Despite medical advances, human suffering from the ancient disease tuberculosis persists as a modern healthcare challenge. Although it is the deadliest infectious disorder in all of human history, it does not have the notoriety of other worldwide fatal illnesses: tuberculosis has become a forgotten scourge.
In 2017, 1.6 million people died from the contagion, and in the last 200 years over one billion individuals have succumbed. The deaths solely from tuberculosis account for more fatalities than from all those dying from malaria, influenza, smallpox, HIV, cholera and the plague combined.
Today, TB’s largest presence is in Africa, South-East Asia and the Western Pacific. Globally, there has been a small yet persistent annual two-percent decrease in the number of new cases. Unfortunately, this low rate of decline is inadequate to eliminate the disease without additional public health measures.
The United States has not been spared. The Centers for Disease Control and Prevention reported that in 2018 over 9,000 people were infected with tuberculosis for the first time. While this represents a decrease in the number of annual cases in recent years, it is insufficient to eradicate the contagion from America in the foreseeable future.
The tubercle bacillus, Mycobacterium tuberculosis, is responsible for the illness. Inhaling this microbe, which is present in the droplets of a cough or sneeze of an actively infected person, spreads the malady. In some instances, the bacteria may travel from the initial infection in the lungs to other organs in the body and produce disease.
TB usually remains dormant for years before a person becomes sick. Most infected people have only a 10% to 15% chance of actually falling ill; but the risk for potential suffering is increased in those who are immune compromised or malnourished. Epidemiologists estimate 25% of the world’s population has latent TB: they are not yet sick and are not able to transmit the contagion.
When activated, tuberculosis’ hallmark lung symptoms are cough, bloody sputum, weakness, weight loss, intermittent fever and night sweats. To confirm the diagnosis, the sputum of a suspected patient is microscopically examined for the bacterium. Chest x-rays are often obtained to look for evidence of the illness in the lungs.
The classic clinical manifestations of TB within various historic populations were described as many as 3,000 years ago. It has been given various names in the past including phthisis, consumption and the white plague. During the 17th century, it was known as the “king’s evil” because it was believed that a version of the disease in the lymph nodes of the neck called scrofula could be healed by the king’s touch. The term tuberculosis was coined in 1834.
For generations the cure was bloodletting, purging and diet. Treatment changed with the discovery of the causative bacterium and the recognition that tuberculosis was a contagious disorder.
These revelations were the impetus for the nineteenth century sanatorium movement that mainly consisted of rest and good nutrition in a healthy environment. This therapeutic approach was beneficial for some sufferers and helped prevent the disease from spreading. It was occasionally combined with the surgical removal of infected lung tissue.
The initial advancement to avoid contracting the illness began in the 1920s with the vaccine BCG when over one billion people were inoculated. Although its effectiveness was limited in adults, it did help in children; and today it is primarily used to prevent childhood tuberculosis in countries with a high prevalence of the affliction.
The discovery and widespread utilization of antimicrobial drugs in the mid-20th century revolutionized TB treatment.
Initially, there was a decisive drop in deaths for several decades; then starting in the 1980s the rate of new tuberculosis infections surged, secondary to an increase in individuals who were immunosuppressed from AIDS. The crisis was further intensified by the emergence of drug resistant forms of the tuberculosis bacterium.
This old disease in the new millennium is a global epidemic requiring additional public health funding to eradicate it by expanding research on the basic biology of the infection and improving diagnostic tests.
In addition, the development of new pharmaceuticals to treat drug-resistant tuberculosis, like the new antibiotic, Pretomanid, which was just approved for use by the Federal Drug Administration on Aug. 14, is essential.
Hopefully, these efforts eventually will lead to tuberculosis’ elimination, and the contagion can then be accurately labeled a “forgotten scourge.”
Stolz is a retired physician and author of the book, “Medicine from Cave Dwellers to Millennials.”
