungs has so many bubbles that if they all were flattened. sneezes. or coughs once. The lungs usually do their job smoothly. That is because they are covered with pleural membranes.
Each droplet from a sneeze or cough contains about three MTB germs. After a sneeze.91 meters) away. 16 . A TB infection can start when someone inhales the germ Mycobacterium tuberculosis (MTB) into his or her lungs. The bacteria in the coughs or sneezes of a person infected with active TB hang in the air in the same way.000 droplets may spread as far as 3 feet (0.Tuberculosis individual sneezes just one time without covering his or her mouth. approximately 40. these tiny drops can hang in the air like fog. each a potential germ carrier. The resulting This is what a sneeze looks like—a fog of tiny droplets.
According to some scientists. where stomach acid kills them. Any swallowed germs travel to the stomach. if a healthy person stays with someone who has active TB twentyfour hours a day for sixty days. tiny particles. convicts in a prison. This can happen to family members who spend a lot of time together. or eating utensils. The body’s first line of protection comes from stiff hairs called olfactory cilia. You will not get the disease if an infected person sneezes near you once or twice. It can also happen to anyone who spends a lot of time in enclosed areas with groups of people. which line the inside of the nose. bedding. TB is not as infectious as the common cold. You cannot catch TB by handling an infected person’s clothes.” TB typically spreads when an uninfected person inhales the infected droplets that the sick person exhales. and soldiers in military barracks. The word pulmonary means “related to the lungs. You have to be exposed to a lot of germs over a long period of time in order for tuberculosis to develop. Fortunately. Another germ barrier is mucus. and microorganisms that people inhale from the surrounding air. the sticky fluid that lines the inside of the nose and the 17 . he or she has only a 50 percent chance of catching the disease. Olfactory cilia trap dust. A healthy person’s body has many ways of protecting itself.WHAT IS TUBERCULOSIS? infection is called pulmonary tuberculosis. students in dormitories. People at a high risk of catching TB include medical workers in hospitals or clinics.
they can travel down the bronchioles all the way to the alveoli.Tuberculosis People in enclosed spaces can breathe in someone else’s germs. The immune system. where it becomes a slimy substance called sputum. back of the throat. From there. Mucus traps and collects bacteria. Mucus can build up in the lungs. stomach acid. Mycobacteria that do make it past these defenses—nose hairs. and mucus—can be breathed into the lungs. the body’s natural defense against disease. the body continues to protect itself. Even then. sends out white blood cells to attack bacteria 18 .
but they do not kill them all. This microscopic photo shows a macrophage engulfing tuberculosis bacteria. Under the microscope they look like tiny sticks. Tuberculosis bacteria are hard to kill. These cells swallow TB germs. They have a tough. When TB bacteria invade. The white blood cells that go after MTB are called macrophages.WHAT IS TUBERCULOSIS? and other harmful invaders. waxy outer shell that protects them even when they are swallowed. 19 . macrophages pile onto the invading germs like tacklers jumping on a runner with a football.
the person has latent TB. They are not destroyed. which weakens the immune system. The TB germs are sealed in the tubercules like money locked in a safe. and people who have a disease that weakens the immune system. Only about one of every ten people with a TB infection has active TB. Inside the walls is a mixture of dead TB germs. 20 . Although people with latent TB carry the germs. but they are isolated from the rest of the body.Tuberculosis However.” Tubercules have hard walls made of scar tissue. People who have weak immune systems include babies and very young children. they do not get sick or experience symptoms of the disease. which means “little swelling. such as acquired immunodeficiency syndrome (AIDS). They can live sealed up like this for years. They could cough and sneeze forever without infecting anyone else. When TB bacteria are alive inside the body but are under control. This means they do get sick and can infect others. Doctors also have discovered that African Americans and Native Americans are a little more likely to get TB than people of other cultural backgrounds. live TB germs. Usually this happens because a person’s immune system is not strong enough to keep the TB bacteria sealed off and under control. The pile of cells forms a lump called a tubercule. and white blood cells. the macrophages isolate the bacteria from the rest of the body. the elderly. Tuberculosis got its name from the Latin word tubercule.
That is Babies have underdeveloped immune when the victim develops a systems. crumbly substance. The germs continue growing while sealed inside the tubercule. This substance eventually becomes a liquid that seeps into the breathing tubes.WHAT IS TUBERCULOSIS? People get active TB because their immune systems cannot hold back the MTB in their bodies. As this germ-filled liquid oozes into other healthy areas of the lungs. there are so many germs that they ooze out of the tubercules. The more holes in the lungs. There. More macrophages arrive to fight the MTB. it leaves holes behind. but the bacteria spread into the lungs. After a time. and the more 21 . the germs eat away at tissue. suffocating cough—one all kinds of diseases. of the early symptoms of TB. the less lung tissue there is to take in air. and infected parts of the lungs turn into a soft. which makes them vulnerable to wet.
it can cause serious damage throughout the body. In the lungs. TB germs collect in these holes. 22 . which become collection areas for other types of germs. When the TB victim coughs or sneezes.Tuberculosis difficult it is to breathe. one especially An X-ray shows what lungs with miliary tuberculosis looks like—tissue punctured by thousands of tiny holes. As tuberculosis continues to spread. the germs in his lungs spray out into the air and infect other people.
23 .” TB germs can also spread into the bloodstream. losing appetite and weight. that patient needs further medical tests. and having night sweats. constantly running a fever. and the tissues that cover the brain and the heart. However. bones. MTB can also attack a person’s kidneys. TB can attack almost any part of the body. joints. DETECTING Tuberculosis At first. One is a persistent cough. People cough for all kinds of ordinary reasons. An X-ray of heavily infected lungs ravaged by this type of TB shows countless little flecks where the disease has made tiny holes. Doctors usually do not suspect anything is seriously wrong with a patient who has a bad cough. Tuberculosis germs can travel to and infect the lymph nodes. At that point. so he called it miliary tuberculosis after the Latin word for “millet. and armpit trap bacteria carried in the bloodstream. One scientist thought the marks resembled little millet seeds. The two most dangerous forms of TB are miliary tuberculosis and tuberculosis meningitis. a doctor cannot always tell whether a person has tuberculosis. collarbone. The disease’s symptoms are fairly common. and they usually do not worry about it.WHAT IS TUBERCULOSIS? deadly form of the disease is called miliary TB. These bean-shaped masses of tissue near the neck. if the patient also complains about feeling tired all the time.
they may do different tests. One is called the Mantoux test. 24 . It is an attempt to provoke a reaction from the body’s immune system. Once doctors suspect that tuberculosis is a possibility. or dead TB cells. The test takes only a second and is no more painful than a pinprick. named after a French doctor named Charles Mantoux.Tuberculosis One of the early symptoms of tuberculosis is a cough that will not go away. just under the skin of the forearm. A health care worker injects a tiny amount of fluid containing tuberculin. who devised it over a hundred years ago.
The wider the bump. the greater the possibility a patient has TB. a patient may show a distinct bump like this on his or her forearm. the doctor measures it with a ruler. Therefore. doctors may also decide to take an X-ray of the lungs. If there are 25 .WHAT IS TUBERCULOSIS? A few days after a pinprick. test. It cannot determine the form of the disease—latent or active. One out of five tests is false. The Mantoux test is not 100 percent accurate. or Mantoux. it only tells doctors that a person carries TB germs. Even if the test is accurate. The doctor inspects the spot where the injection was made. a sign the patient may have tuberculosis. If there is a reddish bump. Two or three days later. the patient returns to the doctor’s office.
if someone has a bad cough. they may show up as bright spots on the X-ray. but it also takes a lot of time. Finally. Technicians might examine the phlegm under a microscope to detect TB bacteria.Tuberculosis lesions. or sputum. or holes. in the lungs. inside the lungs. smeared on glass slides is one way to test for tuberculosis. the doctor will want to test the phlegm. TB bacteria grow very slowly—as Examining samples of a patient’s lung fluid. This lab test is very accurate. 26 . Or they may send a sample to a laboratory to test whether bacteria grow inside the phlegm. or mucus.
Diagnosing TB in children can be difficult. A variety of medicines and treatments help a patient recover and lead a healthy life. they may not have enough TB bacteria in their systems to show up on some of the laboratory tests. 27 . Today.WHAT IS TUBERCULOSIS? long as six weeks—before doctors can identify the infectious bacteria and make a diagnosis. that is no longer true. Knowing that someone has spent signficant time near a person with infectious tuberculosis can be the most valuable piece of medical information of all. Today the disease can be completely cured. Active tuberculosis used to be a death sentence. In the end. Even when children are infected. a doctor’s most useful diagnosis strategy is talking to the patient.
tuberculosis often spread throughout a community. long time.500 years ago. Scientists have found traces of the disease in the lung tissue of a three-thousand-year-old Egyptian mummy and in the remains of a woman buried one thousand years ago in Chile. THE HISTORY OF Tuberculosis T uberculosis has been around for a long. Almost 2. It was so deadly that he Tuberculosis has been around so long that this ancient drawing from an Egyptian tomb shows a man thought to have suffered from the disease. 28 . the famous Greek doctor Hippocrates said that tuberculosis was the most common disease of his time. Wherever people lived together in a crowded environment.
the Latin word for female pig. However. TB also has been called scrofula.THE HISTORY OF TUBERCULOSIS told doctors not to try to treat it. TB was once called consumption because it devoured. The ancient Greeks called it phthisis. which swelled up like a pig’s neck. the origin of TB was a great mystery.” They probably chose this word because TB victims lose their appetites and become weak and pale.) Another name was Prosector’s wart. It was also known as the white plague because victims were so pale from loss of blood. but it would take thousands of years to prove this. a tuberculosis of the skin that coroners. For centuries. TB was called Koch’s disease after Robert Koch. The ancient Greek philosopher Aristotle believed TB spread from one person to another. when people lived by hunting and did not settle in one place. which causes the upper back to curve over. TB was not a major health problem in prehistoric times. when people began to live in settlements and began to raise 29 . TB has gone by many different names. For a long time. and surgeons caught from contaminated dead bodies. Some experts even think that the fictional character the Hunchback of Notre Dame was based on a person who had tuberculosis of the spine. a person from within. (Sometimes TB bacteria infected glands in the neck. from a word meaning “to waste away. or consumed. the man who discovered MTB. Drawings on the walls of Egyptian tombs show hunchbacked people who may have had tuberculosis of the spine. butchers.
The disease then spread from the cows to people who drank milk. New World. For centuries. and Central America. the disease spread. Many medical historians now believe that tuberculosis developed from bacteria in the soil. when researchers found a woman who died of TB in Chile one thousand years ago. who discovered the TB germ. tuberculosis was called Koch’s the disease centuries before disease. and explorers brought the disease to the New World—what is now North. Robert any Europeans arrived in the Koch. Experts once thought TB began in Europe. South. most people lived in villages or small towns. If someone got sick with tuberculosis.Tuberculosis cattle. there were fewer people around to catch it. named after this man. Since most people spent their time 30 . She had At first. That theory was disproved. which spread to cattle grazing near the bacteria. however.
31 . tuberculosis was the cause of one in every three deaths. doctors use ultraviolet light in homeless shelters. Even today. In addition. hospitals. and prisons to combat tuberculosis germs.THE HISTORY OF TUBERCULOSIS outdoors. In eighteenth-century London. Tuberculosis became a very serious health problem when people started moving from the country into cities and began to live in crowded conditions. the germs did not linger in the air. the ultraviolet rays of sunlight killed the germs.
They lived crammed together in rooms with little or no fresh air. More and more people moved to the cities to work in factories. Landlords began bricking up or boarding over windows to avoid paying the window tax. an era called the Industrial Revolution began. As the cities grew. the higher the taxes. landlords had to pay the government a window tax. People worked in dark. so did the number of tuberculosis victims. To make matters worse. They would gather around their king on special days for a ceremony called the king’s touch or the king’s evil. infected air. They rented out these dark. some people in England and France believed they would be cured if their king or queen merely touched them. One of every three people who died in England in those days died of tuberculosis. On Easter Sunday afternoon in 1686. In the early 1700s in England. a TB infection that caused lymph nodes in the neck to swell up. windowless places to people who were forced to breathe stuffy.THE EIGHTEENTH CENTURY The Royal Touch A common form of TB in medieval times was called scrofula. King Louis XIV of France individually touched more than a thousand people. . The more windows a building had. TB spread quickly. In those days. damp buildings.
doctors were frustrated. Some people believed that TB attacked only creative and sensitive people like artists. La Bohème. as well as composer of tuberculosis. In a famous opera. Famous writers such as John Keats and George English poet John Keats died in his twenties Orwell. People were terrified of getting TB. tuberculosis was one of the deadliest diseases known to humans. Frederic Chopin. the sensitive heroine dies tragically from TB. It was then the leading cause of death in the United States. They knew little about what caused TB and had no way to treat it.THE HISTORY OF TUBERCULOSIS THE NINETEENTH CENTURY By the 1800s. At the same time. all died of tuberculosis. There were all kinds of ideas about how and why people got the disease. A more likely explanation is that starving artists died of TB because they lived in unhealthy spaces. 33 .
This was because TB victims had the pale. Because TB was so feared and so mysterious. which was another suspicious sign. People who believed this theory often mentioned authors Charlotte and Emily Brontë. some victims meant they were vampires. the victim might also cough up blood. sisters who wrote the classic novels Jane Eyre and Wuthering Heights. people Superstitious people once thought the developed many superstitions pale white appearance of tuberculosis about it.Tuberculosis Another theory was that victims inherited tuberculosis. Another superstition was that a TB victim might return from the grave to attack the rest of his family. A more logical explanation is that a person with active TB is likely to pass it on to people who live in the same house. Both women died of TB. as did their brother and two other sisters. people thought a person with tuberculosis was the victim of a vampire and would become a vampire himself. In advanced stages of the disease. In New England. 34 . bloodless look of the undead.
’s coffin and had rearranged his bones so he could not rise from the grave and attack other people.B.’s bones and discovered that he had suffered from tuberculosis. Because local people believed that TB victims were vampires. Workmen digging a gravel pit had accidentally disturbed a family cemetery on an abandoned farm.B. Scientists examined J. Among them was one mysterious grave. and came upon human skulls. appeared on the coffin lid. two boys made their way down a muddy slope near Griswold. The initials J. Archaeologists found the remains of twenty-nine people who had been buried there in the 1700s and 1800s. Inside was a man’s skeleton.The Strange Case of the Two Skulls In 1990. Historical detective work revealed that there had been a tuberculosis epidemic in the area during the 1800s.B. which had been taken apart and rearranged as a skull and crossbones. Connecticut. scientists speculated that superstitious people had reopened J. .
” Other doctors suggested building special TB hospitals in places believed to be healthy for people with tuberculosis. Trudeau became interested in TB after he discovered he had the disease in 1873. and died. They recommended that people build their houses on dry ground and in areas with no shade. In Europe. Trudeau moved to the Adirondack Mountains in New York State to spend what was left of his life. the development of sanatoriums began. many people with TB moved from New England to warmer. During the late 1800s. He decided 36 . Some doctors thought that a damp area was a breeding ground for the disease. however. A more logical theory about TB was that it had environmental causes. drier areas like the Southwest and California. Other doctors said moving to a drier climate would help cure the disease.Tuberculosis This seemed to explain why other people in the same family got mysteriously pale. Edward Trudeau. became weaker. They were known as “lungers. one of every three settlers in Arizona said they moved to the state for their health. An American doctor. The first sanatoriums were built in the mountains of Switzerland and Germany. Instead of getting sicker. where the air was clean and clear. For that reason. Trudeau started to feel better.” Each sanatorium was a special clinic where people with TB would go to get better. Sanatorium is from the Latin word meaning “to cure. adopted this idea in the United States. Believing he would die soon.
and he decided to open one on the shore of Saranac Lake in upstate New York. They removed infectious patients from the rest 37 . Sanatoriums did not actually cure people. Doctors there encouraged TB patients to exercise in the chilly air and to eat a healthy diet. Some patients even slept outside in the winter.THE HISTORY OF TUBERCULOSIS In the 1930s. This idea was so popular that hundreds of sanatoriums were built all over the country by the 1920s. but they did have some benefits. He had read about the European sanatoriums. it was common practice to send sickly children to sanitoriums like this one. that all the fresh air was curing him.
and they raised awareness about diseases of the lung. who eventually died of TB. Some people thought there must be a TB germ. a French army doctor named Jean Antoine Villemin took fluids from humans who had TB and injected them into rabbits. a German Patients at sanitoriums took special sun baths in both doctor named Robert Koch made summer and winter to build medical history when he announced up their strength. but also that bacteria cause the disease. he had found the germ that causes tuberculosis. but it still did not explain how the infection took hold. A few years later. In 1865. His discovery proved not only that tuberculosis can be passed from one person to another. The rabbits got tuberculosis as well. Dr. He studied samples from eleven people with severe TB. was the first president of what is known today as the American Lung Association. Each sample contained bacteria that he called the tubercle bacillus—the rod-shaped germ that causes TB. in 1882. Trudeau. This proved that the disease was contagious. 38 . The causes of the disease continued to be a mystery.of the population.
Koch made his historic discovery of the tuberculosis germ. Robert Koch was not a famous scientist with a large staff of assistants. Koch spent the rest of his life looking for a cure. He was a country doctor who worked by himself. With this simple setup. In 1905. but he did discover tuberculin. Koch solved one of the great medical mysteries of his time. After he found the cause of tuberculosis. the substance made from dead TB bacteria that is still used for tuberculosis tests today. Koch won the Nobel Prize for Medicine for his achievements. He did much of his early research in his living room.A Simple Country Doctor Before he announced his discovery. His lab equipment consisted of a microscope that his wife had given him as a birthday gift. This is the simple laboratory where Dr. . He never found it. where he stretched a sheet across the room to mark his homemade laboratory.
or heated. 40 . Doctors attempted all sorts of treatments for curing tuberculosis patients.Tuberculosis THE TWENTIETH CENTURY After Koch proved there was a tuberculosis germ. such as New York. Health regulations required that milk be pasteurized. governments passed laws and issued health regulations to keep people from catching it. let doctors peer inside a person’s lungs. The invention of the X-ray. Some cities. By the 1900s. Doctors sometimes had to remove a couple of ribs to get to the lungs. Doctors and researchers invented new tools to diagnose the disease. It became illegal to spit in public places in the United States. discovered in 1895. required TB victims to register with the city’s department of health so the government could keep track of them and prevent them from infecting others. Neither method was very effective. people continued to get TB. researchers developed the skin test for TB still used today. Another method was to crush something called the phrenic nerve. there was still no sign of a cure. This gave the lung time to rest and recover. some said. In 1908. It was a painful and complicated procedure. to kill the germs from infected cows. One drastic treatment was an operation in which surgeons collapsed an infected lung. Building codes required better ventilation to keep TB germs from lingering in crowded apartments. This paralyzed the diaphragm and supposedly helped infected lungs to relax. Despite these advances.
Finally. Doctors began injecting streptomycin into tuberculosis patients. more than seven hundred American hospitals specialized in TB treatment. in 1943. recovered in a matter 41 . doctors could look inside the body and detect lung damage. Microbiologist Dr.THE HISTORY OF TUBERCULOSIS Once the X-ray was invented. sixty-one years after Robert Koch discovered the TB bacterium. By the late 1930s. Selman Waxman at Rutgers University in New Jersey discovered a wonder drug called streptomycin. a twenty-one-year-old woman. The first person to get the drug. tuberculosis was the most common cause of death in the United States. researchers came up with a cure. At that time. This antibiotic stopped the growth of bacteria like MTB.
By 1985. In 1953. The victory was not that simple. The results were impressive. scientists came up with another antibiotic called isoniazid (INH). Antibiotics seemed to work miracles.Tuberculosis of weeks and went on to live a long. In the 1950s. Not every TB patient was cured. and some people appeared to recover but got the disease again. healthy life.000 cases of TB. In the years following.000. they devised other drugs that could kill various other kinds of TB bacteria. the United States had over 84. anti-tuberculosis drug streptomycin. After some experimentation. they could eliminate any kind of TB a person was likely A drug technician mixes large batches of the to have. The reason was that some types of TB were resistant to streptomycin. scientists discovered that by giving a person streptomycin with one or two other antibiotics. the lowest in 42 . The drug did not destroy all of the bacteria. that number dropped to a little over 22.
and there were significant numbers of prisoners with AIDS. began to get tuberculosis. doctors in New York City noticed something disturbing. Doctors faced a new TB epidemic for several reasons. not fewer people. blood transfusions. TB was an almost forgotten disease all over the world. The health minister of England announced that tuberculosis was practically eliminated in his country. By the early 1980s. These were the perfect places for TB to develop and spread. This disease is spread from person to person through sexual contact. weakens a victim’s immune system so that it has trouble fighting off the TB germ. Health officials started to see tuberculosis cases increasing in prisons. Health experts predicted that the disease would be wiped out by 2010 in the United States and all over the world by 2025. People with AIDS were at risk for catching TB as well. More infectious people were coming to the United States from countries where TB was both common and untreated.THE HISTORY OF TUBERCULOSIS recorded history. The organism responsible for AIDS. a form of TB that is resistant 43 . and sharing hypodermic needles among drug users. People were living in crowded conditions. More people. the human immunodeficiency virus (HIV). EPIDEMIC In the late 1980s. Another cause was AIDS. One was called multi drug-resistant (MDR) TB. New kinds of tuberculosis began to appear.
Experts renewed their attack on the disease. Newer. XDR-TB. By the early 1990s. to the two most powerful TB drugs. health officials realized TB had not gone away. They installed special isolation rooms in hospitals and prisons so they could keep infectious patients away from everyone else. The other TB type. isoniazid and rifampicin.Tuberculosis This health care worker in India uses one of the best weapons against tuberculosis: public education. They opened up special health clinics to treat TB patients. more powerful drugs did not always work on it. 44 . was an even tougher form.
someone is infected with TB Isolating patients in special wards helped germs every second. Once again we are starting to beat an old enemy. 45 .085 cases of TB. however.6 million people died from the disease in 2005. The strategy worked. mated 1. It remains a serious health problem in some parts of the world. The number of cases of tuberculosis in the United States began to shrink. the lowest it has been since 1953. By 2005 there were 14.767. According to the World Health Organization.THE HISTORY OF TUBERCULOSIS They carefully watched TB patients to make sure they took all their antibiotics. After the epidemic of the 1980s. and by 2006 the number had dropped to 13. Today TB is still not conquered. modern medicine is fighting back hard. An estikeep the disease from spreading.
Most of the people who get tuberculosis can be cured. Doctors sort patients with tuberculosis into two general groups: those who have latent TB and those who have active TB. Fortunately. he or she may be one of the lucky 90 percent of the people infected with TB who get the latent form. these methods work very well. He or she can live a long and healthy life. there is no single treatment. never suffer from the 46 . TREATING AND LIVING WITH TUBERCULOSIS B ecause there is more than one form of tuberculosis. Doctors have had to devise different ways of fighting the disease. LATENT Tuberculosis If tests show that a person is infected with MTB but has no symptoms of tuberculosis. Each group is treated with different medications.
TREATING AND LIVING WITH TUBERCULOSIS Isoniazid (lower left) is only one of the many drugs now used against the various kinds of tuberculosis. They take the medicine every day for at least six months. 47 . Someone with latent TB who has a healthy immune system does not have to worry about it. As a precaution. disease. a doctor may prescribe the drug isoniazid. patients with latent TB never have to do anything special after that. and never pass it on to anyone. Doctors usually give it to patients with latent TB. Except for checkups. however. INH is an antibiotic discovered in 1952.
The entire treatment period lasts six months. Experts estimate that one person with active TB who is not treated can spread the disease to as many as fifteen people in a year. Another problem occurs when a TB patient starts feeling better—usually after only about two weeks. not everyone does recover. ethambutol. 48 . they have to take a lot of pills—up to six per day. As people with infectious TB quickly learn. For the last four months. a four-drug combination works best. Still others may stop taking the drugs because they do not like the side effects—feeling tired or sick to their stomachs. There are two problems with stopping treatment too soon. rifampin.Tuberculosis ACTIVE TB Treatment is more complicated for people with active (infectious) TB. Patients take the antibiotics isoniazid. For the first two months. Some TB patients start to think they are cured. patients take all four drugs every day. and no single antibiotic can kill them all. and pyrazinamide. so they stop taking the drugs before the six-month deadline. but also for people around them. Active TB is potentially dangerous not only for the patients themselves. Treating an infectious person is a bit tricky. Usually people recover if they follow doctors’ orders. However. Different kinds of TB bacteria can infect people. they take only two of the drugs—isoniazid and rifampin—every day. For most people.
This is even 49 . This is when the disease turns into MDR-TB. Treatment of MDR-TB can last as long as two years. but the two most powerful TB medications—isonaizid and rifampin—are useless. In addition. Doctors have to use newer drugs. even this second group of drugs will not help a small number of patients. Patients with MDR-TB can still be cured. the remaining bacteria may become drug resistant—harder to kill with standard drugs. Second. They turn out to have what is called extensively drug-resistant TB (XDR-TB). a patient might get sick again.TREATING AND LIVING WITH TUBERCULOSIS Having a patient take all his medicine under the watchful eye of a health professional can prevent him from getting tuberculosis again. First. which are more expensive than older ones.
and health officials worried that he would infect others. He stopped wearing his face mask. They told him to wear a face mask when he was out in public. Daniels stopped taking the drugs too soon. . Daniels grew up in Arizona. Doctors diagnosed him with tuberculosis and gave him some medicine. Daniels became ill and started coughing up blood. but when he was older he decided to return to Russia. American doctors found that he had a more resistant kind of TB and gave him more powerful drugs. where he was born. Once again. Shortly thereafter. had an unusual and scary problem. Daniels returned to Phoenix. A young man named Robert Daniels showed up in their city with a highly infectious form of tuberculosis. Arizona. He did not take it for as long as they recommended because he began to feel better. public health officials in Phoenix. While living in Russia. They worried he might infect others with his dangerous type of TB. He began to feel sick again.Prisoner of Tuberculosis In 2006. They had him picked up and isolated him in a special unit for prisoners in a Phoenix hospital until he recovered from his disease. His tuberculosis changed into the more deadly XDR-TB.
This program is for high-risk patients. These patients need very special. very expensive drugs and may not be completely cured. sneeze. To make sure their patients take all their pills and do not develop the harder-to-cure types of tuberculosis.TREATING AND LIVING WITH TUBERCULOSIS more difficult to treat than MDR-TB. such as people with HIV. some hospitals and clinics have a program called directly observed therapy (DOT). WHAT IS A Tuberculosis PATIENT TO DO? It is crucial that people who have active TB follow their doctors’ treatment instructions. a health care worker sits with a tuberculosis patient every day and watches him or her take the prescribed pills. prisoners. In this program. homeless people. and people who have been careless about taking their drugs in the past. Patients are told to do the following: • • • • take all their medications for a prescribed period of time cover their mouths when they cough. This simple method has been very effective in helping people get better. or laugh use disposable tissues and throw them away in a closed bag air out their bedrooms as much as possible to keep the germs from getting concentrated in the room • avoid going to work or school for at least three weeks after they have begun taking their medication (after this period they should no longer be infectious) 51 .
Face masks help prevent patients and doctors from spreading tuberculosis germs.
Patients may have to do more than take drugs. Their doctors may require them to go to a hospital and stay in a special isolation room with special air vents to filter out the germs. Hospitals workers who treat these patients have to wear face masks to avoid catching the disease.
TREATING AND LIVING WITH TUBERCULOSIS
OLD ENEMY, NEW WEAPONS Tuberculosis has not been wiped out, as some experts predicted. After the epidemic of the 1980s, however, researchers have been fighting back with a new set of medical weapons and tactics. Keeping better track of TB cases helps stop the spread of the disease before it starts. And something as simple as watching a person take the proper TB medicine has made a huge difference in the disease’s cure rate. As result, the numbers of people who get infected continue to drop in developed countries like the United States. Doctors are now adopting some of the same tactics in less-developed areas such as South Africa, where TB is a bigger health problem. Today the World Health Organization says that eight out of ten people who are infected with TB can be cured. Researchers are also trying to improve on old remedies. For example, the diagnostic skin-prick test for tuberculosis has not changed much since the days of Robert Koch back in the 1880s. Today, researchers in New Jersey and California have developed a simpler and more accurate test. They put a sample of a person’s sputum in a test tube, treat it with certain chemicals, and put it under special lights. If they see certain colors, they know a person has a special drug-resistant TB. This test leads to a diagnosis in hours rather than weeks. Some of the standard drugs that have been used for years to
treat TB are not as effective against newer types of tuberculosis. Researchers are working to create more powerful ones. It is not easy. One group of researchers started with a list of more than 100,000 possible drugs. They narrowed the list down to seventy. After much experimentation, they shortened the drug list to twenty-six, then to six, and finally to one. The result of all this work is a drug that goes directly to the lungs, where TB germs live, and kills them quickly.
Looking at the enemy within, here is a microscopic sample of tuberculosis germs in lung fluid.
Many people think a vaccine will be the best way to fight tuberculosis. and it interferes with TB tests. 55 . Vaccines work by exposing the body’s immune system to a weak version of a disease. People who have had the vaccine sometimes mistakenly register positive for the disease when they are actually negative. for example. doctors have not used it in the United States because of its limitations. In addition. TB researchers hope to have a new vaccine against the disease. One reason TB bacteria are hard to destroy is that they have a tough. The BCG vaccine helps protect children from the kind of TB that attacks the brain. A TB vaccine already exists. This makes it easier for cells produced by the immune system to fight off and eliminate MTB. The body’s immune cells learn how to recognize those germs and fight them off before they have a chance to make someone sick. Although the vaccine has been used in Europe. The World Health Organization predicts that doctors will have a whole new group of more effective anti-tuberculosis drugs within decades. its effects wear off over time. it does not seem to work on adults.TREATING AND LIVING WITH TUBERCULOSIS Other drugs are even more specific. Albert Calmette and Camille Guérin. Now there is a new drug that keeps germs from building this coating. waxy coating. but it is old and does not work that well. but it doesn’t prevent the more common type that attacks the lungs. Two French scientists. It is called the BCG vaccine. By 2015. developed it in 1921.
more effective vaccine is the current dream of medical researchers. 56 .Tuberculosis A new.
In 2004. government researchers at the University of Colorado announced that they had been testing a TB vaccine in humans.TREATING AND LIVING WITH TUBERCULOSIS Scientists think they will have better vaccines soon. a doctor is working on a vaccine that a person administers as a nasal spray. U. At the University of Missouri.S. humans will have new. 57 . effective medical weapons to fight an old enemy. Once again.
extensively drug-resistant TB (XDR-TB)—A form of TB that cannot be treated with many of the common TB drugs.Tuberculosis Glossary active TB—The type of tuberculosis in which an infected person develops symptoms and can spread the disease to others. antibiotics—Medications that either kill bacteria or stop them from spreading. latent TB—A condition in which a person has the TB bacteria 58 . diagnosis—A doctor’s determination about the condition of a patient. alveoli—Tiny air sacs in the lungs where the body exchanges oxygen for carbon dioxide. immune system—The body’s natural defense against infectious diseases. bronchioles—Small tubes that transport air inside the lungs. contagious—Able to spread from one organism to another. diaphragm—A dome-shaped muscle that protects the lungs and aids in breathing. bacteria—One-celled organisms that can infect other organisms and make them sick. directly observed therapy (DOT)—A program by which a health care worker makes sure that tuberculosis patients take their medications. epidemic—A situation in which many people have the same illness simultaneously and are infecting each other.
something. mucus—A slimy substance produced in the nose and mouth to protect against harmful germs and viruses. lymph nodes—Bean-shaped masses of tissue near the neck. multi drug-resistant (MDR) TB—A form of active TB whose bacteria cannot be killed by two of the more powerful antiTB drugs. resistant—Unaffected by. collarbone. does not feel sick.Glossary but experiences no symptoms. lesions—Abnormalities. or immune to. tuberculin—A liquid containing a small amount of TB bacteria. and is not contagious. in an infected part of the body. Mycobacterium tuberculosis—The name of the organism that causes TB. macrophages—White blood cells that attack and swallow tuberculosis germs. and armpits. sputum—A slimy substance coughed up from deep in the lungs. or holes. trachea—The windpipe leading from the throat to the lungs. miliary tuberculosis—A dangerous form of TB in which the bacteria spread throughout the body and look like tiny seeds on X-rays. tubercule—A small swelling caused by immune system cells that trap tuberculosis bacteria. isoniazid and rifampsicin. such as wounds. scars. 59 .
NJ: Enslow Publishers. Tuberculosis. 2006. Geneva. World Health Organization. Yancey. MN. Diane. Global Tuberculosis Control: Surveillance. NY 10006 1-800-LUNG-USA (1-800-586-4872) www. The Tuberculosis Update. 2007. 6th Floor New York. Alvin and Virginia. Berkeley Heights.: Twenty-First Century Medical Books.Tuberculosis FIND OUT MORE Organizations The American Lung Association 61 Broadway. Financing. 60 .org Books Silverstein. Switzerland: World Health Organization. Minneapolis. 2006.lungusa. Planning.
nih.tballiance.gov/topics/tuberculosis/default.gov/tb/faqs/default.cdc.htm The TB Alliance www.gov/medlineplus/tuberculosis.org MedlinePlus: Tuberculosis www.virginia.nlm.htm University of Virginia Health System Health Sciences Library: Tuberculosis www.nih.int/mediacentre/factsheets/fs104/en/index.html 61 .edu/uvahealth/adult_infectious/ tuberc.find out more Web Sites Centers for Disease Control and Prevention (CDC) Questions and Answers about Tuberculosis www.html National Institute of Allergy and Infectious Diseases (National Institutes of Health): Tuberculosis www3.who.cfm World Health Organization: Tuberculosis www.healthsystem.niaid.
18 Calmette. 23. 38–39. 34. 12. Camille. 39. 52. 19. 21–22. 44. 16. 10. 38. 25. Robert. 15. 51. 28. 16. 43 children. 29 coughing. 13. 29. TB in. 29 babies. 49 Keats. 32 Koch. 43 Hunchback of Notre Dame. 45. 18. 47. 55 lymph nodes. 50. 22. 40 causes. 22. 33. 50 deaths. bacteria in. 14–15. 10. 53–55 Aristotle. 20 as TB symptom. 52 isoniazid (INH). 39. 26. 53 latent TB.Tuberculosis INDEX Page numbers in bold are illustrations. 53 drugs. 55 breathing. Robert. 10–11. 14 bronchioles. 10–11. 29–34. 55 Hippocrates. 44. 24–25. 11–15. 40. 18–21. 34. 46. See bacteria. 40 mucus. 7. 21–22 bronchial tubes. 42. 13. TB in. 38. 26–27. 12 blood vessels. 13–14. 33 king’s touch. 20. TB in. 53 extensively drug-resistant TB (XDR-TB). 41. 51. 36 lungs. 48. 48–49. 44. 8. 50. TB in. 43. 6–7. 54. 11. 15 alveoli. 28–29 Guérin. 21–23. 50 Daniels. 23. 9. 21. 23. 14. 40. 47. 40 directly observed therapy (DOT). 23 milk. 28–29 history. 20. 43. 21 bacteria. 30. 44. 41 fighting against. 20. 31. 30 consumption. 39. 10. 14. 54 discovery of. 10. 41 diaphragm. TB in. 52 germs. 26. 54. 43 epidemics. 27 Chile. 31. 14. 26 62 . 24. 21–22. 19–20. 23. 40 lesions. TB in. 46–47 laws. 28. 24. active TB. 44–45. 21 Mantoux tests. 32. 54–57 See also tuberculosis (TB) blood cells. 20. 15. 43 air sacs. 31. 11–15. John. 48–49. 47. 20–21. 49–51 face masks. 9. 53 miliary TB. 17–20. Albert. 32. 30. 41–42. 12. 48–51 AIDS (acquired immunodeficiency syndrome). 47. 28–45 HIV (human immunodeficiency virus). TB Greece. 33. 45. 14. 15 brain. 30. See antibiotics Egypt. 36. 23. 17 TB in. TB in. 28. 32 macrophages. 26 lungers. 49. 47. 18 antibiotics. 14. 7. 55 isolation rooms. 17–18. 45. 29 England. 14–15. 21. 35. 29 immune system. 19. 55 cattle. 39. TB. 10.
36–37. 53 vaccines. 13. 32 X-rays. 8. 45. 17 respiratory center. 11. 12 rifampicin/rifampin. 40. 25. 29 pleural membranes. TB in. 29–36. 55 olfactory cilia. 33. 44. 48. 32 skin tests. 20–21. 8. 23 tuberculosis (TB) catching. 23. 22–23. 10. TB. 15 prevention. 29. TB in. 52. 49. 55–57. Edward. 52 See also bacteria. 30 South Africa. 55–57 prisons. 10. 29 window tax. 17. 41 63 . 18. 43–44. 53 statistics. 36. 53 sternum. 39. 41–42. TB in. 40. 21–22. See bacteria. 53 spine. 18–20 white plague. 14 treatments. 32. 16. 11. 26 phrenic nerve. 18 streptomycin. 16–17. 10–11 diagnosing. 24–25. 34. 7. 14. 48. 35. 37. 26. 45. 25–26. 53. 46. 9. 45. 17–18 phlegm. 38 tubercle bacillus. 11. 44 Prosector’s wart. 17. 6–7. 29. 38. 31 United States. Selman. 31. and specific types of tuberculosis ultraviolet light. 16. 41. 20. 29 sputum. 40–55 Trudeau. 55 spreading. 40. 43 description of. Jean Antoine. 43. 42–43. 38 scrofula. 20. 49 sanatoriums.INDEX multi drug-resistant TB (MDR-TB). 21 tuberculin. 18. 34. 44. 29 pulmonary TB. 53 sneezing. 16–19. 24. 40. 23–27. bacteria in. 36–37. 50. 35 victims. 38 Waxman. 39 tuberculosis meningitis. 56 vampires. 14. 40 phthisis. 42–43. 41 white blood cells. 36 Villemin. 24 trachea. 40. 31. 41. 34. 36–38. 42 symptoms. 34. 29. 13 stomach acid. 51 Mycobacterium TB (MTB). 21. 7. TB tubercules. appearance of. 22 soil. 23.
.ABOUT THE AUTHOR Henry Wouk is a writer who lives in the Hudson Valley in New York. He has authored more than a dozen books on health and science and has written articles for a variety of magazines.
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