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“Medical education does not exist
to provide students with a way of
making a living but to ensure
the health of the community”
Rudolf Virchow Mid 1800s
Tuberculosis has
been killing millions
for centuries
Symptoms of untreated active TB
Persistent cough and
Low grade-fever
Difficulty in breathing
Night sweats
Blood in sputum
Cambodian TB patient
Severe weight loss
Picture: World Lung Foundation
TB is an ancient human disease!
Recent evidence supports a diagnosis of TB
in this 500,000 year old Homo erectus
Bone lesions indicative of TB
Credit: Marsha Miller, the University of Texas at Austin
TB is an ancient human disease!
TB spinal lesions have also been found in
Egyptian mummies
It is estimated that from 1700-1900,
TB killed 1 billion people.
The annual death rate in the late 1800s
was 7 million.
TB Ward, Ellis Island
Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926
"Forgotten Ellis Island,”
photographer Stephen Wilkes
After urbanization up to 25%
of all European deaths in the 1800s
may have resulted from TB
TB Ward, Ellis Island
http://www.birdchildsandgoldsmith.com/acatalog/slums.gif
The famous and the infamous died of TB
John Keats Anton Chekhov
Frederic Chopin
Emily Bronte
Simon Bolivar
Henry Thoreau
The famous and the infamous died of TB
along with countless millions
known only to their families
George Orwell
Eleanor Roosevelt
Franz Kafka
Eugene O’Neill
DH Lawrence
In 1900
TB was still
the second
leading cause
of death
in the US
CDC
Now infectious diseases are
much less prominent as causes of death
and TB has dropped off the list
CDC
In the early to mid 1900s TB remained a
major public health challenge in the US
"Prevent Disease: Careless Spitting, Coughing, Sneezing, Spread Influenza and Tuberculosis."
Rensselaer County Tuberculosis Association (Troy, N.Y.), [ca. 1925]
"'Stamp' Out Tuberculosis: Buy Christmas Seals." National Tuberculosis Association, 1924.
American Red Cross. "The Next to Go: Fight Tuberculosis." [American Red Cross], 1919.
In the US TB is now an almost
forgotten disease
US TB deaths
in 2010:
569
CDC
In the US TB is now an almost
forgotten disease
US TB deaths
in 2010:
569
US Influenza deaths: 2125
(90% age >60 years)
US deaths due to dog bites: 30
CDC
But not in the developing world!
TB KILLS
1.3 MILLION PEOPLE EVERY YEAR
OVER 3500 EVERY DAY
ONE PERSON EVERY 27 SECONDS
Stats from WHO, 2012
TB is present world-wide but
Incidence rates differ dramatically
CDC
For this Peruvian family mourning a child dead to TB
the disease is certainly not forgotten
Partners in Health and Harvard Medical School
Dept. of Social Medicine Program in Infectious Disease and Social Change
http://www.hms.harvard.edu/news/releases/family_cemetery.html
Two billion people
--one third of the world’s population-are infected with the bacteria that causes TB
World Lung Foundation (2008)
Worldwide TB causes:
5% of all deaths
Morocco
~10% of all adult deaths
India
China
South Africa
Stats:NIAID/NIH Pix: World Lung Foundation
Left untreated, a person with active TB
will infect 10-15 other people per year
World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html
Left untreated, a person with active TB
will infect 10-15 other people per year
new infections occur at a rate of one per second!
World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html
In most cases TB starts as an
infection of the lungs = pulmonary TB
http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html
X-rays used to be
the primary means of diagnosis
http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html
Now TB exposure is
diagnosed by a skin test
What is an antigen?
What does this test measure?
Tubersol =
a cell-free purified protein fraction
obtained from a human strain
of Mycobacterium tuberculosis
grown on a protein-free
synthetic medium, and inactivated
A positive test result simply means you
have been exposed to TB* at some point
and have developed antibodies to it
*=Active case
Previously “cured”
Inactive case
Vaccinated with BCG
The next step is a
Chest X-ray and a sputum culture
The next frontier: DNA testing to identify
different strains of TB
and assess drug resistance
Dbtechno.com
The next frontier: DNA testing to identify
different strains of TB
and assess drug resistance
July 2008: WHO unveils
$26 million program
to create labs in poor nations
that can do DNA tests
Cost: $5 per test
Time frame: 24 hours
Rather than weeks to months!
However, the TB bacterium can also
Infect many other organs,
causing distinct “diseases
http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html
However, the TB bacterium can also
Infect many other organs,
causing distinct “diseases
Renal TB
www.vetmed.wsu.edu
However, the TB bacterium can also
Infect many other organs,
causing distinct “diseases”
Renal TB
Lupus vulgaris
http://www.ecureme.com/atlas/data/Tuberculosis_of_Skin550_ab.htm
TB infecting the spine
Pott’s disease = tuberculous spondylitis
Credit: Dr Laughlin Dawes
www3.shropshire-cc.gov.uk/. ../med/med_i03.htm
“Miliary TB” is disseminated throughout the body
Here it is presenting in the eye
www.aippg.net/forum/ viewtopic.php?t=11673
Scrofula: TB of the lymph nodes of neck
King Henry IV of France touching
sufferers of scrofula. André de Laurens, 1609
As late as the 1800s, causes and
cures of TB remained mysterious
www.nlm.nih.gov
TB sanitoria were built all around the US
www.umdnj.edu/librweb
This may seem like ancient history to you
Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926
housed over 400 patients, from infants to adults.
Waverly Hills closed in 1961
library.louisville.edu
But they remained in operation until
After Professor Peifer was born
Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926
housed over 400 patients, from infants to adults.
Waverly Hills closed in 1961
library.louisville.edu
Gravely Building,
now the site of the UNC Cancer Hospital
and only torn down in 2010,
was a TB sanitorium
www.med.unc.edu