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“Medical education does not existto provide students with a way ofmaking a living but to ensurethe health of the community”
Rudolf Virchow Mid 1800s
Tuberculosis hasbeen killing millionsfor centuries
Picture: World Lung Foundation
Symptoms of untreated active TB
Persistent cough andLow grade-fever
Difficulty in breathing
Blood in sputum
Severe weight loss
Night sweats
Cambodian TB patient
Credit: Marsha Miller, the University of Texas at Austin
TB is an ancient human disease!
Recent evidence supports a diagnosis of TBin this 500,000 year old Homo erectus
Bone lesions indicative of TB
TB is an ancient human disease!
TB spinal lesions have also been found in Egyptian mummies
It is estimated that from 1700-1900, TB killed 1 billion people.
The annual death rate in the late 1800swas 7 million.
TB Ward, Ellis Island
"Forgotten Ellis Island,”photographer Stephen Wilkes
Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926
After urbanization up to 25%of all European deaths in the 1800s
may have resulted from TB
TB Ward, Ellis Island
http://www.birdchildsandgoldsmith.com/acatalog/slums.gif
The famous and the infamous died of TB
John Keats Frederic ChopinAnton Chekhov
Emily Bronte
Simon BolivarHenry Thoreau
The famous and the infamous died of TBalong with countless millions known only to their families
Eleanor RooseveltDH LawrenceFranz Kafka
George Orwell
Eugene O’Neill
In 1900 TB was still the second
leading causeof death in the US
CDC
Now infectious diseases aremuch less prominent as causes of death
and TB has dropped off the list
CDC
American Red Cross. "The Next to Go: Fight Tuberculosis." [American Red Cross], 1919.
"'Stamp' Out Tuberculosis: Buy Christmas Seals." National Tuberculosis Association, 1924.
"Prevent Disease: Careless Spitting, Coughing, Sneezing, Spread Influenza and Tuberculosis." Rensselaer County Tuberculosis Association (Troy, N.Y.), [ca. 1925]
In the early to mid 1900s TB remained a major public health challenge in the US
In the US TB is now an almostforgotten disease
US TB deaths in 2010:569
CDC
In the US TB is now an almostforgotten disease
US TB deaths in 2010:569
CDC
US Influenza deaths: 2125 (90% age >60 years)
US deaths due to dog bites: 30
Stats from WHO, 2012
But not in the developing world!
TB KILLS1.3 MILLION PEOPLE EVERY YEAROVER 3500 EVERY DAYONE PERSON EVERY 27 SECONDS
TB is present world-wide but Incidence rates differ dramatically
CDC
Partners in Health and Harvard Medical SchoolDept. of Social Medicine Program in Infectious Disease and Social Changehttp://www.hms.harvard.edu/news/releases/family_cemetery.html
For this Peruvian family mourning a child dead to TBthe disease is certainly not forgotten
Two billion people--one third of the world’s population--
are infected with the bacteria that causes TB
World Lung Foundation (2008)
Stats:NIAID/NIH Pix: World Lung Foundation
Worldwide TB causes:
5% of all deaths
~10% of all adult deaths
Morocco
India
South Africa
China
Left untreated, a person with active TBwill infect 10-15 other people per year
World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html
Left untreated, a person with active TBwill infect 10-15 other people per year
World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html
new infections occur at a rate of one per second!
In most cases TB starts as aninfection of the lungs = pulmonary TB
http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html
X-rays used to be the primary means of diagnosis
http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html
Now TB exposure is diagnosed by a skin test
What is an antigen?
What does this test measure?
Tubersol =a cell-free purified protein fraction
obtained from a human strain of Mycobacterium tuberculosis
grown on a protein-free synthetic medium, and inactivated
A positive test result simply means youhave been exposed to TB* at some point
and have developed antibodies to it
*=Active casePreviously “cured”Inactive caseVaccinated with BCG
The next step is aChest X-ray and a sputum culture
The next frontier: DNA testing to identifydifferent strains of TB
and assess drug resistance
Dbtechno.com
The next frontier: DNA testing to identifydifferent strains of TB
and assess drug resistanceJuly 2008: WHO unveils
$26 million program
to create labs in poor nations
that can do DNA tests
Cost: $5 per test
Time frame: 24 hours
Rather than weeks to months!
http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html
However, the TB bacterium can alsoInfect many other organs,causing distinct “diseases
However, the TB bacterium can alsoInfect many other organs,causing distinct “diseases
Renal TB
www.vetmed.wsu.edu
However, the TB bacterium can alsoInfect many other organs,
causing distinct “diseases”
Renal TB
http://www.ecureme.com/atlas/data/Tuberculosis_of_Skin550_ab.htm
Lupus vulgaris
Pott’s disease = tuberculous spondylitisCredit: Dr Laughlin Dawes www3.shropshire-cc.gov.uk/. ../med/med_i03.htm
TB infecting the spine
“Miliary TB” is disseminated throughout the bodyHere it is presenting in the eye
www.aippg.net/forum/ viewtopic.php?t=11673
Scrofula: TB of the lymph nodes of neck
King Henry IV of France touching sufferers of scrofula. André de Laurens, 1609
As late as the 1800s, causes and cures of TB remained mysterious
www.nlm.nih.gov
www.umdnj.edu/librweb
TB sanitoria were built all around the US
Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926housed over 400 patients, from infants to adults.
Waverly Hills closed in 1961library.louisville.edu
This may seem like ancient history to you
Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926housed over 400 patients, from infants to adults.
Waverly Hills closed in 1961library.louisville.edu
But they remained in operation untilAfter Professor Peifer was born
Gravely Building, now the site of the UNC Cancer Hospital
and only torn down in 2010, was a TB sanitorium
www.med.unc.edu