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Tuberculosis

Tuberculosis, more commonly know as just “TB,” is a disease caused by a

bacterial microorganism called Mycobacterium tuberculosis. Tuberculosis is also

known as the white plague comparing it to the bubonic plague, also know as the

black plague. There have been cases recorded as far back as 4000 B.C. The

ancient Greeks and Romans described the disease as a consumption of one's

body. Active tuberculosis does just that, it consumes the organs of a infected

persons body beginning with the lungs. In more recent history it was discovered

the disease was caused by a microorganism. Robert Koch first discovered M.

tuberculosis in the 1880's in his observations of tuberculosis patients and work in

his laboratory. At that time in history the disease was believed to be hereditary

since if one member of a family got the disease then the rest would usually

succumb to the killer. Koch presented his findings to the scientific community in

March of 1882. Research intensified shortly after with the leading minds

theorizing the disease was mainly spread by saliva and sputum of an infected

individual. This led to public health campaigns against spitting in public and

spitting at all. Some locales issued ordnances making it illegal it spit in public. In

the 1960s airborne transmission of tuberculosis, by the air exhaled by infected

individuals, was scientifically confirmed by Richard Riley.

Today tuberculosis is still an active killer, responsible for two to three

million deaths worldwide every year, making it a leading cause of death right

beside HIV/AIDS. It is estimated that two billion of the world's six billion

population have a tuberculosis infection in its latent form. Eight million new

individuals are diagnosed each year with the active form of TB. People with
active cases, if not properly treated, can infect 10 to 15 people each year on

average, of those 5 to 10 percent will develop active TB at one time in their life

(NIAID 2005).

Tuberculosis is caused when M. tuberculosis is inhaled from the air. The

bacteria end up in the alveoli within the lungs. The immune system responds with

macrophages to engulf and devour the bacteria. After engulfing the bacteria

normally the macrophages release enzymes that will destroy the bacteria. M.

tuberculosis is able to counter these enzymes and prevent its own destruction.

Once inside the macrophages the bacteria quickly begin to reproduce until the

macrophage ruptures, releasing more M. tuberculosis into the body. At this time

the human body normally reacts with an increased immune response. Ninety

percentage of the population heals and recovers from the infection. Five percent

develop active TB infection and the remaining five percent develop latent TB.

Latent TB is when the bacteria go dormant, they may or may not be reactivated

by immune responses or stresses later in life.

In the active cases M. tuberculosis normally resides in the lungs because

it grows best in an oxygen rich environment. When the bacteria overcome the

human defenses and start to multiply quicker then they are killed, they begin to

infect the whole lung. Tubercles are formed around dead rotting tissue of the

spent immune cells and bacteria. The bacteria can then infect other parts of the

body by entering the blood stream. Tuberculosis can infect the kidney, muscles,

brain, lymph nodes; there are no organs that are safe from its attack. M.

tuberculosis can infect the spinal column causing it to collapse, lymph nodes
eventually breaking through the surface of the skin, or the larynx taking away the

voice. The body releases tumor necrosis factor, a hormone also called cachectin,

which effectively starves the human cells by interrupting lipid metabolism. This

leads to the look of the body being eroded away or consumed.

Tuberculosis is transmitted mainly through breathing the same air as an

infected contagious individual. The simple act of breathing can release some of

the bacteria into the air. Coughing and sneezing can release thousands of

droplets into the air each one can float around in the air for hours waiting for a

new victim. The exact amount of bacteria inhaled to cause tuberculosis has not

been determined , in most cases it takes prolonged exposure to infected air. The

susceptibility of a person to contracting the disease depends on how healthy the

individual inhaling the microbes is. Individuals that are immunocompromised by

HIV/AIDS or drugs are at a greater risk. Health care workers, high-risk racial or

ethnic populations, and illegal drug users are at a greater risk.

Symptoms of tuberculosis according to the Center for Disease Control and

Prevention (CDC) include; a bad cough that lasts 3 weeks or longer, pain in the

chest, and coughing up blood or sputum. These symptoms are caused by the

acute infection of the bacteria in the lungs causing the break down of tissue

within. On coughing the infected person coughs up some of the diseased tissue

or blood from the infection. Other symptoms listed are; weakness or fatigue,

unexplained weight loss, loss of appetite, chills, fever, and night sweats. The

CDC also recommends all individuals with HIV routinely get tested for

tuberculosis as well as individuals in high risk areas such as jails or homeless


shelters.

Treatment of tuberculosis historically was spending time at a sanatorium

in isolation from society. There patients were given a special diet and

environment to live that was thought to be beneficial. During the 1920s doctors

started to perform a procedure called a pneumothorax, in a collapse of an

infected lung in a vive to starve the bacteria of oxygen. This procedure was

preformed into the 1960s with sometimes partially removal of the infected lung.

After the advent of antibiotics, specifically streptomycin in 1944, there was a cure

for the disease. It was quickly found out that other antibiotics in combination

resulted in better treatment and recovery. Treatment today is usually a

combination of rifampicin and isoniazid over 6-12 months since M. tuberculosis is

a very tough bacteria to kill off (Markel 2004).. Recently new strains have formed

that are called Multi-drug resistant TB (MDR-TB), resistance to the two first line

drugs, and Extensively drug-resistant TB (XDR-TB), resistance to one or more

second line drugs as well as the first line drugs. This new strain is developed by

treated individuals not completing their full course of antibotics, mainly in

underdeveloped countries. In response the World Health Organization (WHO)

has recommended a program called Directly Observed Treatment Shortcourse

(DOTS). DOTS requires health care workers to monitor a patient over six to eight

months ensuring their daily dose is received. In the cases of drug resistant TB,

DOTSPlus is used which monitors the patient for 18-24 months taking up to

seven different medications daily. The WHO predicts the program will save ten

million lives in the next ten years (Markel 2004).


There is a vaccine available, Bacille Calmette-Guerin (BCG), that was

developed at the Pasteur Institute between 1905 and 1921 formulated from TB

infection in bovine. The effectiveness is variable (0-80%) and is lowest in areas

where M. tuberculosis is not very prevalent, with some trials showing no

protective effect. In the United States BCG is not recommended because the

amount of active infected individuals is too low for the vaccine to be effective.

The vaccine can also cause a positive reaction on the simple skin test used

widely throughout the United States. The vaccine is administered during infancy

and only protects through childhood. In some countries BCG is given several

times throughout childhood into early adulthood in an effort to maintain the

immunity (Colditz et al. 1994).

Some current research by Corixa and GlaxoSmithKline Biologicals

involves using recombinant tuberculosis vaccine by using recombinant DNA

technology to fuse two proteins with adjuvants to cause a strong immune

response. The proteins are modified from proteins that were identified in infected

individuals (NIAID 2004). Oxford University is backing, MVA85A , a vaccine

currently being tested in South Africa, based on a modified vaccinia virus Ankara.

It works by expressing an antigen from M. tuberculosis (Ibanga 2006).

Tuberculosis is a serious world epidemic affecting millions each year and

killing more than 2 million a year. Even with mankind's cutting edge technology

we will not be able to exterminate the disease until we can provide adequate

health care for the entire population of the world. In short tuberculosis is a

effective evolving killer that is hard to eradicate. Charles Dickens more elegantly
described tuberculosis: “a disease which medicine never cured, wealth warded

off, or poverty could boast exemption from—which sometimes moves in giant

strides, and sometimes at a tardy sluggish pace, but, slow or quick, is ever sure

and certain” (Dickens 1902).


Works Cited

Centers for Disease Control and Prevention (CDC).Trends in Tuberculosis, 2006


– United States [Internet]. CDC. 2007 [cited 14 Mar. 2008] Available from:
http://www.cdc.gov/tb/pubs/tbfactsheets/TBTrends.htm

Centers for Disease Control and Prevention (CDC). Tuberculosis: Learn the
Signs and Symptoms of TB Disease [Internet]. CDC. 2008. [cited 14 Mar.
2008] Available from:http://www.cdc.gov/Features/TBsymptoms

Colditz GA, Brewer TF, Berkey CS, et al. 1994. Efficacy of BCG Vaccine in the
Prevention of Tuberculosis. Journal of American Medical Association. 271:
698–702.

Dickens C. 1902. Nicholas Nickleby. New York (NY): Harper and Brothers. 460 p.

Ibanga HB, Brookes RH, Hill PC, et al. Early Clinical Trials with a New
Tuberculosis Vaccine, MVA85A, in Tuberculosis-Endemic Countries:
Issues in Study Design [Internet]. National Institutes of Health; 2006.
[cited 14 Mar. 2008] Available
from:http://www.ncbi.nlm.nih.gov/pubmed/16870530

National Institute of Allergy and Infectious Diseases (NIAID). First U.S.


Tuberculosis Vaccine Trial in 60 Years Begins [Internet]. National
Institutes of Health; 2004. [cited 14 Mar. 2008] Available from:
http://www.nih.gov/news/pr/jan2004/niaid-26.htm

National Institute of Allergy and Infectious Diseases (NIAID). A Killer Returns: the
Face of the Epidemic, Tuberculosis [Internet]. National Institutes of
Health; 2005. [cited 14 Mar. 2008]. Available from:
http://www3.niaid.nih.gov/topics/tuberculosis/Research/researchFeatures/
history/historical_killer.htm

Markel H. 2004.. When Germs Travel: Six Major Epidemics That Have Invaded
America Since 1900 and the Fears They Have Unleashed. New York
(NY): Pantheon Books. 263 p.

Shnayerson M, Plotkin MJ. 2002. The Killers Within: the Deadly Rise of Drug-
Resistant Bacteria. Boston (MA): Little, Brown and Company 328p..

Tierno PM. 2001. The secret life of germs: observations and lessons from a
microbe hunter. New York (NY): Pocket Books. 290 p.