Tuberculosis (TB) is a disease that transforms tissue into a mucous. It causes symptoms such as weight and appetite loss, and loss of strength. In advanced stages the disease is accompanied by a cough, difficulty in breathing, and coughing up of blood. Tuberculosis has been one of the leading causes of death from disease throughout the history of the world. The disease has infected and/or killed many famous people such as John Keats, Henry D. Thoreau, Emily and Charlotte Bronte, Fredrick Chopin, Robert Louis Stevenson, Ralph Waldo Emerson, Sir Walter Scott, Edgar Allan Roe, George Orwell, Adolph Hitler, and Vivien Leigh, as well as billions of other people.
People become infected with tuberculosis by inhaling tiny droplets of moisture that contain the TB bacteria. These droplets form when a person with TB coughs, sneezes, or spits. Infection can also be caused by eating food or drinking food from infected cattle. There are two types of infection; primary and reactivated. Primary infection occurs when someone inhales tubercle bacilli deep into the tiniest tubes of the lung. Macrophages (members of the body's defense system that engulfs foreign material) attack these invading bacilli. These cells may kill or engulf the bacteria without killing them. Other defending cells trap the remaining bacilli in hard lumps called tubercles. The bacteria are then harmless. Many people have had primary infections without even knowing that they did. Very few people die from primary infections and may carry it with them for many years before it is reactivated (if it ever is). Reactivated infection occurs when the bacilli break out of the tubercles due to a weakening of the body's defenses. The bacilli multiply and invade surrounding tissue. In their weakened state macrophages unsuccessfully attack the bacilli. The multiplying bacilli breakthrough the lung tube walls and invade a blood vessel. Alveolar macrophages and white blood cells accumulate at the site of the reactivated bacteria and forms caseous material. This material liquefies and moves up the respiratory tract and is coughed up as sputum.
The first test undergone to determine if a person has TB is called TB skin tests. Within a few weeks after a primary infection the skin of the person develops an allergy to TB. In skin test an injection of weakened or dead tuberculosis bacteria is inserted right under the skin. If a rash develops at the site of the injection, that is an indicator that the person has had TB in the past. After a positive skin test, chest x-rays are done. These may reveal tubercles or other signs of the disease. A laboratory test is then done. This is when a physician examines the patients' sputum under a microscope to determine if the bacilli are present. If there are bacilli in the sputum they are cultured to determine if they are tuberculosis bacilli or another kind. These cultures also help determine what drugs would be most effective against the bacteria. Once the tests have come up positive the person is diagnosed as having tuberculosis.
Treatment for tuberculosis has swung from rest to exercise and back to rest again. One of the earliest treatment centers for tuberculosis was in a “sanitarium.” Their treatments were fresh air, mild exercise, and bed rest. This approach was used most in the 1880's and last until the 1940's. Today patients can be treated in their own homes by drugs, some of which are isoniazid, rifampin, ethambutol, streptomycin, and pyrazinamide. These drugs help stop bacterial growth. Two or more drugs are often used because the TB bacteria may resist one of them. Surgery is only used in extreme cases. There are two ways of treating TB by surgery- collapse and excisional. Collapse surgery was introduced in 1882 by an Italian named Carlo Forlanin. He discovered that by inserting a nitrogen gas into the infected lung, the gas enveloped the lung causing it to collapse. This ends the good oxygen supply to the lung which causes the bacteria to stop multiplying, as tuberculosis needs oxygen to thrive. Excisional surgery is when tissue infected by the bacilli is removed. This can include part or all of a lung. Tuberculosis can be prevented in a number of ways. A vaccination known as BCG (Bacille Calmette-Guerin) offers some protection from it. It is prepared from a living but weakened form of tubercle bacilli. Good nutrition can also play a part in preventing it. This keeps your body healthy and your immune system strong. Hygiene, or cleanliness, can also help prevent TB. Cleanliness in public places have varied over the years but recently the standards have not been very high. Vaccination, nutrition, and cleanliness can help prevent the spread of TB.
By the mid 1970's tuberculosis was considered a thing of the past, a conquered enemy. By the early 1980's government spending programs on the research and care of tuberculosis were down to almost nothing. Tuberculosis cases had been declining in number as well as severity. And then it happened. The number of TB cases in 1985- increased. Stunned, people world wide watched as more cases increased every year. Between 1985-1991 the U.S. alone had an increase of 18% of new cases reported. In the 1980's there were 25,000 new cases and about 2,000 of them died. By 1991 three million people world wide were dying each year from this “conquered” enemy. If that wasn't scary enough, the bacteria seemed to be resisting the drugs administered to patients. How could this happen? What was causing it? Research discovered that a high percentage of the TB deaths were people with HIV/AIDS. O.K. That settled the question of how this epidemic started (weakened immune systems). But the drug resistance? Doctors found that most of their patients prematurely stopped taking their medicine and that the bacteria from these patients had produced more bacteria resistant to the drugs the patient had stopped taking. These bacteria were then passed to someone else who was given two different kinds of drugs to take. This person stopped taking their medicine before they were completely well. The drug resistant bacteria (or Super Bugs) then became resistant to those drugs and all of this information was passed to the next generation of bacteria. This bacterium is passed to another person and so on until a bacterium resistant to all known medicines has emerged. In this recent epidemic governments mainly ignored it until it was almost too late. Also people (especially children and teens) are not aware of this looming problem. They continue to cough and sneeze without covering their mouths and to spit on the sidewalks. People need to become better aware of the problem and take the proper precaution against the spread and contraction of tuberculosis. It isn't conquered yet.
