I remember as a child a mysterious plot of land near our home that had always intrigued me. It was a huge fenced in area with lots of trees and grass, and a few rather run down looking buildings. It sort of reminded me of a cemetery with no tombstones. I asked my father one day what it was, and he told me it was the old “TB sanitarium.” Even today, that image registers in my mind the impression that Tuberculosis is a relic of the past, long since cured and forgotten about. Unfortunately, that is the farthest thing from the truth. Tuberculosis is today one of the most common and deadly infectious diseases in the world. Let’s find out some more about it.
What is Tuberculosis?
Tuberculosis (TB) is a potentially fatal illness cause by a bacterial infection. It has the ability to affect almost any part of the body, but the vast majority of infections are found in the lungs. The culprit behind this disease is a bacterium called the tubercle bacillus or Mycobacterium tuberculosis.
TB has plagued human societies for thousands of years. Evidence of it has been discovered in Egyptian mummies, and in bones over 5000 years old. In 1882, a German physician named Robert Koch isolated the microorganism responsible for TB. He made this opportune discovery at a time when one out of every seven deaths in Europe was attributable to TB. Antibiotics had yet to be discovered, so the only known treatment at the time was to isolate patients in special hospitals or sanitariums with other TB victims. The illness spread even more rapidly in Europe during the industrial revolution when more people began living in crowded, unsanitary conditions. As immigrants poured into America and the living conditions deteriorated in the cities, TB got a foothold here too. By the beginning of the 20th century, TB infected 80% of Americans under the age of 20, and it was the leading cause of death. Sanitariums sprang up all over this country, and by 1938, there were over 700 of them here in the U.S. (like the one I mentioned in the introduction to this article).
Streptomycin, the first antibiotic effective against M. tuberculosis, was discovered in the early 1940s, and the infection began to subside. However, TB made a comeback, starting in the mid-1980s. This was thought to be the result of crowded and unsanitary conditions in many urban ghettos, homeless shelters, and prisons. The AIDS epidemic has also played a role. AIDS patients are much more susceptible to contracting TB than the general population, due to their compromised immune systems. TB has begun to decline in the U.S. in the last few years, but it is still a major national health problem. Approximately 10-15 million Americans are currently infected with TB, and it estimated that one million of these will eventually develop active TB.
Around the world, the situation is even worse. Approximately 8-10 million new cases are estimated to occur every year worldwide. 1-2 million people die each year from TB, and the World Health Organization predicts that these numbers will continue to climb. Approximately 2 billion people—33% of the world’s population—are currently infected with TB.
It’s important to make a distinction between those infected with TB, and those with active TB. There are many more people who carry the TB bacteria in their systems but are not actively sick and infectious. Those who simply have the TB infection have no symptoms, and are not contagious. Those with active TB are sick from the illness, and are also contagious and can spread TB to others.
What Are the Symptoms of Tuberculosis?
Most active TB is found in the lungs (pulmonary tuberculosis). The most common symptoms of active pulmonary TB include:
- A cough that produces discolored or bloody sputum, and lasts for 21 days or longer.
- Low-grade fever
- Night sweats
- Loss of appetite
- Unexpected weight loss
- Painful breathing or coughing spells (pleurisy: “inflammation of the pleura, a membrane of the lungs”)
TB can also settle in other parts of the body, including the central nervous system, spine (causing back pain), kidneys (blood in the urine), urinary tract, bones, joints, bone marrow and lymphatic system, and muscles.
Infants who are born to mothers that have active TB have a 50% chance of showing symptoms themselves during their first 12 months of life. Their symptoms may include:
- Poor feeding, leading to malnutrition.
- Failure to thrive.
- Swollen liver and spleen.
- Breathing difficulties.
What Complications Can Occur from Tuberculosis?
- If left untreated, pulmonary TB, the most common type, can progress to the point of causing permanent lung damage. The illness can migrate to other parts of the body as well, where it can literally affect almost any system or organ in the body. Without intervention, many of these additional infections can be life threatening.
- There are two particular complications that are especially dangerous:
- Meningeal TB: This is often found in elderly folks who have an outbreak of TB after carrying the dormant bacteria for many years. It may come on quickly with a high fever and severe headache. It can quickly lead to coma and death.
- Miliary TB: This is often a result of advanced pulmonary TB that spreads quickly throughout the body via the vascular system. This often affects AIDS patients and elderly folks with weakened immune systems.
- Both of the above are especially dangerous to children. Early diagnosis is critical, but is often difficult in kids. Even if they are sick, their symptoms are not as readily discernable as they are in adults.
- The most dangerous complication of TB is the emergence of drug-resistant strains. This is already happening, and experts expect it to continue. This is a huge ongoing problem for many bacterial diseases, as antibiotics have been over prescribed and they lose their effectiveness.
What Are the Risk Factors for Tuberculosis?
- TB is primarily spread through airborne droplets that are broadcast when an infected person coughs, sneezes, or talks. TB is infectious, but not as easily spread as some other infectious diseases. Generally, you must spend an extended amount of time with an infected person to catch TB. Thus, it is most often spread through family members, friends, or co-workers.
- Close contact with an infected individual who has active infectious TB.
- Nationality: People from certain parts of the world where TB is common are at a greater risk. These nations include Africa, Asia, the former Soviet Union, and Latin America.
- Race: In the U.S., Asian-Americans have the highest incidence. African-Americans, Native-Americans, and Hispanics have a higher risk than Caucasian-Americans.
- Gender: Men have a higher risk than women, in most parts of the world. Men are more likely to die from TB as well.
- Immune compromised: If you have a weakened immune system due to an illness such as AIDS or diabetes, your risk is greater. It is also greater if you are currently or have in the past undergone any cancer treatments such as chemotherapy.
- Age: The older you are, the greater your risk. This is because of a couple of main factors. First, our immune systems usually weaken as we age, making us more susceptible to infections of any kind. Secondly, many elderly folks live in group care homes where the chances of TB spreading are greater.
- Substance abuse: If you abuse drugs or alcohol, your immune system is weakened, and thus your risk is increased.
- Malnutrition: An unhealthy diet or one with too few calories can increase your risk of TB. This is a big problem in many third world countries.
- Poor medical care: Again, a common problem in many non-industrialized nations.
- Health care workers: If you are in the health care field, especially if you work around a lot of patients with TB, your risk is increased. Wearing protective gear and effective hand washing will help to reduce your risk.
- Correctional facility workers: Prisons, even modern ones, are a high-risk place to live or work, especially when it comes to contracting TB. They are often overcrowded and under ventilated, factors that contribute to the spread of TB.
- International travel: If you travel to other parts of the world, especially areas where TB is common, you are at increased risk.
What Treatments Are Available for Tuberculosis?
Medications are the cornerstone of modern treatment for TB. Despite the occurrence of drug-resistant strains, the best tool for fighting TB is still drug therapy. There are three main goals of the drug treatments:
- To lower the number of bacilli bacteria in the patients body as quickly as possible.
- To prevent the effects of drug resistance by initially treating with two or three different drugs at once.
- To initiate long-term treatment to avoid a relapse.
Hospitalization is rarely required these days, at least in this part of the world. Patients who are taking the medications usually cease to be infectious within two weeks. Follow up consists of monthly exams to monitor side effects and take sputum tests. Side effects are not common, but like with so many other pharmaceutical drugs, they can be serious. They are very hard on the liver, and they can produce flu-like symptoms.
A very creative and effective public health program was put into place in 1991 that has become a model for fighting common infectious diseases around the world. It is called “directly observed therapy short-course” or DOTS. It involves health care professionals visiting patients and administering their TB medication for them so that they don’t have to remember and implement the regimen themselves. Following this protocol has lead to an amazing 95% cure rate for TB, even in some of the poorest countries in the world. It also cuts down on the spread of drug-resistant strains, and is much more economical that hospitalizing patients or handing out meds that are not used properly. I would love to see more common sense approaches to health care such as these. Now all we have to do is come up with a cure for TB that doesn’t require the use of drugs with dangerous consequences.