Tuberculosis, the Most Infectious Disease in the World

In the United States, where I live, tuberculosis is a disease we hardly think about. It’s really only when we are required by law to be tested before we begin work on a new job where we deal with food or take care of people that we even think about the ramifications of the disease.

It wasn’t always so.

Until the discovery and implementation of antibiotics in the 1900s, one in seven people died from tuberculosis in the United States alone making it the number one cause of death.

In this article, we shall explore together the history of TB and how it is still affecting our world today.

The Types, Signs, and Symptoms of Tuberculosis

 Doctors recognize two different types of tuberculosis based on the activity of the disease in your body. The reason is that the human body can harbor the bacteria that causes tuberculosis and our immune system can usually prevent us from becoming ill. The two types are known as latent TB and active TB.

Latent Tuberculosis is the diagnosis given when you have an infection of TB, but the bacteria is causing no symptoms to your body. This type of TB is not contagious but can turn active, so close monitoring of a person with latent tuberculosis is vital.

It is estimated that 2 billion people globally have latent TB.

Active Tuberculosis makes the infected person sick and is highly contagious. This form of TB can make the person ill a few weeks after infection but can also lay dormant for many years and then strike.

There are no symptoms with latent tuberculosis, but active tuberculosis is very different. The signs and symptoms of active tuberculosis include:

  • Coughing that lasts three or more weeks
  • Coughing up blood
  • Chest pain
  • Pain when breathing or coughing
  • Unintentional weight loss
  • Fatigue
  • Fever
  • Night Sweats
  • Chills
  • Loss of appetite

It is not just the lungs that affected by tuberculosis, as it can also affect the kidneys, spine or brain. If a tuberculosis infection occurs in other organs, the symptoms will vary according to which organ is involved.

People with compromised immune systems cannot adequately defend against the TB bacteria. Many diseases and medications weaken a person’s immune system including the following:

  • HIV/AIDS
  • Severe Kidney Disease
  • Chemotherapy
  • Diabetes
  • Transplantation rejection drugs
  • Malnutrition
  • Medications to treat rheumatoid arthritis, Crohn’s disease and psoriasis
  • Being very young
  • Being very old

When tuberculosis infects the lungs, it consumes them from the inside out. This slowly diminishes the lungs capacity and causes the chest to become engorged with blood that fills the lungs. The result is a productive hacking cough.

As the lungs become full of blood, they are afloat in the chest, and the tuberculosis bacteria infect other people by spewing from the infected person in tiny droplets that are coughed up or otherwise expelled.

Finally, after blood and other liquids fill the lungs, the lungs cannot provide enough oxygen to maintain the life of the infected person, and respiratory failure occurs. To put it bluntly, the person drowns.

Before death, the person will have excruciating pain and as they struggle to breathe after their body has wasted away leaving them haggard and thin.

It is no wonder tuberculosis used to be called both consumption and the wasting disease.

The History of the Effort to Defeat a Killer 

Tuberculosis is one of the oldest diseases ever to inflict mankind. When ancient mummies entombed by the Egyptians are recovered and examined many show signs of tubercular decay. In fact, TB was very common in both ancient Rome and Greece.

The reign tuberculosis had on mankind continued until 1882 when Robert Koch, a German physician, discovered that a microbe, Mycobacterium Tuberculosis (Mtb) was the cause of TB.

Dr. Koch argued that tuberculosis was not a genetic flaw, but a highly contagious disease that is spread when an infected person coughs, sneezes, speaks or laughs. The condition, he continued, then becomes airborne in the droplets expelled by the infected person and is transmitted to someone else.

Flash forward to 1939 and meet Doctor Selman Waksman, a soil microbiologist who was working for the Department of Microbiology at New Jersey Agricultural Experimental station at Rutgers University in New Brunswick.

Dr. Waksman studied the effects of the microbes in soil on one another and had knowledge of fungi and the techniques needed to study them. Actinomycetes are in a family of microbes that he knew were classified as being between bacteria and fungi.

Waksman discovered that the actinomycetes had a peculiar effect on some types of bacteria found in soil that inhibited their growth. Waksman recognized the potential of such bacteria and decided to study TB and how the tiny microbes might affect the growth of the deadly disease-causing bacteria.

Penicillin had by then been widely used to treat bacterial infection and been wildly successful, so Dr. Waksman thought that perhaps he might find something that would cure tuberculosis.

Then in April 1943 during the height of the second world war, Waksman along with graduate student Albert Schatz did just that, they found the formula for streptomycin, a compound that would rock the world that had suffered for so long from the killer, tuberculosis.

Soon after the discovery of streptomycin, two doctors from the Mayo Clinic, W.H. Feldman and H. Corin Hinshaw began using a crude form of streptomycin on animals. The doctors then arranged for the pharmaceutical company Merck to produce large quantities of streptomycin to begin clinical trials in humans.

On November 20, 1944 streptomycin was first administered to a human being as a treatment of tuberculosis. Then on July 13, 1947, the same patient was discharged from the sanatorium in which he had been living after having been given the new diagnosis of arrested pulmonary tuberculosis.

This was not a cured case, but it was a significant victory for mankind over a killer that had stocked us for many millennia.

The Global and Recent History of Tuberculosis

Although tuberculosis in the United States has become uncommon today, in the years 1985-1992 the rate of infections increased due to the HIV epidemic, cutbacks in public health funds and treatment programs losing money as well. With the increasing problems of poverty, drug abuse, and homelessness, it is believed TB has a chance to become a national concern soon.

Soon after the sharp increase in TB cases in the United States in 1992, the federal government of the United States put renewed emphasis on the treatment of tuberculosis and prevention. This leads the Disease Control and Prevention in 1993 to report that nearly 13,000 cases were found in the US a reduction of 3.8% from the previous year.

But in other parts of the world tuberculosis continues to infect and kill millions.

There is an estimate that states that one-third of the population of the globe is infected with Tuberculosis bacteria, and 16.2 million people have TB.

Not only this, but tuberculosis is one of the world’s leading causes of death with the World Health Organization estimates 1.8 million people are dying and 500,000 people were also infected with HIV.

The countries with the highest incidence of tuberculosis are Africa, Afghanistan, Bangladesh, Brazil, Cambodia, China, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, the Philippines, the Russian Federation, South Africa, the United Republic of Tanzania, Thailand, Uganda, Viet Nam and Zimbabwe.

The Hardest Hit Country in the World by Tuberculosis: India

The incidence of TB is lowest in most high-income countries like Western Europe, Canada, the United States, Australia and New Zealand with less than ten cases reported in 100,000 people. However, this low prevalence of tuberculosis is not shared by the countries of India and China.

 The fact is that two of the hardest regions in the world by tuberculosis are India and China with both countries having huge populations, many living in hard to reach areas thus making them easy pickings for the TB bacteria to flourish.

However, the epidemic of tuberculosis in India is the most insidious.

The website Hindustan Times reported that in 2016 an estimated 279,000 people were diagnosed and 423,000 people died in India of tuberculosis making it the country with the highest number of deaths from that disease in the world.

The reasons so many people in India are dying from TB are many, but the main two are the delay in diagnosis of many cases and the fact that many people diagnosed with the disease do not receive adequate treatment.

The Delay in Diagnosis. In many parts of India, health workers are forced to use an old-fashioned method to discover if a patient has active tuberculosis. The technique involves getting two sputum smears at different times of the day and analyzing them using a microscope. This procedure is a slow process with a large margin for error.

There are machines, that were introduced in Africa and Europe, that can diagnose active tuberculosis accurately and quickly, but there are fewer than eight-hundred available across India.

The fact that forty percent of the Indian population has latent tuberculosis adds massively to the problem. This problem adds danger to the situation in that country because latent TB is being spread by people with active TB. Of those with the latent form, 1 in 10 will eventually become active cases, with a higher percentage among those with weakened immune systems, compounding the problem enormously.

The Problem of Receiving Adequate Treatment. Because tuberculosis is so rampant in India, the World Health Organization recommended to them that it is vitally important to treat all people who test positive not just those with active TB. However, the government objects because targeting latent AND active TB in the country due to the high costs and massive public relations campaigns that would need to be done.

However, specialists like Dr. Jennifer Furin, a lecturer in the Harvard School of Medicine in the Department of Global Health and Social Medicine, state that unless latent cases are also treated the problem of TB will never end.

Unless India decides to spend the money and time spreading the word among its citizens that tuberculosis can be treated and how to avoid getting the disease in the first place, TB will continue to take thousands of lives every year.

When treatment is received by infected individuals in India, there is a considerable problem with compliance. The regimen of antimicrobial drugs to treat TB must be spread out over a long period of time. Because of the time factor, many citizens of India infected with TB do not see immediate relief or even signs of progress.

This lack of obvious cues telling them they are recovering often means the patient will lose hope in the medications and quit taking them.

The discontinuance of the strong antimicrobial medications by disgruntled patients has led to an even more dire problem, resistance by the bacteria to these powerful drugs.

The Compounding Problem of Air Pollution and Tuberculosis

 Studies done in Taiwan, Japan, and the United States have shown a link between air pollution and the risk of active tuberculosis. The pollution of tiny particles that enter the lungs and the bloodstream have been correlated with TB. In fact, a study was done by

The U.S. National Institutes of Health (NIH) in 2016 stated that exposure to exhaust particles from diesel-fueled vehicles suppresses the function of some immune cells that protect against becoming infected with the TB bacteria.

Not only are fossil fuels used in vehicles a cause for concern in the number of cases and deaths in India, but the use of cooking fuels and smoking also are significant contributors to the problem.

New Tuberculosis Priorities in India Today

 An Indian publication, The Hindu reported in an article written in 2017 that India has increased the amount it budgets for the fight against tuberculosis. The World Health Organization reported that from this increased amounted to an increase from 700 crore rupees ($7 million U.S.) in 2015 to 2,500 crore rupees ($25 billion U.S.) in the year 2016.

Most of India’s budgeted funds go to combat active TB that claimed the death of 42 thousand people in 2016. However, in the face of the report by the WHO stating they need also to end latent tuberculosis in their country.

This increased spending on programs to end the human suffering caused by TB in India has resulted in a 12% drop in deaths by the disease being reported in 2017. However, the number of drug-resistant cases of TB went up from 79,000 to 84,000, a figure which the Indian government blamed on the deployment of better diagnostic tools to find such examples.

The government of India has decided to commit themselves to achieve a “90-90-90 Target” by the year 2035. That is a 90% reduction in incidences of mortality and money spent due to tuberculosis. They plan to do this by improving diagnostic procedures, shorter treatment courses, a better vaccine, and utilizing preventive measures.

World Trends in Tuberculosis and What You Can Do

In 1993, the World Health Organization (WHO) stated that TB is a “global health emergency” then asked all governments around the world to make the control of the spread of tuberculosis a number one priority.

The result of this declaration was the peak of the disease I 2005 when 8.6 million cases were reported and a gradual decline of reported TB cases since then.

Tuberculosis is not a problem of one nation or one people, it killers indiscriminately without regard to age, religion, sex, or political affiliation.

There are a few things that we can do as citizens of the world to not only keep ourselves safe but to end this terrible blight on humanity. These steps include identification of those with TB and vaccinating young children.

The first step above is to identify those who have contracted TB. This can be done with a simple examination including a sputum check to see if there are any live bacteria in the person’s lungs. When a person is identified as having the presence of tuberculosis bacteria in their body, then humane and proactive measures should be taken to treat their condition.

However, the incidences of stigma in some regions of the world prevent many from going to be checked and hiding from treatment if they do go. There need to be more measures to end patients with TB from becoming the object of ridicule in their communities. This can only be done through education and punitive measures against those who treat those with tuberculosis badly.

Second, vaccinations are available to help aid young children from contracting tuberculosis. However, in countries where the percentage of TB infections are not high, these vaccinations are frowned upon because most cases of tuberculosis are transmitted from adult to adult.

The vaccine is called Bacillus Calmette-Guerin (BCG and was developed first in the 1920s. The vaccine is one of the most widely used and reaches more than 80% of all newborn children and infants in the world.

The Global Community Must Work Together  

In the current global political climate, researchers, doctors and suffers of tuberculosis are often met by governments and citizens not wishing to work together. This resistance is unfortunate as if we worked together as a global community, we could soon find a cure and eradicate TB once and for all.

If we all do our part, the disease tuberculosis can quickly become relegated to the history books and looked at in future generations as a mere curiosity of the past.

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Disclaimer: The opinions expressed in this post are the personal views of the author. They do not necessarily reflect the views of PatientNextDoor. Any omissions or errors are the author’s and PatientNextDoor does not assume any liability or responsibility for them.

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