Why a Doctor Wants You to Know These 9 Crucial Facts About Tuberculosis

An ancient disease that is still an epidemic in much of the world, tuberculosis, or TB, is largely misunderstood. Here’s what you need to know about tuberculosis symptoms, tuberculosis treatment, and more.

woman coughingiStock/ThinkstockIn 19th century Europe, tuberculosis was epidemic. Racked with fevers, night sweats, and blood-tinged, painful coughing, victims slowly wasted away before they ultimately succumbed to “consumption” or “The White Plague.”   Tuberculosis was responsible for as many as 25 percent of all deaths in Europe, notably among the young and the poor.

Without a clear understanding of the disease, speculation abounded as to whether it was the result of heredity, “bad air,” or social conditions. Then, on March 24, 1882, Dr. Robert Koch, a German physician, announced to the Physiological Society of Berlin that he had discovered the cause of tuberculosis (TB), a bacteria called Mycobacterium tuberculosis. Dr. Koch’s revolutionary lecture is considered by many to be one of the most important in medical history. In 1905, Dr. Koch was presented with the Nobel Prize in Physiology or Medicine for his work, and in 1982, the World Health Organization (WHO) designated March 24 “World TB Day” to remember his contributions.

Although TB has been largely forgotten in wealthier nations like America—where a cure has existed for more than 60 years—worldwide TB remains a major public health problem. According to the World Health Organization, approximately one-third of the world’s population is infected with TB—and its death toll is second only to HIV.   Because TB primarily affects young adults in their most productive years, the global health and economic burden is enormous. The emergence of antibiotic resistance is making the disease costlier and more dangerous than ever, and the age of air travel is bringing it to our door.

And even though TB is relatively uncommon in America, nearly 10,000 cases were reported in 2013.

In commemoration of World TB day, here are nine facts about tuberculosis—past and present.

Critical TB News to Know Now

1. You don’t have to feel sick to have—or spread—TB

Tuberculosis is spread through the air. When a person with infectious, or “active” TB in their lungs coughs, spits, or sneezes, they spreads microscopic droplets, which can be inhaled by people nearby. Since the initial symptoms of TB may be mild, patients may not even realize they are infected. Over a year, a person with active TB can infect up to 10 to 15 other people. Most infected people don’t develop symptoms but simply harbor the bacteria in their bodies—a condition known as “latent TB”—that is not contagious. About 10 percent of patients with latent TB will develop an active infection. This is more likely among people with impaired immune systems, like those with cancer, diabetes, HIV, and those who use tobacco.

2. TB does not affect only those in poor countries

The World Health Organization estimates that 9 million people get TB every year, and an estimated 1.5 to 3 million people die from TB every year. The disease leaves more than 10 million children orphaned each year. While 95 percent of TB deaths occur in developing countries, TB affects every part of the world. The year 2013 saw nearly 10,000 cases in the America (a majority occurred in people born outside the U.S.).

3. If you suspect TB, get tested

If you have been exposed to someone with tuberculosis, or have such concerning symptoms as a prolonged fever and cough, chills, fatigue, chest pain, and weight loss, you should be tested by your physician or local health department. There are two tests used to check for TB: a skin test (which is used most commonly) and a blood test. During the skin test a needle injects a tiny amount of liquid (called tuberculin), under the skin. A healthcare provider then re-checks that area in two to three days to assess for a reaction. The TB blood test looks for how a person’s blood cells respond to tuberculosis in a laboratory. The blood test can be useful in patients who have had a questionable skin test result, have an impaired immune system, or have previously received the tuberculosis vaccine.

4. Inappropriate antibiotic use makes TB harder to treat

TB is usually treatable and curable. Standard TB is treated with four antimicrobial medicines over a six-month period. But without access to or proper adherence to a strict, appropriate regimen, the disease can persist and spread. TB also has the potential to develop drug resistance. An estimated 480,000 people developed multi-drug resistant TB in 2013 (which means resistance to two of the major drugs used to treat it.) These patients require an even longer treatment course (20+ months), which is more expensive, more likely to cause adverse reactions, and even tougher to adhere to.

It is estimated that 9 percent of these patients may develop extensively drug resistant TB strains—bacteria resistant to the most powerful first and second-line drugs. The WHO’s “Stop TB Strategy” aims to dramatically reduce TB by ensuring early detection, adequate drug supplies, and providing standardized treatments.

TB’s Fascinating History

5. TB is older than the mummies

Tuberculosis appears to be one of the most ancient diseases in human history. Skeletons of Egyptian mummies show clear evidence of the disease dating back 6,000 years, although some scientists believe it is much older than that. Genetic analysis of mycobacterium seem to suggest that modern strains of M. tuberculosis originated from a common ancestor in Africa about 15,000 to 20,000 years ago. A group of international researchers led by Sebastien Gagneux of the Swiss Tropical and Public Health Institute believe they can trace TB back 70,000 years.

6. TB was called “consumption” because its victims wasted away

The term “phthisis,” or “to waste away “ first appears in Greek literature.  Hippocrates in Book 1, Of the Epidemics (410-400 BCE) described a disease of “weakness of the lung” associated with fever, chills, “constant sweats” and cough “brought up rarely and with difficulty” which he refers to as phthisis. “Consumption was the most considerable of the diseases which then prevailed” Hippocrates wrote, noting that it was almost always fatal.

7. Death from TB was romanticized

Tuberculosis reached epidemic proportions in Europe and North America in the 19th and 20th centuries. Famous victims included Emily Bronte, John Keats, Anton Chekov, Albert Camus, Frederic Chopin, Franz Kafka and Henry David Thoreau. The illusion of these pale, wan artists ethereally wasting away served to romanticize TB. “To be consumptive was almost a mark of distinction,” noted French physician Rene Dubos. At the peak of the Romantic Period, victims of TB became leading characters in many works of art including Fantine in Victor Hugo’s novel Les Miserables, Mimì, the heroine of Pucchini’s opera, and the character Smike in Charles Dickens’ Nicholas Nickleby.

8. Before antibiotics, sanitariums were created to treat tuberculosis

In the late 1800s, long before antibiotics existed, a theory emerged that a good diet, rest, sunshine, and fresh mountain air were helpful in controlling the disease. In 1859 Herman Brehmer opened the first TB Sanitarium in the German Alps, and sanitariums quickly sprung up all over the Alps. In 1885 Edward Livingston Trudeau founded the first in North America, the Adirondack Cottage Sanitarium at Lake Saranac, New York. Dr. Trudeau’s most famous patient was Scottish author Robert Louis Stevenson, who came to Saranac Lake in 1887.

Western states soon developed their own facilities, advertising to Eastern sufferers that the West’s high altitude, and clean, dry air were superior and even curative. History scholar Cynthia Stout’s doctoral dissertation proposed that by 1900, one-third of Colorado residents made the trip because of tuberculosis. Although it is not clear if sanitarium care changed the outcome for sufferers, the sanitaria did isolated the sick from the general population.

9. Physicians working with TB patients were responsible for important medical advances

In 1816, René Laennec, a renowned French physician, invented the stethoscope while working with tuberculosis patients and cadavers at the L’hôpital Necker in Paris.  Laennec’s stethoscope was revolutionary. It allowed him to accurately describe many diseases of the lungs, and at the same time preserved the modesty of female patients (as the doctor no longer had to place an ear on the patient’s chest.) He died of tuberculosis at age 45. In 1895, Wilhelm Röntgen discovered the X-ray, which allowed physicians to diagnose and track the progression of the disease. He won the Nobel Prize in 1901 for his discovery.

Charlotte Brown is an assistant professor of pediatrics at Vanderbilt University.

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