The history of Tuberculosis (TB) which has regained its position as the world's most prevalent deadly disease.
Tuberculosis (TB) is proving to be one of the most stubborn infectious diseases in the world. Looking at its history provides some answers as to why this is the case.
Yesterday
Tuberculosis (TB) in humans has been identified in remains dating from the Early Bronze Age, 5000 years ago. Some Egyptian mummies were found to be tubercular. We find mention of its scourge in Deuteronomy.
The epidemiology, as we know it now, suggests prevalence increases in proportion to crowded living conditions, malnutrition, and poverty. Yet, the disease is so infectious it can afflict anyone, whatever their living conditions.
Only in the late nineteenth century was TB finally identified as a bacillus. Attempts at cures prior to that time, and even up to the late 1940's, were generally unsuccessful. In the Middle Ages, the "Royal Touch" was much sought after because kings were believed to be sacred, possessed of the healing power by mere touch. Some surgeons collapsed lungs; others removed ribs to be sure the collapse was permanent. Concoctions using gold were administered in the twentieth century, up until about 1935. Not only didn't they work; they were often toxic in their own right.
The x-ray was invented in 1895 and was immediately used for diagnosis. As rest and improved diet became perceived as possible cures, sanatoriums became more numerous. In the United States, more than 100,000 beds were available in 1950.
The number of sanatorium beds declined rapidly when antibiotic cocktails using streptomycin in combination with other drugs were made available, beginning in the late 1940's. At least in the developed countries, TB seemed to be beaten.
Today
Beginning in the mid-1980's, new drug-resistant strains of TB began to appear. The disease had never fully gone away. It had remained active in rural, impoverished sections of the United States; among people in the developed countries, it had never abated. Active cases in the United States increased by 16%.
New York City experienced an epidemic in the 1990's. Here, one in five cases were found to be drug resistant, and treatment cost rose to $250,000 per patient. Resistant strains have been found in 100 countries. The World Health Organization estimates that two billion people are infected with TB and that two to three million now die each year from this disease.
Johns Hopkins University has researched that only 30% of people exposed to TB are actually infected and that, of these, a further 5% may develop active TB later in life. For people who have tested positive for HIV, these percentages rise dramatically.
Tomorrow
The infectious spread of TB today, certainly yesterday, and probably tomorrow, is related to living conditions-diet, housing, access to health care.
At least three other factors now have an impact as well:
1. AIDS and its assault on immune systems make people with HIV much more vulnerable to TB.
2. The inability of medical research to keep up with development of drug resistant strains of TB must figure in, together with the very high cost of administering those treatments we do have in hand.
3. Environmental deterioration world-wide must be seen as the third factor. Some argue that this is causing weakening of the human immune systems generally, and, also, pressuring other living organisms, such as tubercule bacillus, to change.
Prospects for the future are mixed. Researchers certainly know the task before them. Socio-economic pressure may eventually build to the point where this work will become a priority. That process appears to have started.
