Apple #50: Tuberculosis

I'm reading one of Dostoevsky's novels, The Idiot, and one of the characters in the book is running around with tuberculosis. It struck me that a lot of novels from his day had characters with tuberculosis, which makes me think the disease must have pretty common. Which is probably the case if everybody who had it went around coughing up blood everywhere. But I'm curious: what made the disease go away, just about, and when did that happen?

• Tuberculosis is a kind of bacteria. It can attack any part of the body, but usually it goes for the lungs.

Microscopic view of the tuberculosis bacteria.
(Photo from La Corporacion para Investigationes Biologicas in Colombia)

• The disease is airborne, and it can be transmitted when people who are infected cough or sneeze.

• People can be infected with a latent form of tuberculosis, which means they have no symptoms, but they can still spread the bacteria.

(1930s poster from the National Library of Medicine)

• Tuberculosis has been active for thousands of years. Spinal column fragments of some Egyptian mummies show signs of decay associated with tuberculosis.

• In classical Greece, they called the disease "phthisis," which translated to "consumption." Most people called the disease "consumption" in the 18th and 19th centuries.

• Medical understanding of the disease progressed slowly. Over the course of centuries, people began to realize things about it such as that it killed nearly everyone it infected, it was highly contagious, to the point where the belongings of a person who had died from the disease should be burned, and that it seemed that "wonderfully minute living creatures" must be behind its transmission.

• In the late 1800's, an English doctor suggested that TB could be cured. One patient he knew went to the Himalayas and was cured. So he built the first sanitorium for TB patients. This started a lot of people building and going to sanitoria and healing waters and all kinds of places, seeking a cure for TB.

• The main benefit of the sanitoria was to separate the infected from the healthy population. Sanitoria-goers were also helped by better nutrition, rest, and a cleaner environment.

• Also in the late 1800's, an Italian doctor discovered that collapsing a lung had a beneficial effect on the disease. This started a raft of procedures called the pneumothorax, which was a surgical method to reduce lung volume. (This procedure appears in Thomas Mann's The Magic Mountain. It sounded so ridiculous to me, I wondered if he made it up.)

• Finally, in 1943, an antibiotic was developed by a man named Selman Waksman. The antibiotic was first administered to a human in 1944. The disease stopped its progression, the bacteria disappeared from the patient's sputum, and the man recovered fully.

• In years following, the antibiotic was administered widely, and more antibiotics were developed. Strains of bacteria resistant to the antibiotic soon appeared, but the use of combination therapies was effective against those strains.

• In industrialized countries, the incidence of TB dropped steadily.
  

• In developing countries, however, the story is very different. Of the 8 million people infected with TB each year, 95% of them are from countries where economic conditions are poor: Africa, parts of Asia, Latin America, and China.

• In the mid-1980's, the incidence of TB in industrialized countries stopped declining. Since then, the rate of infection in these countries has actually increased. Reasons for the increase include
  
1. immigration from countries where TB is more common
   
2. HIV -- people with HIV have weak immune systems that are susceptible to infection from more diseases, including TB
   
3. a decline in the active treatment and prevention of the disease, based on the assumption that it is no longer a problem
   
4. strains of bacteria resistant even to multi-drug treatment. Today, most people infected with TB are given four antibiotics to take simultaneously.

• For a while, people thought that singer Amy Winehouse had tuberculosis, since she looked super-skinny and absolutely horrible. But that's what heroin and crack addiction will do for you, along with a really bad chest infection.

• In general, much of the research in tuberculosis seems to be focused on examining the bacteria at the genetic level, in part to understand how the bacteria functions and spreads, how and why it has developed drug resistance, and what drugs might be developed to attack the bacteria at the genetic level.

• Currently, the key to preventing the spread of the disease is early detection and treatment. For people such as health care workers in areas of high risk, personal respirators are recommended.

Sources
Centers for Disease Control, National Center for HIV, STD, and TB Prevention, "Questions and Answers about TB"
New Jersey Medical School, National Tuberculosis Center, Brief History of Tuberculosis
Goshen College, Biology 206, History of Tuberculosis
Johns Hopkins Center for Tuberculosis Research, University of Illinois at Chicago Institute for Tuberculosis Research, Stanford Center for Tuberculosis Research