What is Tuberculosis?
Tuberculosis is an infection caused by the bacterium, Mycobacterium tuberculosis. The bacterium doesn’t just affect the lungs but can also attack other organs and parts of the body like the brain, kidneys and spine. Treatment for tuberculosis can be quite effective, provided the treatment is strictly adhered to in terms of medications and dosages, as well as the duration of treatment. Failure to treat the disease appropriately often spells disaster as it greatly increases the risk of fatality. As in the case of almost all infectious diseases, the adverse effects of tuberculosis are highest in developing and underdeveloped countries, where huge sections of the population live in extreme poverty.
Tuberculosis was once a dreaded disease across the world but it was largely contained in the developed world with advances in medical science. The history of tuberculosis has had some ups and downs however, as the disease began to make a resurgence in the 1980’s with the onset of the HIV epidemic. Patients suffering from AIDS have a compromised immune system, making them more vulnerable to various infections, including tuberculosis. This made HIV positive patients perfect hosts for the disease. Efforts to control the rise of tuberculosis were somewhat effective by the mid-1990s. Unfortunately, the past decade has witnessed a new problem that has raised old fears of tuberculosis. There are different types of tuberculosis and some strains have developed resistance to antitubercular antibiotics, rendering conventional medications ineffective. This has given rise to a whole new set of problems and concerns about the abuse of antibiotics, irresponsible usage of medications, and failure to adhere to recommended dosages, as these issues have contributed to and continue to aggravate the problem.
How Do You Get Tuberculosis?
Tuberculosis is an air-borne disease that spreads through the inhalation of contaminated air. When a patient suffering from an active tuberculosis infection coughs, sneezes or expels air, tiny droplets that contain germs are also released into the air. An individual can develop tuberculosis from inhaling such air. While this may seem terrifying, fortunately the risk of infection for healthy adults is rather low. In most cases, the infected person will just exhale a few bacilli and the healthy immune system can fight off the infection. The risk of infection is only high for individuals who are in prolonged contact with someone suffering from an active infection. Prolonged contact would imply being around the infected person for at least 3 weeks or a few months.
Keep in mind that despite tuberculosis transmission, a person who is infected will not necessarily suffer from the signs and symptoms of tuberculosis. The bacteria is contained and controlled by the immune system and the infection is said to be latent. The infection is said to be active when the bacteria go out of control as the immune system fails to contain the infection.
While tuberculosis is highly contagious, it does not pose a grave public health risk. While public awareness is important to prevent spread of the infection and to effectively treat existing cases, it is not a cause for panic. To put things in perspective here are some interesting facts and statistics on tuberculosis.
- According to the World Health Organization (WHO), a third of mankind is infected with the tuberculosis bacteria, but just a small fraction of those infected actually develop and suffer from tuberculosis. Anyone who is at high risk should get tested however, as latent infections may turn active in some cases. According to estimates from WHO, up to 10% of all those with latent TB infections will develop active TB.
- Although tuberculosis is curable, the disease has the highest fatality rate after HIV, when looking at fatalities from a single infectious agent. The disease kills around 5000 people each day.
- The risk of tuberculosis is much higher for individuals with a weakened immune system, which is why a patient with HIV is more likely to develop active TB. The odds of an HIV patient developing an active infection are in fact so much higher that the WHO puts estimates of risk as being 26 to 31 times higher as compared to a healthy adult. The disease is responsible for the deaths of a quarter of all HIV fatalities.
- Tuberculosis in children is a huge problem as tuberculosis diagnosis and treatment is a lot more complicated when dealing with children. In addition, children also suffer on account of adult tuberculosis fatalities, which have resulted in around 10 million orphans. In 2013 alone, tuberculosis killed 80,000 children, not including those who suffered from HIV infection.
- Sadly, the burden of tuberculosis rests heaviest on those who can least afford it. Of the 9 million people who suffered active tuberculosis in 2013, 1.5 million succumbed to the disease. Most of these deaths occurred in low and middle income countries in the developing world.
- The greatest per capita rate of infection is recorded in the African region, with 29% of all TB cases being recorded in Africa. Half of all new cases are concentrated within just 6 countries in Asia, including India, Pakistan, Bangladesh, China, Indonesia and the Philippines.
- Multidrug resistant tuberculosis has become increasingly problematic in recent years and around 480,000 people were afflicted with this variant of the disease in 2013.
- Although the risk of transmission may not be anywhere near as high as with mundane infections like the common cold, tuberculosis is contagious and does present a very real risk. If the infection is not treated, a patient with an active infection is believed to help spread the disease by infecting an average of 10 to 15 people in a year.
- Tuberculosis tests for diagnosis are conducted with both skin and blood tests. Testing is critical to control the disease as the bacteria may remain dormant, as in case of a latent infection, and can be killed with appropriate treatment. Treatment is essential to ensure the infection does not become active. Active tuberculosis requires antibiotic treatment that spans four to nine months.
- A patient infected with both HIV and tuberculosis is four times more likely to succumb to the disease during treatment, as compared to someone who only has a tuberculosis infection. Effective treatment for tuberculosis in HIV patient is still feasible, as studies have found that the additional treatment with cotrimoxazole (an antibiotic) can lower the death rate during treatment by as much as 40%.
- Most cases of multidrug resistant TB develop as a result of patients abandoning treatment or neglecting dosage recommendations midway through treatment. This makes adherence to treatment recommendations from health care providers imperative to the effective treatment and control of TB.
- The WHO came up with a Millennium Development Goal aimed at reversing and restricting the spread of the disease by 2015. The Stop TB Strategy was part of this initiative to drive down the economic costs and death rate from TB by providing universal access to diagnostic and treatment facilities for TB patients.
- This goal seems to be well on track, as global infection rates have been gradually declining and the death rate from TB has fallen by 45% in the period of 1990 to 2013. In just 13 years, from 2000 to 2013, efforts at tuberculosis control through diagnosis and treatment are believed to have saved around 37 million lives.
- In addition to lives saved through diagnosis and treatment, there has also been great progress in controlling the transmission of TB. There has been a decline in the numbers of people being infected with TB. There has been a marked decline in TB cases in both China and Brazil, with China observing a remarkable 80% decline in TB deaths.
- In 2012, TB treatment was so effective that TB treatment was successful n 86% of all treated cases.
- A quarter of all deaths in Europe are estimated to have been caused by tuberculosis infection during the 19th and early 20th century.
- Tuberculosis was commonly referred to as consumption because of the symptoms of wasting away with pronounced weight loss.
- Tuberculosis has been an indiscriminate killer claiming some of the best and the brightest through the course of human history. Notable casualties include literary giants, royalty, music composers and philosophers like Emily Bronte, George Orwell, John Keats, Frederic Chopin, Igor Stravinsky, Franz Kafka, Voltaire, Henry VII of England, Louis XVII of France, Eleanor Roosevelt and Muhammad Ali Jinnah.
- French bacteriologists Albert Calmette and Camille Guérin created the first tuberculosis vaccine in 1921 using a live strain of the bacteria. In their honor, the vaccine was christened the bacille Calmette-Guerin or BCG. The vaccine first came to be widely used in Europe and South America in 1930.
- After having been in decline for decades, tuberculosis began to raise its ugly head during the 1980s and was declared a global emergency by the World Health Organization in 1993.
- TB puts an enormous strain on developing countries as it creates a vicious downward spiral in economically backward communities. The disease affects those most vulnerable, such as those living in poverty with little access to health care, often suffering from malnutrition. The disease claims the lives of young adults, most often in their productive years, resulting in further economic hardship for afflicted communities. It is estimated that TB treatment drains the poorest economies of the world of as much as US$12 billion annually.
- Nunn AJ, Mwaba P, Chintu C, Mwinga A, Darbyshire JH, Zumla A; UNZA-UCLMS Project LUCOT Collaboration. Role of co-trimoxazole prophylaxis in reducing mortality in HIV infected adults being treated for tuberculosis: randomized clinical trial. BMJ. 2008 Jul 10;337:a257. - (doi: 10.1136/bmj.a257. PubMed PMID: 18617486; PubMed Central PMCID: PMC2656923.)