Tuberculosis—the Face of Struggles, the Struggles We Face, and the Dreams That Lie Within (2024)

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Tuberculosis—the Face of Struggles, the Struggles We Face, and the Dreams That Lie Within (1)

Emerging Infectious Diseases

Patrick K. MoonanTuberculosis—the Face of Struggles, the Struggles We Face, and the Dreams That Lie Within (2)

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Tuberculosis disease, or phthisis (ϕθίσις, the Greek word for consumption), was named by the father of allopathic medicine, Hippocrates (c. 460–370 BCE), because the disease appeared to consume the affected person through substantial weight loss and wasting (1). Hippocrates warned his students against treating persons in late stages of tuberculosis, because nearly all of their patients would die, which would likely tarnish their reputations as healers (2).

Today, >10 million persons become ill with tuberculosis, and 2 million die from the disease each year (3). India accounts for the largest number of persons with tuberculosis and tuberculosis-related deaths in the world. In 2016, 1.9 million tuberculosis cases were reported to the Revised National Tuberculosis Programme of India (3). An additional 1.2–5.3 million patients were estimated to have received treatment for the disease in the private sector of India but remained unrecognized by the global surveillance system (4). Many millions of future case-patients will emerge from the huge reservoir of an estimated 354 million persons currently infected with tuberculosis in India (5).

India has a large burden of poverty and malnutrition among both adults and children. Malnutrition has wide-ranging effects on health, including increased susceptibility to infectious diseases such as tuberculosis (6). In 2016, malnutrition was the leading risk factor for 14.6% of the total disability-adjusted life-years for all-cause illness and death in India (7). More than half of all cases of active tuberculosis among women (55%, 95% CI 27%–76%) and men (54%, 95% CI 26%–75%) in India are attributable to susceptibility caused by malnutrition (8).

Having been inspired by the faces behind tuberculosis, the artist Stefan Prakash Eicher (http://www.stefaneicher.com/), born in Maharashtra, India, captures the essence of the term “consumption” through his portrait of an emaciated and wasting man rescued from the streets of New Delhi. In What Dreams Lie Within (Figure), dark tones represent muscle atrophy recessed against a bony torso and sunken cheeks to highlight the debilitating cost of advanced stages of tuberculosis, partly due to catabolic losses by a cachetin-induced mechanism (a macrophage-secreted cytokine) (9) and malnutrition (10). Billowing clouds and a blue sky of hope within his eyes subtly support the struggle of survival found within the intensity of his furrowed brow.

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Figure

What Dreams Lie Within by Stefan Prakash Eicher. Oil on canvas, 2009.

Each year on March 24, we commemorate World TB Day (https://wwwnc.cdc.gov/EID/page/world-tb-day) in honor of the day Robert Koch announced at the University of Berlin Institute of Hygiene that he discovered the cause of consumption, the tuberculosis bacillus. World TB Day is a time to remember the millions of faces of persons who suffer from tuberculosis, to reflect on struggles we face as public health practitioners to end the epidemic, and to find hope in the eyes of the patients we treat and in the dreams that lie within our surviving patients searching for a better tomorrow.

Biography

Dr. Moonan is a senior epidemiologist in the Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, and has provided technical support to the Revised National Tuberculosis Programme of India for nearly a decade. His public health interests include tuberculosis transmission, operational research, and strengthening national tuberculosis programs to better manage drug-resistant forms of tuberculosis.

Footnotes

Suggested citation for this article: Moonan P. Tuberculosis—the face of struggles, the struggles we face, and the dreams that lie within. Emerg Infect Dis. 2018 Mar [date cited]. http://dx.doi.org/10.3201/eid2403.170128

References

1. Daniel TM, Iversen PA. Hippocrates and tuberculosis.Int J Tuberc Lung Dis. 2015;19:373–4. 10.5588/ijtld.14.0736 [PubMed] [CrossRef] [Google Scholar]

2. Finer KR. Tuberculosis. New York: Chelsea House for Infobase Publishing; 2003. [Google Scholar]

3. World Health Organization. Global tuberculosis report, 2017. Geneva: The Organization 2017 [cited 2017 Dec 1]. http://www.who.int/tb/publications/global_report/en/

4. Arinaminpathy N, Batra D, Khaparde S, Vualnam T, Maheshwari N, Sharma L, et al. The number of privately treated tuberculosis cases in India: an estimation from drug sales data.Lancet Infect Dis. 2016;16:1255–60. 10.1016/S1473-3099(16)30259-6 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

5. Houben RM, Dodd PJ. The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling.PLoS Med. 2016;13:e1002152. 10.1371/journal.pmed.1002152 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

6. Schaible UE, Kaufmann SH. Malnutrition and infection: complex mechanisms and global impacts.PLoS Med. 2007;4:e115. 10.1371/journal.pmed.0040115 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

7. Dandona L, Dandona R, Kumar GA, Shukla DK, Paul VK, Balakrishnan K, et al.; India State-Level Disease Burden Initiative Collaborators. Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study.Lancet. 2017;390:2437–60. 10.1016/S0140-6736(17)32804-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Bhargava A, Benedetti A, Oxlade O, Pai M, Menzies D. Undernutrition and the incidence of tuberculosis in India: national and subnational estimates of the population-attributable fraction related to undernutrition.Natl Med J India. 2014;27:128–33. [PubMed] [Google Scholar]

9. Friedland JS. Cytokines, phagocytosis, and Mycobacterium tuberculosis.Lymphokine Cytokine Res. 1993;12:127–33. [PubMed] [Google Scholar]

10. Cegielski JP, McMurray DN. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals.Int J Tuberc Lung Dis. 2004;8:286–98. [PubMed] [Google Scholar]

Articles from Emerging Infectious Diseases are provided here courtesy of Centers for Disease Control and Prevention

Tuberculosis—the Face of Struggles, the Struggles We Face, and the Dreams That Lie Within (2024)

FAQs

What is the main cause of tuberculosis? ›

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. People with active TB disease in the lungs or voice box can spread the disease. They release tiny droplets that carry the bacteria through the air. This can happen when they're speaking, singing, laughing, coughing or sneezing.

What are the long term effects of tuberculosis? ›

If TB of the lung is not treated early or if treatment isn't followed, long-lasting (permanent) lung damage can result. TB can also cause infection of the bones, spine, brain and spinal cord, lymph glands, and other parts of the body.

How did Robert Koch discover tuberculosis? ›

By modifying the method of staining, Koch discovered the tubercle bacillus and established its presence in the tissues of animals and humans suffering from the disease. A fresh difficulty arose when for some time it proved impossible to grow the organism in pure culture.

What are the three stages of TB? ›

There are 3 stages of TB—exposure, latent, and active disease. A TB skin test or a TB blood test can diagnose the disease. Treatment exactly as recommended is necessary to cure the disease and prevent its spread to other people.

What kills tuberculosis? ›

How Is Active TB Treated? If you have an active TB disease you will probably be treated with a combination of antibacterial medications for a period of six to 12 months. The most common treatment for active TB is isoniazid INH in combination with three other drugs—rifampin, pyrazinamide and ethambutol.

What are the early warning signs of tuberculosis? ›

Common symptoms include:
  • a cough that lasts more than 3 weeks – you may cough up mucus (phlegm) or mucus with blood in it.
  • feeling tired or exhausted.
  • a high temperature or night sweats.
  • loss of appetite.
  • weight loss.
  • feeling generally unwell.

How does TB affect a person's life? ›

Tuberculosis (TB) is a disease caused by germs that are spread between people through the air. TB usually affects the lungs but may also affect other parts of the body, including the brain, kidneys or spine. It can be deadly if left untreated.

Can you fully recover from tuberculosis? ›

Active, drug-sensitive TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. The vast majority of TB cases can be cured when medicines are provided and taken properly.

Does tuberculosis stay in your system forever? ›

Active TB can be very harmful to your health, but it can be cured with a course of medicine. If you have latent TB, the TB bacteria in your body are 'asleep'. You are not ill and you cannot pass TB on to others. However, the bacteria might 'wake up' in the future, making you ill with active TB.

Why is tuberculosis called white death? ›

In the 1700s, TB was called “the white plague” due to the paleness of the patients. TB was commonly called “consumption” in the 1800s even after Schonlein named it tuberculosis. During this time, TB was also called the “Captain of all these men of death.”

What animal did tuberculosis come from? ›

It is a major zoonotic disease, and cattle are the main source of infection for humans. It also affects other domesticated animals such as sheep, goats, equines, pigs, dogs and cats, and wildlife species such as wild boars, deer, and antelopes.

Is tuberculosis still around? ›

TB is Still Here – New CDC Data Show U.S. Cases Increased Again in 2022. Preliminary TB data released by CDC ahead of World TB Day show that the number of U.S. TB disease cases increased 5% in 2022 to 8,300 cases. CDC is calling on healthcare providers and communities disproportionately affected by TB to Think. Test.

What does TB look like on skin? ›

The face, hands, and legs are the commonest sites involved. The tuberculous chancre appears 1-4 weeks after inoculation, presenting initially as a firm red papule which becomes a painless shallow ulcer with a granular base and undermined edge. Sporotrichoid lesions and enlarged regional lymph nodes can develop.

Is it safe to be around someone with tuberculosis? ›

TB is spread through the air. The droplets containing the bacteria must be inhaled for the infection to spread from one person to another. This means that being near someone with TB disease when they cough, sneeze, or even talk close to your face for an extended period of time puts you at risk for infection.

Why is TB not spread by kissing? ›

The germs spread from person to person through the air. People who have TB disease in their throat or lungs spread the germs in the air when they cough, sneeze, talk, or sing. If you breathe in the air that has the germs, you can get TB. TB is not spread by touching, kissing, or sharing food or dishes.

What is the most common way to get tuberculosis? ›

Tuberculosis (TB) germs spread through the air from one person to another. TB germs can get into the air when someone with active TB disease coughs, speaks, or sings. People nearby may breathe in these germs and become infected. People with inactive TB, also called latent TB infection, cannot spread TB germs to others.

Where did tuberculosis come from? ›

tuberculosis appear to have originated from a common ancestor about 20,000–15,000 years ago. Currently circulating strains fall into six major lineages, or clades, all of which are present in East Africa; their global distribution varies, however. Analysis based on the known mutation rate of M.

What is the natural cause of tuberculosis? ›

TB is caused by bacteria (Mycobacterium tuberculosis) and it most often affects the lungs. TB is spread through the air when people with lung TB cough, sneeze or spit. A person needs to inhale only a few germs to become infected.

Can tuberculosis be cured? ›

Active, drug-sensitive TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. The vast majority of TB cases can be cured when medicines are provided and taken properly.

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