Tuberculosis cases are rising
Why you should be concerned
Tuberculosis has returned as the leading cause of death among infectious diseases worldwide. The recent outbreak of TB among over 70 people in the Kansas City area confirms an awful realization: TB is making a comeback.
Once thought to be under control, TB cases are increasing globally. Driven by drug resistant strains, gaps in testing, lower rates of infant vaccination, and weakened healthcare systems - including the United States.
TB is preventable, and can often be cured, but sometimes its diagnosis is tricky. If tuberculosis is not treated, death comes to about half the individuals.
The antibiotic resistant TB means treatment takes longer, costs more money, and is unfortunately less effective.
Airborne and global spread emphasizes that outbreaks don’t stay local. You’re not in Kansas anymore.
Malnutrition, over nutrition, weakened immune systems, the rise of chronic diseases, and more HIV/AIDS mean populations become more vulnerable.
The interruption of testing from the COVID pandemic disrupted surveillance and treatment programs.
As a nation, we need to strengthen public health initiatives. While some have lost respect for the medical establishment, we must still work to educate about a disease as old as civilization.
While we have a vaccine, it is for children in endemic areas, and lasts between five and fifteen years. Revaccination is not recommended. Currently, several vaccines against TB are in development, which can be used for adults and children.
Many don’t know the history of tuberculosis, and that is due to modern medicine. The last sixty years, the ability to both detect tuberculosis and treat TB have made us complacent.
We have stopped testing for TB in many places we did. We do not test people from other countries with work or student visas, for example. Many schools no longer require testing for entrance, with California being the exception.
Tuberculosis the Medicine
Tuberculosis (TB) is caused by a highly infectious bacterium called Mycobacterium tuberculosis. This bacteria is the smallest living organism on planet Earth. Antibiotics are used to treat TB.
The antibiotics commonly used for the treatment of tuberculosis are isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB).
The primary mode of transmission is through the air. Breathing creates small droplets that remain suspended in the air for an hour. These are easily inhaled by individuals in close proximity to an infected person. Closer proximity and poor ventilation mean we provide opportunity for TB. We saw what happens with poor ventilation during COVID, from cruise ships to airplanes, buildings, and schools. [1-2]
Patients with active pulmonary TB are highly infectious. This can be the person coughing next to you. That infected person might think it’s allergies, or a cold, unaware of their deadly sputum. Coughing, sneezing, or even talking release these infectious droplets into the air.[1][3] Bacteria remain on those aerosol particles and live under the most extreme environmental conditions. [4]
Highly infectious strains of Mycobacterium tuberculosis disable the immune response, allowing bacteria to occupy the lungs. Bacteria become settled in the lungs, where they destroy lung tissue and make a cavity (seen on the x-ray and called a cavitary lesion). From these cavities, bacteria easily travel out of the airway and infect others. [5]
“Super-spreaders" are responsible for most epidemics. Spreading far more bacteria than other infected people. Even though these individuals can be without symptoms. Yes, a bit scary.[6] [7-8]
The high infectiousness of TB is due to the efficient airborne transmission of M. tuberculosis, the ability of the bacteria to remain viable in aerosols and super-spreaders.
TB caused more deaths than heart disease ever has
Prior to 1900, TB was the most common cause of death. Consider today we have 209 deaths from heart disease per 100,000 people. But in the 1700’s we had over 800 deaths per 100,000 people from tuberculosis. Tuberculosis as a cause of death was four times more common than heart disease today.
Many famous people died from tuberculosis. The deaths of former Presidents Andrew Jackson and James Monroe were from TB. In addition, the composer Chopin, poet John Keats, author Franz Kafka and Doc Holiday of Tombstone all died of tuberculosis.
Tuberculosis has been found in Egyptian and Peruvian mummies, discussed in the Bible, as well as ancient writings from China and India.
The invention of the stethoscope was for tuberculosis. The initial use of x-ray machines was for broken bones, but then chest x-rays became common use to diagnose tuberculosis.
REFERENCES:
Behrman A, Buchta WG, Budnick LD, et al.Journal of Occupational and Environmental Medicine. 2013;55(8):985-8. doi:10.1097/JOM.0b013e3182a0d7cd.
2.Droplets, Dust and Guinea Pigs: An Historical Review of Tuberculosis Transmission Research, 1878-1940.Donald PR, Diacon AH, Lange C, et al.
The International Journal of Tuberculosis and Lung Disease : The Official Journal of the International Union Against Tuberculosis and Lung Disease. 2018;22(9):972-982. doi:10.5588/ijtld.18.0173.
3.Cough and the Transmission of Tuberculosis.
Turner RD, Bothamley GH.The Journal of Infectious Diseases. 2015;211(9):1367-72. doi:10.1093/infdis/jiu625.
4.Enhanced Tenacity of Mycobacterial Aerosols From Necrotic Neutrophils.
Pfrommer E, Dreier C, Gabriel G, et al.Scientific Reports. 2020;10(1):9159. doi:10.1038/s41598-020-65781-9.
Lovey A, Verma S, Kaipilyawar V, et al.Nature Communications. 2022;13(1):884. doi:10.1038/s41467-022-28506-2.
Melsew YA, Gambhir M, Cheng AC, et al.BMC Infectious Diseases. 2019;19(1):244. doi:10.1186/s12879-019-3870-1.
Nduba V, Njagi LN, Murithi W, et al.Nature Communications. 2024;15(1):7604. doi:10.1038/s41467-024-52122-x.
8.The Infectiousness of Tuberculosis Patients Coinfected With HIV.
Escombe AR, Moore DA, Gilman RH, et al.PLoS Medicine. 2008;5(9):e188. doi:10.1371/journal.pmed.0050188.
And antibiotic resistant strains were being kept down and out of the world by USAID. Guess what? Not anymore. Thanks Elon. No amount of money would save you if you got it.
Why are TB cases rising? I’m 81,and I remember my mom taking us kids to the county Health clinic for chest xray and physical ( grew up on a farm) and I’m a retired social worker and I had to get a skin TB test 1x each year.