February 13, 2006
TB Or Not TB
By Michael D. Shaw
A notorious killer is making a comeback, although in some parts of the world it never really left. I’m referring to tuberculosis (TB), causing a genuine health crisis that one hopes will grab some attention away for more fashionable issues such as global warming and secondhand smoke. No less an authority than the World Health Organization (WHO) identifies the resurgence of TB as a significant worldwide problem.
It was the brilliant Nobel Prize winning German physician Robert Koch, who, in 1882 identified the various species of tubercle bacillus as the cause of the disease.
The illness, which primarily involves the respiratory system, scars the lungs; induces fever, weight loss, and fatigue; and can be fatal. Its return is a warning to all who believe that this condition, like other perceived health and hygiene crises of the distant past (including bed bugs, covered last week) has been banished from the First World. On the contrary. Since the mid-1980’s, the number of deaths caused by TB began to rise in developed countries.
Just what caused this unwanted comeback? For starters, you can blame increased international travel, that brought all the problems of the developing world—including overburdened, inadequate health care systems and appalling poverty—into closer interaction with the industrialized world. Add to this the spread of HIV (human immunodeficiency virus), that markedly increases the chances that a TB-infected individual will develop active tuberculosis, and suddenly, it’s no surprise.
Koch’s work brought management of TB out of the Stone Age, but it would not be until the 1940’s and 50’s that various true miracle drugs, including Isoniazid, rifampcin, and streptomycin, brought relatively quick and sure cures to those afflicted. But, as with all antibiotic therapy, eventual drug resistance is possible. Generally, this can be avoided by using a combination of drugs.
Still, if treatment is cut short for some reason, or if a single pharmaceutical is used, the surviving bacilli can reinfect the patient, possibly leading to a condition whereby the pathogen is resistant to many drugs. These so-called multidrug-resistant strains of the bacilli defy most attempts at therapy, causing an acute form of TB that is often fatal.
TB is hardly a recent scourge. Tissue samples from 4,000 years ago, taken from mummified corpses, show evidence of the disease. Medical historians estimate that as mankind moved toward the Industrial Age, TB was responsible for around 20% of all deaths in England and Wales in the 17th and 18th centuries.
Consider this alarming statistic, which places things in a deservedly serious light: 8.8 million people worldwide currently have some form of TB infection; and more than 2 million people died from this disease in 2002 alone, the last year such extensive records were made available. Those who pride themselves on being socially conscious or involved with women’s issues might examine these figures from the WHO:
In the developing countries, the leading causes of death of women aged 15–44 are
- TB — 9%
- war — 3%
- HIV — 3%;
- heart disease — 3%
The WHO predicts that by 2020 nearly one billion people will be newly infected with TB, and 70 million of them will die. TB global blackspots include Eastern Europe with 250,000 cases per year, Southeast Asia at 3 million cases per year, and sub-Saharan Africa with 2 million cases per year.
Far too often, health care modalities and priorities are set by current fashion, and TB is just not as “sexy” as AIDS. Yet, millions of people are dying, and the problem must be publicly acknowledged and dealt with accordingly.
If not, despite all of our technological advances, the end result for far too many will be as if they had lived hundreds of years ago.