[ Where resistance to isoniazid is high, ethambutol may be added for the last four months as an alternative.] Treatment with anti-TB drugs for at least 6 months results in higher success rates when compared with treatment less than 6 months, even though the difference is small. Shorter treatment regimen may be recommended for those with compliance issues. There is also no evidence to support shorter anti-tuberculosis treatment regimens when compared to a 6-month treatment regimen. However recently, results from an international, randomized, controlled clinical trial indicate that a four-month daily treatment regimen containing high-dose, or "optimized," rifapentine with moxifloxacin (2PHZM/2PHM) is as safe and effective as the existing standard six-month daily regimen at curing drug-susceptible tuberculosis (TB) disease.
Recurrent disease
If tuberculosis recurs, testing to determine which antibiotics it is sensitive to is important before determining treatment. If multiple drug-resistant TB (MDR-TB) is detected, treatment with at least four effective antibiotics for 18 to 24 months is recommended.
Medication administration
Directly observed therapy
Directly observed treatment, short-course (DOTS, also known as TB-DOTS) is the name given to the tuberculosis (TB) control strategy recommended by the World Health Organization. According to WHO, "The most cost-effective way to stop the spread of T ...
, i.e., having a health care provider watch the person take their medications, is recommended by the World Health Organization (WHO) in an effort to reduce the number of people not appropriately taking antibiotics. The evidence to support this practice over people simply taking their medications independently is of poor quality. There is no strong evidence indicating that directly observed therapy improves the number of people who were cured or the number of people who complete their medicine. Moderate quality evidence suggests that there is also no difference if people are observed at home versus at a clinic, or by a family member versus a health care worker. Methods to remind people of the importance of treatment and appointments may result in a small but important improvement. There is also not enough evidence to support intermittent rifampicin-containing therapy given two to three times a week has equal effectiveness as daily dose regimen on improving cure rates and reducing relapsing rates. There is also not enough evidence on effectiveness of giving intermittent twice or thrice weekly short course regimen compared to daily dosing regimen in treating children with tuberculosis.
Medication resistance
Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible MTB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication. Drug-resistant TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs. Totally drug-resistant TB is resistant to all currently used drugs. It was first observed in 2003 in Italy, but not widely reported until 2012, and has also been found in Iran and India. There is some efficacy for linezolid
Linezolid is an antibiotic used for the treatment of infections caused by Gram-positive bacteria that are resistant to other antibiotics. Linezolid is active against most Gram-positive bacteria that cause disease, including streptococci, van ...
to treat those with XDR-TB but side effects and discontinuation of medications were common. Bedaquiline
Bedaquiline, sold under the brand name Sirturo, is a medication used to treat active tuberculosis. Specifically, it is used to treat multi-drug-resistant tuberculosis (MDR-TB) along with other medications for tuberculosis. It is used by mouth.
...
is tentatively supported for use in multiple drug-resistant TB.
XDR-TB is a term sometimes used to define ''extensively resistant'' TB, and constitutes one in ten cases of MDR-TB. Cases of XDR TB have been identified in more than 90% of countries.
For those with known rifampicin or MDR-TB, molecular tests such as the Genotype® MTBDRsl Assay (performed on culture isolates or smear positive specimens) may be useful to detect second-line anti-tubercular drug resistance.
Prognosis
Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune system defenses and begin to multiply. In primary TB disease (some 1–5% of cases), this occurs soon after the initial infection.[ However, in the majority of cases, a ]latent infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
occurs with no obvious symptoms.[ These dormant bacilli produce active tuberculosis in 5–10% of these latent cases, often many years after infection.][
The risk of reactivation increases with ]immunosuppression
Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse react ...
, such as that caused by infection with HIV. In people coinfected with ''M. tuberculosis'' and HIV, the risk of reactivation increases to 10% per year.[ Studies using ]DNA fingerprinting
DNA profiling (also called DNA fingerprinting) is the process of determining an individual's DNA characteristics. DNA analysis intended to identify a species, rather than an individual, is called DNA barcoding.
DNA profiling is a forensic tec ...
of ''M. tuberculosis'' strains have shown reinfection contributes more substantially to recurrent TB than previously thought, with estimates that it might account for more than 50% of reactivated cases in areas where TB is common. The chance of death from a case of tuberculosis is about 4% , down from 8% in 1995.[
In people with smear-positive pulmonary TB (without HIV co-infection), after 5 years without treatment, 50-60% die while 20-25% achieve spontaneous resolution (cure). TB is almost always fatal in those with untreated HIV co-infection and death rates are increased even with antiretroviral treatment of HIV.
]
Epidemiology
Roughly one-quarter of the world's population has been infected with ''M. tuberculosis'',[ with new infections occurring in about 1% of the population each year.][ However, most infections with ''M. tuberculosis'' do not cause disease,] and 90–95% of infections remain asymptomatic.[ In 2012, an estimated 8.6 million chronic cases were active. In 2010, 8.8 million new cases of tuberculosis were diagnosed, and 1.20–1.45 million deaths occurred (most of these occurring in ]developing countries
A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
). Of these, about 0.35 million occur in those also infected with HIV. In 2018, tuberculosis was the leading cause of death worldwide from a single infectious agent. The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002.
Tuberculosis incidence is seasonal, with peaks occurring every spring and summer. The reasons for this are unclear, but may be related to vitamin D deficiency during the winter. There are also studies linking tuberculosis to different weather conditions like low temperature, low humidity and low rainfall. It has been suggested that tuberculosis incidence rates may be connected to climate change.
At-risk groups
Tuberculosis is closely linked to both overcrowding and malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues a ...
, making it one of the principal diseases of poverty
Diseases of poverty (also known as poverty-related diseases) are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one o ...
. Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients.
The rate of tuberculosis varies with age. In Africa, it primarily affects adolescents and young adults. However, in countries where incidence rates have declined dramatically (such as the United States), tuberculosis is mainly a disease of the elderly and immunocompromise
Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...
d (risk factors are listed above). Worldwide, 22 "high-burden" states or countries together experience 80% of cases as well as 83% of deaths.
In Canada and Australia, tuberculosis is many times more common among the aboriginal peoples
Indigenous peoples are culturally distinct ethnic groups whose members are directly descended from the earliest known inhabitants of a particular geographic region and, to some extent, maintain the language and culture of those original people ...
, especially in remote areas. Factors contributing to this include higher prevalence of predisposing health conditions and behaviours, and overcrowding and poverty. In some Canadian aboriginal groups, genetic susceptibility may play a role.
Socioeconomic status (SES) strongly affects TB risk. People of low SES are both more likely to contract TB and to be more severely affected by the disease. Those with low SES are more likely to be affected by risk factors for developing TB (e.g. malnutrition, indoor air pollution, HIV co-infection, etc.), and are additionally more likely to be exposed to crowded and poorly ventilated spaces. Inadequate healthcare also means that people with active disease who facilitate spread are not diagnosed and treated promptly; sick people thus remain in the infectious state and (continue to) spread the infection.
Geographical epidemiology
The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many African, Caribbean, South Asian, and eastern European countries test positive in tuberculin tests, while only 5–10% of the U.S. population test positive. Hopes of totally controlling the disease have been dramatically dampened because of many factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.
In developed countries, tuberculosis is less common and is found mainly in urban areas. In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research.
In 2010, rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139.
Russia
Russia has achieved particularly dramatic progress with a decline in its TB mortality rate—from 61.9 per 100,000 in 1965 to 2.7 per 100,000 in 1993;[Global Tuberculosis Control]
, World Health Organization, 2011. however, mortality rate increased to 24 per 100,000 in 2005 and then recoiled to 11 per 100,000 by 2015.
China
China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010.[ The number of new cases has declined by 17% between 2004 and 2014.]
Africa
In 2007, the country with the highest estimated incidence rate of TB was Eswatini
Eswatini ( ; ss, eSwatini ), officially the Kingdom of Eswatini and formerly named Swaziland ( ; officially renamed in 2018), is a landlocked country in Southern Africa. It is bordered by Mozambique to its northeast and South Africa to its no ...
, with 1,200 cases per 100,000 people. In 2017, the country with the highest estimated incidence rate
In epidemiology, incidence is a measure of the probability of occurrence of a given medical condition in a population within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time peri ...
as a % of the population was Lesotho
Lesotho ( ), officially the Kingdom of Lesotho, is a country landlocked country, landlocked as an Enclave and exclave, enclave in South Africa. It is situated in the Maloti Mountains and contains the Thabana Ntlenyana, highest mountains in Sou ...
, with 665 cases per 100,000 people.
India
As of 2017, India had the largest total incidence, with an estimated 2,740,000 cases. According to the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO), in 2000–2015, India's estimated mortality rate dropped from 55 to 36 per 100,000 population per year with estimated 480 thousand people died of TB in 2015. In India a major proportion of tuberculosis patients are being treated by private partners and private hospitals. Evidence indicates that the tuberculosis national survey does not represent the number of cases that are diagnosed and recorded by private clinics and hospitals in India.
North America
In the United States Native Americans have a fivefold greater mortality from TB, and racial and ethnic minorities accounted for 84% of all reported TB cases.
In the United States, the overall tuberculosis case rate was 3 per 100,000 persons in 2017. In Canada, tuberculosis is still endemic in some rural areas.
Western Europe
In 2017, in the United Kingdom, the national average was 9 per 100,000 and the highest incidence rates in Western Europe
Western Europe is the western region of Europe. The region's countries and territories vary depending on context.
The concept of "the West" appeared in Europe in juxtaposition to "the East" and originally applied to the ancient Mediterranean ...
were 20 per 100,000 in Portugal.
File:Tuberculosis incidence (per 100,000 people), OWID.svg, Number of new cases of tuberculosis per 100,000 people in 2016.
File:Tuberculosis world map-Deaths per million persons-WHO2012.svg, Tuberculosis deaths per million persons in 2012
File:Tuberculosis deaths by region, OWID.svg, Tuberculosis deaths by region, 1990 to 2017.
History
Tuberculosis has existed since antiquity.[ The oldest unambiguously detected ''M. tuberculosis'' gives evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago. However, whether tuberculosis originated in bovines, then transferred to humans, or whether both bovine and human tuberculosis diverged from a common ancestor, remains unclear. A comparison of the ]gene
In biology, the word gene (from , ; "...Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a ba ...
s of ''M. tuberculosis'' complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as researchers previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans even before the Neolithic Revolution
The Neolithic Revolution, or the (First) Agricultural Revolution, was the wide-scale transition of many human cultures during the Neolithic period from a lifestyle of hunting and gathering to one of agriculture and settlement, making an incre ...
. Skeletal remains show some prehistoric humans (4000 BC) had TB, and researchers have found tubercular decay in the spines of Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
ian mummies
A mummy is a dead human or an animal whose soft tissues and organs have been preserved by either intentional or accidental exposure to chemicals, extreme cold, very low humidity, or lack of air, so that the recovered body does not decay furth ...
dating from 3000 to 2400 BC. Genetic studies suggest the presence of TB in the Americas
The Americas, which are sometimes collectively called America, are a landmass comprising the totality of North America, North and South America. The Americas make up most of the land in Earth's Western Hemisphere and comprise the New World. ...
from about AD 100.
Before the Industrial Revolution
The Industrial Revolution was the transition to new manufacturing processes in Great Britain, continental Europe, and the United States, that occurred during the period from around 1760 to about 1820–1840. This transition included going f ...
, folklore often associated tuberculosis with vampire
A vampire is a mythical creature that subsists by feeding on the Vitalism, vital essence (generally in the form of blood) of the living. In European folklore, vampires are undead, undead creatures that often visited loved ones and caused mi ...
s. When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members.
Although Richard Morton established the pulmonary form associated with tubercles
In anatomy, a tubercle (literally 'small tuber', Latin for 'lump') is any round nodule, small eminence, or warty outgrowth found on external or internal organs of a plant or an animal.
In plants
A tubercle is generally a wart-like projection ...
as a pathology in 1689, due to the variety of its symptoms, TB was not identified as a single disease until the 1820s. Benjamin Marten
Benjamin Marten (c.1690–1752) was an English physician from "Theobald's Row" near Red Lyon Square, Holborn, and one of several sons of a tailor.
In 1720 he conjectured in ''"A New Theory of Consumptions - More Especially a Phthisis or Consump ...
conjectured in 1720 that consumptions were caused by microbes which were spread by people living close to each other. In 1819, René Laennec
René-Théophile-Hyacinthe Laennec (; 17 February 1781 – 13 August 1826) was a French physician and musician. His skill at carving his own wooden flutes led him to invent the stethoscope in 1816, while working at the Hôpital Necker ...
claimed that tubercles were the cause of pulmonary tuberculosis. J. L. Schönlein first published the name "tuberculosis" (German: ''Tuberkulose'') in 1832. Between 1838 and 1845, John Croghan, the owner of Mammoth Cave
Mammoth Cave National Park is an American national park in west-central Kentucky, encompassing portions of Mammoth Cave, the longest cave system known in the world.
Since the 1972 unification of Mammoth Cave with the even-longer system under F ...
in Kentucky from 1839 onwards, brought a number of people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year. Hermann Brehmer opened the first TB sanatorium
A sanatorium (from Latin '' sānāre'' 'to heal, make healthy'), also sanitarium or sanitorium, are antiquated names for specialised hospitals, for the treatment of specific diseases, related ailments and convalescence. Sanatoriums are often ...
in 1859 in Görbersdorf (now Sokołowsko
Sokołowsko (german: Görbersdorf) is a village and traditional climatic health resort in Gmina Mieroszów, within Wałbrzych County, Lower Silesian Voivodeship, in south-western Poland. First information about Goerbersdorff appears in 1357,as a ...
) in Silesia
Silesia (, also , ) is a historical region of Central Europe that lies mostly within Poland, with small parts in the Czech Republic and Germany. Its area is approximately , and the population is estimated at around 8,000,000. Silesia is split ...
. In 1865, Jean Antoine Villemin
Jean-Antoine Villemin (January 28, 1827 – October 6, 1892) was a French physician born in Prey, Vosges. In 1865 he demonstrated that tuberculosis was an infectious disease.
Biography
Villemin was born in the department of Vosges, and studie ...
demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals. (Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson
Sir John Scott Burdon-Sanderson, 1st Baronet, FRS, HFRSE D.Sc. (21 December 182823 November 1905) was an English physiologist born near Newcastle upon Tyne, and a member of a well known Northumbrian family.
Biography
He was born at Jesmond ...
.)
Robert Koch
Heinrich Hermann Robert Koch ( , ; 11 December 1843 – 27 May 1910) was a German physician and microbiologist. As the discoverer of the specific causative agents of deadly infectious diseases including tuberculosis, cholera (though the Vibrio ...
identified and described the bacillus causing tuberculosis, ''M. tuberculosis'', on 24 March 1882. In 1905, he was awarded the Nobel Prize in Physiology or Medicine
The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accord ...
for this discovery. Koch did not believe the cattle and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the pasteurization
Pasteurization or pasteurisation is a process of food preservation in which packaged and non-packaged foods (such as milk and fruit juices) are treated with mild heat, usually to less than , to eliminate pathogens and extend shelf life.
The ...
process. Koch announced a glycerine
Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids known ...
extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". Although it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. World Tuberculosis Day
World Tuberculosis Day, observed on 24 March each year, is designed to build public awareness about the global epidemic of tuberculosis (TB) and efforts to eliminate the disease. In 2018, 10 million people fell ill with TB, and 1.5 million die ...
is marked on 24 March each year, the anniversary of Koch's original scientific announcement.
Albert Calmette
Léon Charles Albert Calmette ForMemRS (12 July 1863 – 29 October 1933) was a French physician, bacteriologist and immunologist, and an important officer of the Pasteur Institute. He discovered the Bacillus Calmette-Guérin, an attenuated for ...
and Camille Guérin
Jean-Marie Camille Guérin (; 22 December 1872 – 9 June 1961) was a French veterinarian, bacteriologist and immunologist who, together with Albert Calmette, developed the Bacillus Calmette-Guérin (BCG), a vaccine for immunization against tube ...
achieved the first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called bacille Calmette–Guérin (BCG). The BCG vaccine was first used on humans in 1921 in France, but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II.
Tuberculosis caused widespread public concern in the 19th and early 20th centuries as the disease became common among the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, TB still caused one in six deaths in France. After TB was determined to be contagious, in the 1880s, it was put on a notifiable-disease list in Britain; campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria
A sanatorium (from Latin '' sānāre'' 'to heal, make healthy'), also sanitarium or sanitorium, are antiquated names for specialised hospitals, for the treatment of specific diseases, related ailments and convalescence. Sanatoriums are often ...
that resembled prisons (the sanatoria for the middle and upper classes offered excellent care and constant medical attention).[ Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years ( 1916).][ When the Medical Research Council formed in Britain in 1913, it initially focused on tuberculosis research.
In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths. In the 18th and 19th century, tuberculosis had become epidemic in Europe, showing a seasonal pattern.] By the 1950s mortality in Europe had decreased about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before the arrival of streptomycin
Streptomycin is an antibiotic medication used to treat a number of bacterial infections, including tuberculosis, ''Mycobacterium avium'' complex, endocarditis, brucellosis, ''Burkholderia'' infection, plague, tularemia, and rat bite fever. Fo ...
and other antibiotics, although the disease remained a significant threat.[ In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Prior to the introduction of this medication, the only treatment was surgical intervention, including the "]pneumothorax
A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve ...
technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal.
In India, tuberculosis prevalence was first investigated by Dr. Arthur Colborne Lankester
Arthur is a common male given name of Brythonic origin. Its popularity derives from it being the name of the legendary hero King Arthur. The etymology is disputed. It may derive from the Celtic ''Artos'' meaning “Bear”. Another theory, more ...
, an English medical missionary and physician. He was selected by the government to undertake the study for one year and collaborate with all the provincial governments of India to expand the reach of the research. He eventually published a book titled ''Tuberculosis in India.''
'
Because of the emergence of multidrug-resistant tuberculosis (MDR-TB), surgery has been re-introduced for certain cases of TB infections. It involves the removal of infected chest cavities ("bullae") in the lungs to reduce the number of bacteria and to increase exposure of the remaining bacteria to antibiotics in the bloodstream. Hopes of eliminating TB ended with the rise of drug-resistant strains in the 1980s. The subsequent resurgence of tuberculosis resulted in the declaration of a global health emergency by the World Health Organization (WHO) in 1993.
Society and culture
Names
Tuberculosis has been known by many names from the technical to the familiar.[ () is a Greek word for consumption, an old term for pulmonary tuberculosis;][ around 460 BCE, ]Hippocrates
Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
described phthisis as a disease of dry seasons. The abbreviation ''TB'' is short for ''tubercle bacillus
''Bacillus'' (Latin "stick") is a genus of Gram-positive, rod-shaped bacteria, a member of the phylum ''Bacillota'', with 266 named species. The term is also used to describe the shape (rod) of other so-shaped bacteria; and the plural ''Bacilli ...
''. ''Consumption'' was the most common nineteenth century English word for the disease. The Latin root meaning 'completely' is linked to meaning 'to take up from under'. In ''The Life and Death of Mr Badman
''The Life and Death of Mr. Badman: An Analysis of a Wicked Man's Life, as a Warning For Others, Presented to the World in a Familiar Dialogue Between Mr. Wiseman and Mr. Attentive'' is a 1680 book by John Bunyan. It was designed as a companion to ...
'' by John Bunyan
John Bunyan (; baptised 30 November 162831 August 1688) was an English writer and Puritan preacher best remembered as the author of the Christian allegory ''The Pilgrim's Progress,'' which also became an influential literary model. In addition ...
, the author calls consumption "the captain of all these men of death." "Great white plague" has also been used.[
]
Art and literature
Tuberculosis was for centuries associated with poet
A poet is a person who studies and creates poetry. Poets may describe themselves as such or be described as such by others. A poet may simply be the creator ( thinker, songwriter, writer, or author) who creates (composes) poems (oral or writte ...
ic and art
Art is a diverse range of human activity, and resulting product, that involves creative or imaginative talent expressive of technical proficiency, beauty, emotional power, or conceptual ideas.
There is no generally agreed definition of wha ...
istic qualities among those infected, and was also known as "the romantic disease". Major artistic figures such as the poets John Keats
John Keats (31 October 1795 – 23 February 1821) was an English poet of the second generation of Romantic poets, with Lord Byron and Percy Bysshe Shelley. His poems had been in publication for less than four years when he died of tuberculo ...
, Percy Bysshe Shelley
Percy Bysshe Shelley ( ; 4 August 17928 July 1822) was one of the major English Romantic poets. A radical in his poetry as well as in his political and social views, Shelley did not achieve fame during his lifetime, but recognition of his achie ...
, and Edgar Allan Poe
Edgar Allan Poe (; Edgar Poe; January 19, 1809 – October 7, 1849) was an American writer, poet, editor, and literary critic. Poe is best known for his poetry and short stories, particularly his tales of mystery and the macabre. He is wide ...
, the composer Frédéric Chopin
Frédéric François Chopin (born Fryderyk Franciszek Chopin; 1 March 181017 October 1849) was a Polish composer and virtuoso pianist of the Romantic period, who wrote primarily for solo piano. He has maintained worldwide renown as a leadin ...
, the playwright Anton Chekhov
Anton Pavlovich Chekhov (; 29 January 1860 Old Style date 17 January. – 15 July 1904 Old Style date 2 July.) was a Russian playwright and short-story writer who is considered to be one of the greatest writers of all time. His career ...
, the novelists Franz Kafka
Franz Kafka (3 July 1883 – 3 June 1924) was a German-speaking Bohemian novelist and short-story writer, widely regarded as one of the major figures of 20th-century literature. His work fuses elements of realism and the fantastic. It ...
, Katherine Mansfield
Kathleen Mansfield Murry (née Beauchamp; 14 October 1888 – 9 January 1923) was a New Zealand writer, essayist and journalist, widely considered one of the most influential and important authors of the modernist movement. Her works are celebra ...
, Charlotte Brontë
Charlotte Brontë (, commonly ; 21 April 1816 – 31 March 1855) was an English novelist and poet, the eldest of the three Brontë sisters who survived into adulthood and whose novels became classics of English literature.
She enlisted i ...
, Fyodor Dostoevsky
Fyodor Mikhailovich Dostoevsky (, ; rus, Фёдор Михайлович Достоевский, Fyódor Mikháylovich Dostoyévskiy, p=ˈfʲɵdər mʲɪˈxajləvʲɪdʑ dəstɐˈjefskʲɪj, a=ru-Dostoevsky.ogg, links=yes; 11 November 18219 ...
, Thomas Mann
Paul Thomas Mann ( , ; ; 6 June 1875 – 12 August 1955) was a German novelist, short story writer, social critic, philanthropist, essayist, and the 1929 Nobel Prize in Literature laureate. His highly symbolic and ironic epic novels and novella ...
, W. Somerset Maugham
William Somerset Maugham ( ; 25 January 1874 – 16 December 1965) was an English writer, known for his plays, novels and short stories. Born in Paris, where he spent his first ten years, Maugham was schooled in England and went to a German un ...
, George Orwell
Eric Arthur Blair (25 June 1903 – 21 January 1950), better known by his pen name George Orwell, was an English novelist, essayist, journalist, and critic. His work is characterised by lucid prose, social criticism, opposition to totalitar ...
, and Robert Louis Stevenson
Robert Louis Stevenson (born Robert Lewis Balfour Stevenson; 13 November 1850 – 3 December 1894) was a Scottish novelist, essayist, poet and travel writer. He is best known for works such as ''Treasure Island'', ''Strange Case of Dr Jekyll a ...
, and the artists Alice Neel, Jean-Antoine Watteau, Elizabeth Siddal
Elizabeth Eleanor Siddall (25 July 1829 – 11 February 1862), better known as Elizabeth Siddal, was an English artist, poet, and artists' model. Significant collections of her artworks can be found at Wightwick Manor and the Ashmolean. Siddal ...
, Marie Bashkirtseff
Marie Bashkirtseff (born Mariya Konstantinovna Bashkirtseva, russian: Мария Константиновна Башки́рцева; 1858–1884) was a Ukrainian artist from the Russian Empire who worked in Paris, France. She died aged 25.
Li ...
, Edvard Munch
Edvard Munch ( , ; 12 December 1863 – 23 January 1944) was a Norwegian painter. His best known work, ''The Scream'' (1893), has become one of Western art's most iconic images.
His childhood was overshadowed by illness, bereavement and the dr ...
, Aubrey Beardsley
Aubrey Vincent Beardsley (21 August 187216 March 1898) was an English illustrator and author. His black ink drawings were influenced by Woodblock printing in Japan, Japanese woodcuts, and depicted the grotesque, the decadent, and the erotic. He ...
and Amedeo Modigliani
Amedeo Clemente Modigliani (, ; 12 July 1884 – 24 January 1920) was an Italian painter and sculptor who worked mainly in France. He is known for portraits and nudes in a modern style characterized by a surreal elongation of faces, necks, and ...
either had the disease or were surrounded by people who did. A widespread belief was that tuberculosis assisted artistic talent. Physical mechanisms proposed for this effect included the slight fever and toxaemia that it caused, allegedly helping them to see life more clearly and to act decisively.
Tuberculosis formed an often-reused theme in literature
Literature is any collection of written work, but it is also used more narrowly for writings specifically considered to be an art form, especially prose fiction, drama, and poetry. In recent centuries, the definition has expanded to include ...
, as in Thomas Mann
Paul Thomas Mann ( , ; ; 6 June 1875 – 12 August 1955) was a German novelist, short story writer, social critic, philanthropist, essayist, and the 1929 Nobel Prize in Literature laureate. His highly symbolic and ironic epic novels and novella ...
's ''The Magic Mountain
''The Magic Mountain'' (german: Der Zauberberg, links=no, ) is a novel by Thomas Mann, first published in German in November 1924. It is widely considered to be one of the most influential works of twentieth-century German literature.
Mann st ...
'', set in a sanatorium
A sanatorium (from Latin '' sānāre'' 'to heal, make healthy'), also sanitarium or sanitorium, are antiquated names for specialised hospitals, for the treatment of specific diseases, related ailments and convalescence. Sanatoriums are often ...
; in music
Music is generally defined as the art of arranging sound to create some combination of form, harmony, melody, rhythm or otherwise expressive content. Exact definitions of music vary considerably around the world, though it is an aspect ...
, as in Van Morrison
Sir George Ivan Morrison (born 31 August 1945), known professionally as Van Morrison, is a Northern Irish singer-songwriter and multi-instrumentalist whose recording career spans seven decades. He has won two Grammy Awards.
As a teenager in t ...
's song "T.B. Sheets
"T.B. Sheets" is a blues-influenced song written and recorded by Northern Irish singer-songwriter Van Morrison. Bang Records issued the song on his first solo album, '' Blowin' Your Mind!'' (1967). It later appeared on the Bang compilation '' T.B. ...
"; in opera
Opera is a form of theatre in which music is a fundamental component and dramatic roles are taken by singers. Such a "work" (the literal translation of the Italian word "opera") is typically a collaboration between a composer and a librett ...
, as in Puccini
Giacomo Puccini ( Lucca, 22 December 1858Bruxelles, 29 November 1924) was an Italian composer known primarily for his operas. Regarded as the greatest and most successful proponent of Italian opera after Verdi, he was descended from a long ...
's ''La bohème
''La bohème'' (; ) is an opera in four acts,Puccini called the divisions ''quadri'', ''tableaux'' or "images", rather than ''atti'' (acts). composed by Giacomo Puccini between 1893 and 1895 to an Italian libretto by Luigi Illica and Giuseppe G ...
'' and Verdi
Giuseppe Fortunino Francesco Verdi (; 9 or 10 October 1813 – 27 January 1901) was an Italian composer best known for his operas. He was born near Busseto to a provincial family of moderate means, receiving a musical education with the h ...
's ''La Traviata
''La traviata'' (; ''The Fallen Woman'') is an opera in three acts by Giuseppe Verdi set to an Italian libretto by Francesco Maria Piave. It is based on ''La Dame aux camélias'' (1852), a play by Alexandre Dumas ''fils'' adapted from his own 18 ...
''; in art
Art is a diverse range of human activity, and resulting product, that involves creative or imaginative talent expressive of technical proficiency, beauty, emotional power, or conceptual ideas.
There is no generally agreed definition of wha ...
, as in Monet
Oscar-Claude Monet (, , ; 14 November 1840 – 5 December 1926) was a French painter and founder of impressionist painting who is seen as a key precursor to modernism, especially in his attempts to paint nature as he perceived it. During ...
's painting of his first wife Camille on her deathbed; and in film
A film also called a movie, motion picture, moving picture, picture, photoplay or (slang) flick is a work of visual art that simulates experiences and otherwise communicates ideas, stories, perceptions, feelings, beauty, or atmosphere ...
, such as the 1945 ''The Bells of St. Mary's
''The Bells of St. Mary's'' (1945) is an American musical comedy-drama film, produced and directed by Leo McCarey and starring Bing Crosby and Ingrid Bergman. Written by Dudley Nichols and based on a story by McCarey, the film is about a priest ...
'' starring Ingrid Bergman
Ingrid Bergman (29 August 191529 August 1982) was a Swedish actress who starred in a variety of European and American films, television movies, and plays.Obituary ''Variety'', 1 September 1982. With a career spanning five decades, she is often ...
as a nun with tuberculosis.
Public health efforts
In 2014, the WHO adopted the "End TB" strategy which aims to reduce TB incidence by 80% and TB deaths by 90% by 2030. The strategy contains a milestone to reduce TB incidence by 20% and TB deaths by 35% by 2020. However, by 2020 only a 9% reduction in incidence per population was achieved globally, with the European region achieving 19% and the African region achieving 16% reductions. Similarly, the number of deaths only fell by 14%, missing the 2020 milestone of a 35% reduction, with some regions making better progress (31% reduction in Europe and 19% in Africa). Correspondingly, also treatment, prevention and funding milestones were missed in 2020, for example only 6.3 million people were started on TB prevention short of the target of 30 million.
The World Health Organization (WHO), the Bill and Melinda Gates Foundation
The Bill & Melinda Gates Foundation (BMGF), a merging of the William H. Gates Foundation and the Gates Learning Foundation, is an American private foundation founded by Bill Gates and Melinda French Gates. Based in Seattle, Washington, it was ...
, and the U.S. government are subsidizing a fast-acting diagnostic tuberculosis test for use in low- and middle-income countries as of 2012. In addition to being fast-acting, the test can determine if there is resistance to the antibiotic rifampicin which may indicate multi-drug resistant tuberculosis and is accurate in those who are also infected with HIV. Many resource-poor places have access to only sputum microscopy.
India had the highest total number of TB cases worldwide in 2010, in part due to poor disease management within the private and public health care sector. Programs such as the Revised National Tuberculosis Control Program
The National Tuberculosis Elimination Program (NTEP) is the Public Health initiative of the Government of India that organizes its anti-Tuberculosis efforts. It functions as a flagship component of the National Health Mission (NHM) and provides ...
are working to reduce TB levels among people receiving public health care.
A 2014 EIU-healthcare report finds there is a need to address apathy and urges for increased funding. The report cites among others Lucica Ditui " Bis like an orphan. It has been neglected even in countries with a high burden and often forgotten by donors and those investing in health interventions."
Slow progress has led to frustration, expressed by the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria
The Global Fund to Fight AIDS, Tuberculosis and Malaria (or simply the Global Fund) is an international financing and partnership organization that aims to "attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, t ...
– Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it." Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government as of 2014, although adherence is often variable. Commercial treatment providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations. The government of Brazil provides universal TB care, which reduces this problem. Conversely, falling rates of TB infection may not relate to the number of programs directed at reducing infection rates but may be tied to an increased level of education, income, and health of the population. Costs of the disease, as calculated by the World Bank
The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Interna ...
in 2009 may exceed US$150 billion per year in "high burden" countries. Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250 million rural migrants in China.
There is insufficient data to show that active contact tracing helps to improve case detection rates for tuberculosis. Interventions such as house-to-house visits, educational leaflets, mass media strategies, educational sessions may increase tuberculosis detection rates in short-term. There is no study that compares new methods of contact tracing such as social network analysis with existing contact tracing methods.
Stigma
Slow progress in preventing the disease may in part be due to stigma associated with TB. Stigma may be due to the fear of transmission from affected individuals. This stigma may additionally arise due to links between TB and poverty, and in Africa, AIDS. Such stigmatization may be both real and perceived; for example, in Ghana, individuals with TB are banned from attending public gatherings.
Stigma towards TB may result in delays in seeking treatment, lower treatment compliance, and family members keeping cause of death secret – allowing the disease to spread further. In contrast, in Russia stigma was associated with increased treatment compliance. TB stigma also affects socially marginalized individuals to a greater degree and varies between regions.
One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling. Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence. Despite this, studies on the relationship between reduced stigma and mortality are lacking , and similar efforts to decrease stigma surrounding AIDS have been minimally effective. Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable. A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.
Research
The BCG vaccine has limitations, and research to develop new TB vaccines is ongoing. A number of potential candidates are currently in phase I and II clinical trials.[ Two main approaches are used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines.][ ]MVA85A MVA85A (modified vaccinia Ankara 85A) is a vaccine against tuberculosis developed by researchers led by Professor Helen McShane at Oxford University. This vaccine produces higher levels of long-lasting cellular immunity when used together with the o ...
, an example of a subunit vaccine, is in trials in South Africa as of 2006, is based on a genetically modified vaccinia
''Vaccinia virus'' (VACV or VV) is a large, complex, enveloped virus belonging to the poxvirus family. It has a linear, double-stranded DNA genome approximately 190 kbp in length, which encodes approximately 250 genes. The dimensions of the ...
virus. Vaccines are hoped to play a significant role in treatment of both latent and active disease.
To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development as of 2006, including prizes, tax incentives, and advance market commitments
An advance market commitment (AMC) is a binding contract, typically offered by a government or other financial entity, used to guarantee a viable market for a product once it is successfully developed. Generally AMCs are used in circumstances wher ...
. A number of groups, including the Stop TB Partnership, the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research. Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280 million (US) from the Bill and Melinda Gates Foundation
The Bill & Melinda Gates Foundation (BMGF), a merging of the William H. Gates Foundation and the Gates Learning Foundation, is an American private foundation founded by Bill Gates and Melinda French Gates. Based in Seattle, Washington, it was ...
to develop and license an improved vaccine against tuberculosis for use in high burden countries.
A number of medications are being studied as of 2012 for multidrug-resistant tuberculosis, including bedaquiline
Bedaquiline, sold under the brand name Sirturo, is a medication used to treat active tuberculosis. Specifically, it is used to treat multi-drug-resistant tuberculosis (MDR-TB) along with other medications for tuberculosis. It is used by mouth.
...
and delamanid
Delamanid, sold under the brand name Deltyba, is a medication used to treat tuberculosis. Specifically it is used, along with other antituberculosis medications, for active multidrug-resistant tuberculosis. It is taken by mouth.
Common side effe ...
. Bedaquiline received U.S. Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) approval in late 2012. The safety and effectiveness of these new agents are uncertain as of 2012, because they are based on the results of relatively small studies. However, existing data suggest that patients taking bedaquiline in addition to standard TB therapy are five times more likely to die than those without the new drug, which has resulted in medical journal articles raising health policy questions about why the FDA approved the drug and whether financial ties to the company making bedaquiline influenced physicians' support for its use.
Steroids add-on therapy has not shown any benefits for active pulmonary tuberculosis infection.
Other animals
Mycobacteria infect many different animals, including birds, fish, rodents, and reptiles. The subspecies ''Mycobacterium tuberculosis'', though, is rarely present in wild animals. An effort to eradicate bovine tuberculosis caused by ''Mycobacterium bovis
''Mycobacterium bovis'' is a slow-growing (16- to 20-hour generation time) aerobic bacterium and the causative agent of tuberculosis in cattle (known as bovine TB). It is related to ''Mycobacterium tuberculosis'', the bacterium which causes tube ...
'' from the cattle and deer herds of New Zealand
New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island count ...
has been relatively successful. Efforts in Great Britain have been less successful.
, tuberculosis appears to be widespread among captive elephant
Elephants are the largest existing land animals. Three living species are currently recognised: the African bush elephant, the African forest elephant, and the Asian elephant. They are the only surviving members of the family Elephantidae an ...
s in the US. It is believed that the animals originally acquired the disease from humans, a process called reverse zoonosis
A reverse zoonosis, also known as a zooanthroponosis (Greek "animal", "man", ''"''disease") or anthroponosis, is a pathogen reservoired in humans that is capable of being transmitted to non-human animals.
Terminology
Anthroponosis refers to p ...
. Because the disease can spread through the air to infect both humans and other animals, it is a public health concern affecting circus
A circus is a company of performers who put on diverse entertainment shows that may include clowns, acrobats, trained animals, trapeze acts, musicians, dancers, hoopers, tightrope walkers, jugglers, magicians, ventriloquists, and unicyclist ...
es and zoo
A zoo (short for zoological garden; also called an animal park or menagerie) is a facility in which animals are kept within enclosures for public exhibition and often bred for conservation purposes.
The term ''zoological garden'' refers to zoo ...
s.
References
External links
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*
*
WHO global 2016 TB report (infographic)
WHO tuberculosis country profiles
"Tuberculosis Among African Americans"
1990-11-01, ''In Black America
Produced at KUT, ''In Black America'' is a long-running, nationally syndicated program dedicated to all facets of the African American experience. John L Hanson Jr. profiles a diverse selection of current and historically significant figures wh ...
''; KUT Radio, American Archive of Public Broadcasting
The American Archive of Public Broadcasting (AAPB) is a collaboration between the Library of Congress and WGBH Educational Foundation, founded through the efforts of the Corporation for Public Broadcasting. The AAPB is a national effort to digitall ...
( WGBH and the Library of Congress)
Working Group on New TB drugs
tracking clinical trials and drug candidates
{{Authority control
Airborne diseases
Articles containing video clips
Health in Africa
Healthcare-associated infections
Infectious causes of cancer
Mycobacterium-related cutaneous conditions
Vaccine-preventable diseases
Wikipedia infectious disease articles ready to translate
Wikipedia medicine articles ready to translate (full)