Tuberculosis: Wikis

  
  
  
  
  









































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Tuberculosis
Classification and external resources

Chest X-ray of a patient with far-advanced tuberculosis
ICD-10 A15.A19.
ICD-9 010018
OMIM 607948
DiseasesDB 8515
MedlinePlus 000077 000624
eMedicine med/2324 emerg/618 radio/411
MeSH D014376
.Tuberculosis or TB (short for Tubercles Bacillus) is a common and often deadly infectious disease caused by mycobacteria, usually Mycobacterium tuberculosis in humans.^ Tuberculosis usually causes symptoms.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ TB properly refers only to disease caused by Mycobacterium tuberculosis .
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria.

[1] .Tuberculosis usually attacks the lungs but can also affect other parts of the body.^ If the tuberculosis is in the lungs, the bacilli can be expelled into the air, infect others, and continue the cycle of tuberculosis infection and disease.
  • Tuberculosis - a knol by Charles Daley 28 January 2010 1:01 UTC knol.google.com [Source type: FILTERED WITH BAYES]

^ Organisms may then spread hematogenously to any part of the body, particularly the apical-posterior portion of the lungs, epiphyses of the long bones, kidneys, vertebral bodies, and meninges.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Diagnosing TB in other parts of the body ( extrapulmonary TB ) requires more testing.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

.It is spread through the air, when people who have the disease cough, sneeze, or spit[2].^ Tuberculosis is spread from person-to-person through the air.
  • Tuberculosis - a knol by Charles Daley 28 January 2010 1:01 UTC knol.google.com [Source type: FILTERED WITH BAYES]

^ Tuberculosis is a disease that is spread from person-to-person through the air.
  • Tuberculosis - a knol by Charles Daley 28 January 2010 1:01 UTC knol.google.com [Source type: FILTERED WITH BAYES]

^ It is spread through the air from person to person through respiratory secretions such as sputum or aerosols released by coughing, sneezing, laughing, or breathing.

.Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims.^ Most (about 95%) primary infections are asymptomatic and followed by a latent (dormant) phase.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ In another 10% of those with latent TB infection that has not been treated, the mycobacteria will later be reactivated and begin to multiply - leading to active progressive tuberculosis disease.

^ However, some patients - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis.

.The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss.^ Night sweats and a fever.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

^ Symptoms of active TB, such as a persistent cough, fatigue, fever, or night sweats.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

^ Fever, chills, and night sweats.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

.Infection of other organs causes a wide range of symptoms.^ While infection of other organs such as the brain, bones, intestines, and kidneys also occurs, these are rare.
  • Tuberculosis: What You Need To Know 28 January 2010 1:01 UTC www.fsis.usda.gov [Source type: Academic]

^ Untreated, the infection can progress until large areas of the lung and other organs are destroyed.
  • tuberculosis Facts, information, pictures | Encyclopedia.com articles about tuberculosis 28 January 2010 1:01 UTC www.encyclopedia.com [Source type: Academic]

^ Tuberculosis (TB) is a chronic bacterial infection that usually infects the lungs, although other organs are sometimes involved.
  • Tuberculosis - New York Presbyterian Hospital 20 September 2009 21:55 UTC www.nyp.org [Source type: FILTERED WITH BAYES]
  • Tuberculosis - New York Presbyterian Hospital 28 January 2010 1:01 UTC nyp.org [Source type: FILTERED WITH BAYES]
  • Tuberculosis (TB), Robert Wood Johnson University Hospital, New Brunswick, NJ, 08903 28 January 2010 1:01 UTC www.rwjuh.edu [Source type: Academic]
  • http://medicalcenter.osu.edu/patientcare/healthcare_services/lung_diseases/lung/tuberculosis/ 28 January 2010 1:01 UTC medicalcenter.osu.edu [Source type: FILTERED WITH BAYES]
  • Tuberculosis (TB) 28 January 2010 1:01 UTC www.chp.edu [Source type: Academic]

.Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids.^ See an illustration of a tuberculin skin test .
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

^ Slovis BS, Plitman JD, and Haas DW. The case against anergy testing as a routine adjunct to tuberculin skin testing.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ A tuberculin skin test (also called a TB skin test, PPD test, or Mantoux test) that indicates a TB infection means you need treatment to prevent active TB. .
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

.Treatment is difficult and requires long courses of multiple antibiotics.^ Not taking the full course of treatment also allows antibiotic-resistant strains of the bacteria to develop, making treatment more difficult.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

^ Long-term treatment with a combination of drugs is required.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.Contacts are also screened and treated if necessary.^ Screening is not usually necessary for contacts of non-pulmonary TB patients.
  • Tuberculosis Management | Doctor | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ However, it is important that your close contacts are screened so that any cases of tuberculosis are identified and treated as early as possible.
  • Patient information leaflet - Tuberculosis 28 January 2010 1:01 UTC www.cks.nhs.uk [Source type: FILTERED WITH BAYES]

^ Screening of casual contacts is less fruitful and is only necessary if the index case is highly infectious or the contacts are particularly susceptible, such as young children or immunocompromised adults.
  • Tuberculosis Management | Doctor | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

.Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis.^ Extensively drug-resistant tuberculosis (XDR TB) is an emerging concern.

^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

^ Given the low prevalence of drug-resistant M. tuberculosis in most parts of the United States, the cost of routine testing of all initial isolates is difficult to justify.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

.Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Guérin vaccine.^ Geographic latitude and the efficacy of bacillus Calmette-Guérin vaccine.

^ Applying experiences from trials of bacille Calmette-Guérin vaccine.

^ Brewer, 2000: Brewer TF Preventing tuberculosis with bacillus Calmette-Guerin vaccine: a meta-analysis of the literature.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.A third of the world's population are thought to be infected with M. tuberculosis,[3] and new infections occur at a rate of about one per second.^ About one third of the world's population is infected.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Mycobacterium tuberculosis is one of the best examples of successful co-evolution, since the bacilli have infected one third of the human population, but in 90% of the cases without causing overt disease.
  • Tuberculosis Pulmonary | HIV ATLAS 28 January 2010 1:01 UTC www.hivatlas.org [Source type: Academic]

^ Although its incidence has decreased dramatically in the United States, the World Health Organization (WHO) estimates that one-third of the world’s population is currently infected with M. tuberculosis and that a new person is infected every second.

[4] .The proportion of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still increasing.^ While the numbers of new cases of active TB have again declined in the U.S. due to constant vigilance by the medical community, TB remains a significant national and global public health concern.

^ Although its incidence has decreased dramatically in the United States, the World Health Organization (WHO) estimates that one-third of the world’s population is currently infected with M. tuberculosis and that a new person is infected every second.

^ Health care practitioners who have close contact with active cases have increased risk.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

[4] .In 2007 there were an estimated 13.7 million chronic active cases, 9.3 million new cases, and 1.8 million deaths, mostly in developing countries.^ Developing Countries United States is Failing at Eradicating Tuberculosis, Reports Says A new report is definitely showing that the original goal of eliminating tuberculosis (TB) from the United States by 2010 will not be reached.

^ While the numbers of new cases of active TB have again declined in the U.S. due to constant vigilance by the medical community, TB remains a significant national and global public health concern.

^ Today, it is estimated that there are 400,000 cases of MDR-TB, globally.
  • Tuberculosis - a knol by Charles Daley 28 January 2010 1:01 UTC knol.google.com [Source type: FILTERED WITH BAYES]

[5] .In addition, more people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse, or AIDS.^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

^ However, some patients - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis.

^ If your immune system is compromised by an illness, such as AIDS, or by corticosteroid or chemotherapy drugs, you may not respond to the Mantoux test, even though you're infected with TB. Diagnosing TB in HIV-positive people is further complicated because many symptoms of AIDS are similar to TB symptoms.
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

.The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5-10% of the US population test positive.^ However, in low-prevalence situations, this test is usually done only on smear-positive specimens.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ In the US, most children and other people without specific TB risk factors should not be tested to avoid false-positive reactions.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Several cohort studies have demonstrated a high incidence of active tuberculosis among HIV-infected individuals with positive tuberculin skin test results ( Table 1 ).

[1]

Contents

Classification

.The current clinical classification system for tuberculosis (TB) is based on the pathogenesis of the disease.^ In another 10% of those with latent TB infection that has not been treated, the mycobacteria will later be reactivated and begin to multiply - leading to active progressive tuberculosis disease.

^ However, some patients - especially those with compromised immune systems - may progress directly from initial TB infection to active tuberculosis.

^ To provide a classification scheme for tuberculosis that is based on pathogenesis, is consistent with current chemotherapeutic and chemopreventive recommendations, and is applicable to all in whom the diagnosis is or should be considered.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[citation needed]
Classification System for TB
Class Type Description
0 No TB exposure
Not infected
No history of exposure
Negative reaction to tuberculin skin test
1 TB exposure
No evidence of infection
History of exposure
Negative reaction to tuberculin skin test
2 TB infection
No disease
Positive reaction to tuberculin skin test
Negative bacteriologic studies (if done)
No clinical, bacteriologic, or radiographic evidence of TB
3 TB, clinically active M. tuberculosis cultured (if done)
Clinical, bacteriologic, or radiographic evidence of current disease
4 TB
Not clinically active
History of episode(s) of TB
or
Abnormal but stable radiographic findings
Positive reaction to the tuberculin skin test
Negative bacteriologic studies (if done)
and
No clinical or radiographic evidence of current disease
5 TB suspect Diagnosis pending
TB disease should be ruled in or out within 3 months

Signs and symptoms

.
Main symptoms of variants and stages of tuberculosis,[6][7] with many symptoms overlapping with other variants, while others are more (but not entirely) specifc for certain variants.
^ Because the process frequently coexists with other disorders, especially hepatic cirrhosis with ascites, the symptoms of tuberculosis may be obscured.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Tuberculosis in rabbits more closely resembled human tuberculosis than that produced in any other animal model.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ And in many other diseases people were troubled with swelling, but more especially in phthisical cases.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

Multiple variants may be present simultaneously.
Scanning electron micrograph of Mycobacterium tuberculosis
.When the disease becomes active, 75% of the cases are pulmonary TB, that is, TB in the lungs.^ A case of active pulmonary tuberculosis with hypercalcemia.

^ In immunocompetent patients with drug-susceptible pulmonary TB, even severe disease and large cavities usually heal if appropriate therapy is instituted and completed.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Chest x-ray may show signs of primary or active TB; in miliary TB, it shows thousands of 2- to 3-mm interstitial nodules evenly distributed through both lungs.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

.Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks.^ Pulmonary symptoms include productive cough, chest pain, and dyspnea.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ If the AST level is less than three times the upper limit of normal, the symptoms are assumed not to be due to hepatic toxicity.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Symptoms of cardiopulmonary origin tend to occur later and include cough, dyspnea, orthopnea, ankle swelling, and chest pain.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily.^ Symptoms include fever, chills, weakness, malaise, and often progressive dyspnea.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Other common symptoms include fever, night sweats, weight loss, shortness of breath, haemoptysis, and chest pain.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Symptoms vary by site but generally include fever, malaise, and weight loss.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

[4]
.In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis.^ A case of active pulmonary tuberculosis with hypercalcemia.

^ Disseminated TB and TB meningitis may be fatal in up to 25% of cases despite optimal treatment.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Therefore, after a positive skin test, active tuberculosis must be ruled out before providing treatment for latent infection.

[8] .This occurs more commonly in immunosuppressed persons and young children.^ Since the epiphyseal region of bones is highly vascularized in infants and young children, bone involvement with tuberculosis is much more common in children than adults.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Tuberculous meningitis is a more frequent manifestation of neurotuberculosis than is brain tuberculoma and is more commonly seen in children.

^ This sequence may be more common among young children and recently infected or reinfected immunosuppressed patients.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

.Extrapulmonary infection sites include the pleura in tuberculosis pleurisy, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints in Pott's disease of the spine.^ MR imaging of central nervous system tuberculosis.

^ Syndrome -- Central nervous system tuberculosis : Description: Tuberculous meningitis is a particularly devastating disease.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Severe forms include meningeal and central-nervous-system tuberculosis, spinal tuberculosis, abdominal tuberculosis, bilateral pleural effusion, pericardial effusion, and bone and joint tuberculosis involving more than one site.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.An especially serious form is disseminated TB, more commonly known as miliary tuberculosis.^ TB Rare TB Infections: Endometrial Tuberculosis & Genital Tuberculosis For individuals who acquire TB, there is a risk for developing a rare form of infection known as genital tuberculosis or endometrial tuberculosis By Christine Cadena   |  Published 5/12/2008 More topics: Tuberculosis .

^ Most of these forms of tuberculosis are missed, especially among nursing-home patients.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Tuberculosis of the liver and spleen is most likely secondary to hematogenous dissemination of the primary form of the disease.

.Extrapulmonary TB may co-exist with pulmonary TB as well.^ In active pulmonary TB, even moderate or severe disease, patients may have no symptoms, except “not feeling well,” anorexia, fatigue, and weight loss, which develop gradually over several weeks, or they may have more specific symptoms.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Limited data suggest that ELISA serologic diagnosis may be useful for the diagnosis of extrapulmonary tuberculosis and of pulmonary tuberculosis in children from whom it is difficult to obtain sputum specimens.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Other sites: Rarely, TB may develop on abraded skin in patients with cavitary pulmonary TB. TB may infect the wall of a blood vessel and has even ruptured the aorta.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

[9]

Causes

.The primary cause of TB, Mycobacterium tuberculosis, is a small aerobic non-motile bacillus.^ TB properly refers only to disease caused by Mycobacterium tuberculosis .
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Shafer RW, Singh SP, Larkin C, Small PM. Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in an immunocompetent patient.

^ However, these indirect methods for TB diagnosis have not been proven valid in most exotic species susceptible to Mycobacterium tuberculosis complex (which includes M. bovis ) infection.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

High lipid content of this pathogen accounts for many of its unique clinical characteristics.[10] .It divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour.^ Resistance to EMB is less common than that to the other first-line drugs.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ However, most children have few symptoms other than a brassy cough, and the primary focus usually resolves spontaneously with or without treatment.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

[11] (For example, one of the fastest-growing bacteria is a strain of E. coli that can divide roughly every 20 minutes.) Since MTB has a cell wall but lacks a phospholipid outer membrane, it is classified as a Gram-positive bacterium. .However, if a Gram stain is performed, MTB either stains very weakly Gram-positive or does not retain dye due to the high lipid & mycolic acid content of its cell wall.^ Spoligotyping is very widely-used, due to its simplicity, its high reproducibility, and its binary result format; and advantage when using databases.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Another valuable tool has been the use of high performance liquid chromatography (HPLC) to detect the species-specific mycolic acids produced by those genera that contain these unique fatty acids.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ If pretreatment susceptibility testing is not performed, an initial isolate should be retained for approximately 6 months for subsequent study by the laboratory if the patient does not respond as expected.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[12] MTB can withstand weak disinfectants and survive in a dry state for weeks. .In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in vitro.^ M. bovis is indistinguishable from M. tuberculosis except by culture followed by in vitro tests.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ In others, illness develops after an interval of 1 yr to many years when the organisms begin to grow within an old focus.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ This test is an in vitro diagnostic aid that measures a component of cell-mediated immune reactivity to M. tuberculosis .
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[13]
.Using histological stains on expectorate samples from phlegm (also called sputum), scientists can identify MTB under a regular microscope.^ This is done by sending samples of sputum (phlegm) to the laboratory.
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Using certain histological techniques on expectorate samples from phlegm (also called sputum), scientists can identify MTB under a regular microscope.

^ An abnormal chest X-ray may be suggestive of tuberculosis but the diagnosis can only be confirmed by identifying the TB germ in specimens taken from the patient such as the sputum (phlegm).
  • Patient information leaflet - Tuberculosis 28 January 2010 1:01 UTC www.cks.nhs.uk [Source type: FILTERED WITH BAYES]

.Since MTB retains certain stains after being treated with acidic solution, it is classified as an acid-fast bacillus (AFB).^ Methods for selective staining of mycobacteria are the conventional acid-fast stain (of which the Ziehl-Neelsen is an example) and the fluorochrome procedure, which uses such stains as auramine and rhodamine.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Since zoonotic transmission of TB does occur, the identification of acid fast bacilli (AFB) in clinical specimens from animals is a cause of concern, unease, and occasionally misconception for animal care handlers and zoo personnel.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ Whenever possible, diagnostic specimens should be examined for acid-fast bacilli (AFB) and cultured for mycobacteria.

[1][12] .The most common acid-fast staining technique, the Ziehl-Neelsen stain, dyes AFBs a bright red that stands out clearly against a blue background.^ Methods for selective staining of mycobacteria are the conventional acid-fast stain (of which the Ziehl-Neelsen is an example) and the fluorochrome procedure, which uses such stains as auramine and rhodamine.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ In addition to acid-fast staining, sputum can be tested using nucleic acid amplification techniques (NAAT) for TB; this test can shorten the time needed to diagnose TB from 1 to 2 wk to 1 to 2 days.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Mycobacteria are most easily detected by fluorochrome stains, with which the bacilli fluoresce a bright yellow-green or range-yellow (depending on the stain) against a black background.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy.^ The stains most commonly used are the fluorochrome stains (auramine-rhodamine or auramine O), examined by fluorescence microscopy under lower magnifications (x150 and x450).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ AFB identified on smear are not diagnostic of tuberculosis, as the acid-fast stain detects mycobacteria other than M tuberculosis , including M avium-intracellulare complex or M kansasii .

.The M. tuberculosis complex includes four other TB-causingmycobacteria: M. bovis, M. africanum, M. canetti and M. microti.^ Tuberculosis and other mycobacteria as zoonoses.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ However, these indirect methods for TB diagnosis have not been proven valid in most exotic species susceptible to Mycobacterium tuberculosis complex (which includes M. bovis ) infection.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ In 2005, 46 regional Ministers of Health in Africa declared that a dramatic rise in tuberculosis (TB) cases was cause for emergency.

[14] .M. africanum is not widespread, but in parts of Africa it is a significant cause of tuberculosis.^ In 2005, 46 regional Ministers of Health in Africa declared that a dramatic rise in tuberculosis (TB) cases was cause for emergency.

^ Thiacetazone, which is used in many developing countries for the treatment of tuberculosis, has been reported to cause frequent and significant skin reactions in HIV-seropositive patients being treated for tuberculosis.

^ Reactions caused by infection with mycobacteria other than M. tuberculosis (cross-reactions) commonly occur in many parts of the world.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[15][16] .M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has largely eliminated this as a public health problem in developed countries.^ Human infection with M. bovis has essentially been eliminated in developed countries as a result of the pasteurization of milk and effective tuberculosis control programs for cattle.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Likewise, in developed countries with long history of tuberculosis control such as Australia, Canada, Denmark, France, the Netherlands, the United States, and the United Kingdom trends suggest that MDR-TB is not a major public health issue but problem limited to specific groups including immigrants, refugees, and homeless ( Espinal et al., 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ TB of the tonsils, lymph nodes, abdominal organs, bones, and joints was once commonly caused by ingestion of milk or milk products (eg, cheese) contaminated with M. bovis , but this transmission route has been largely eradicated in developed countries by slaughtering cows that test positive on a tuberculin skin test and by pasteurization of milk.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

[1][17] M. canetti is rare and seems to be limited to Africa, although a few cases have been seen in African emigrants.[18] .M. microti is mostly seen in immunodeficient people, although it is possible that the prevalence of this pathogen has been underestimated.^ On the other hand, although M. microti is not usually pathogenic, it is possible that the prevalence of M. microti infections has been underestimated.

^ Although the genus mycobacterium includes may species, we will be concerned only with M. tuberculosis, the most prevalent species found to be pathogenic to normal human hosts.
  • TUBERCULOSIS 20 September 2009 21:55 UTC www.uic.edu [Source type: Academic]

^ In 2004, the prevalence (number of existing cases) of active TB disease was 14.6 million people with an incidence (number of new cases) of 8.9 million people and mortality (number of deaths) of 1.7 million people mostly in developing countries .
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

[19]
.Other known pathogenic mycobacteria include Mycobacterium leprae, Mycobacterium avium and M. kansasii.^ They also are not influenced by preexisting hypersensitivity from BCG vaccination or infection with environmental mycobacteria other than M. kansasii , M. szulgai , and M. marinum .
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ AFB identified on smear are not diagnostic of tuberculosis, as the acid-fast stain detects mycobacteria other than M tuberculosis , including M avium-intracellulare complex or M kansasii .

The last two are part of the nontuberculous mycobacteria (NTM) group. Nontuberculous mycobacteria cause neither TB nor leprosy, but they do cause pulmonary diseases resembling TB.[20]

Risk factors

.Persons with silicosis have an approximately 30-fold greater risk for developing TB. Silica particles irritate the respiratory system, causing immunogenic responses such as phagocytosis which consequently results in high lymphatic vessel deposits[21].^ Corticosteroids are sometimes used to treat TB when inflammation is a major cause of morbidity and are indicated for patients with acute respiratory distress syndrome or closed-space infections, such as meningitis and pericarditis.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ A reaction of greater than or equal to 10 mm is classified as positive in persons who do not meet the above criteria but who have other risk factors for tuberculosis.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ The aim of the present study was to investigate the relationship between smoking and tuberculosis (TB) among high-risk silicotic patients in Hong Kong.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

.It is this interference and blockage of macrophage function which increases the risk of tuberculosis[22].^ Increased risk of tuberculosis is widely recognized to be associated with increased poverty, yet there have been few analyses of the social determinants of tuberculosis, particularly in high-burden settings.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

^ SETTING: It has been well documented that smoking increases the risk of tuberculosis (TB).
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

^ Persons with medical conditions that increase the risk of tuberculosis (silicosis, gastrectomy, diabetes, immunosuppressive therapy, lymphomas, etc.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

.Persons with chronic renal failure who are on hemodialysis also have an increased risk: 10—25 times greater than the general population.^ In addition to immunocompromised individuals, other population groups who are at increased risk include minorities, the poor, alcoholics, immigrants from third-world countries, prisoners, the aged, nursing home residents, and the homeless.

^ Health care practitioners who have close contact with active cases have increased risk.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ A reaction of greater than or equal to 10 mm is classified as positive in persons who do not meet the above criteria but who have other risk factors for tuberculosis.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

.Persons with diabetes mellitus have a risk for developing active TB that is two to four times greater than persons without diabetes mellitus, and this risk is likely greater in persons with insulin-dependent or poorly controlled diabetes.^ Design Case-control study of exposure to a variety of risk factors before and during the development of pulmonary tuberculosis.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

^ Persons with LTBI who are included among those at increased risk for TB should be offered treatment.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Students with the most exposure, those in <=3 classes with the patient, were most at risk (Relative Risk: 5.7) ( Phillips et al., 2004 ) Of the 5 household contacts, all were infected and 3 (60%) had developed active TB disease.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.Other clinical conditions that have been associated with active TB include gastrectomy with attendant weight loss and malabsorption, jejunoileal bypass, renal and cardiac transplantation, carcinoma of the head or neck, and other neoplasms (e.g., lung cancer, lymphoma, and leukemia) [1].^ Active TB. This condition makes you sick and can spread to others.
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

^ Signs and symptoms of active TB include: .
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

^ Signs and symptoms of TB of the lungs include: .
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

.Given that silicosis greatly increases the risk of tuberculosis, more research about the effect of various (indoor) air pollutants on the disease would be necessary.^ Risk factors Anyone can get tuberculosis, but certain factors increase your risk of the disease.
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

^ Latest Research : Infectious Diseases : Tuberculosis Diabetes mellitus increases risk of TB .

^ By producing a progressive decline in cell-mediated immunity, HIV alters the pathogenesis of tuberculosis, greatly increasing the risk of developing disease in coinfected individuals and leading to more frequent extrapulmonary involvement and atypical radiographic manifestations.

Some possible indoor source of silica includes paint, concrete and Portland cement.
.Low body weight is associated with risk of tuberculosis as well.^ Comparable specificity of 2 commercial tuberculin reagents in persons at low risk for tuberculosis infections.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Tuberculosis may involve nearly any organ or structure in the body and produce signs and symptoms related to the specific site as well as systemic illness.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Increased risk of tuberculosis is widely recognized to be associated with increased poverty, yet there have been few analyses of the social determinants of tuberculosis, particularly in high-burden settings.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

A body mass index (BMI) below 18.5 increases the risk by 2—3 times. .On the other hand, an increase in body weight lowers the risk [2], [3].^ Sagittal T2-weighted MR image demonstrates areas of increased signal intensity due to edema in vertebral bodies.

Patients with diabetes mellitus are at increased risk of contracting tuberculosis,[23] and they have a poorer response to treatment, possibly due to poorer drug absorption[24]
.Other conditions that increase risk include IV drug abuse; recent TB infection or a history of inadequately treated TB; chest X-ray suggestive of previous TB, showing fibrotic lesions and nodules; prolonged corticosteroid therapy and other immunosuppressive therapy; Immunocompromised patients (30-40% of AIDS patients in the world also have TB) hematologic and reticuloendothelial diseases, such as leukemia and Hodgkin's disease; end-stage kidney disease; intestinal bypass; chronic malabsorption syndromes; vitamin D deficiency;[25] and low body weight.^ On vitamin d therapy of non-hypovitaminosis diseases.

^ In addition to immunocompromised individuals, other population groups who are at increased risk include minorities, the poor, alcoholics, immigrants from third-world countries, prisoners, the aged, nursing home residents, and the homeless.

^ Their findings came from a study that identified an extraordinarily high incidence of vitamin D deficiency amongst those communities in London most at risk from the disease, which kills around two million people each year.

[1][9]
.Twin studies in the 1940s showed that susceptibility to TB was heritable.^ Case-control and contact studies consistently show protection against TB meningitis and disseminated disease in children under 5.
  • CCDM::Tuberculosis 28 January 2010 1:01 UTC myph.org [Source type: Academic]

^ Humoral immune response Early studies utilizing crude antigen preparations of M. tuberculosis showed seroreactive antibodies in TB patients.
  • Tuberculosis 2007 | Chapter 13: Immunological Diagnosis 28 January 2010 1:01 UTC tuberculosistextbook.com [Source type: Academic]

^ Twin studies in the 1950's showed that the course of TB infection was highly dependent on the genetics of the patient.

.If one of a pair of twins got TB, then the other was more likely to get TB if he was identical than if he was not.^ Tests using highly purified antigens not widely available have been found to be more specific than those using PPD or other unpurified antigens.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Reactions in persons who have had recent close contact with tuberculosis and in persons with abnormal chest radiographs consistent with tuberculosis are more likely to represent infection with M. tuberculosis than cross-reactions.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Tuberculosis in rabbits more closely resembled human tuberculosis than that produced in any other animal model.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[26] .These findings were more recently confirmed by a series of studies in South Africa.^ To find more recent articles, please visit the following: MMWR at http://www.cdc.gov/mmwr/mmwrsrch.htm CDC Web Search at http://www.cdc.gov/search.do .
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ About 8% of all adult deaths in South Africa (more than 20 000 deaths a year) were caused by smoking.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

^ Increased transmission is consistent with our finding that patients who abuse substances were more likely to be involved in a localized genotype cluster, which can represent recent transmission.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

[27][28][29] .Specific gene polymorphisms in IL12B have been linked to tuberculosis susceptibility.^ Vitamin D receptor gene polymorphisms and susceptibility M. tuberculosis in native Paraguayans.

^ Identifying genetic susceptibility factors for tuberculosis in Africans: a combined approach using a candidate gene study and a genome-wide screen.

^ Influence of candidate susceptibility genes on tuberculosis in a high endemic region.

[30]
Some drugs, including rheumatoid arthritis drugs that work by blocking tumor necrosis factor-alpha (an inflammation-causing cytokine), raise the risk of activating a latent infection due to the importance of this cytokine in the immune defense against TB.[31]
In 1996 Jonathan Scott was infected with the desease and lumps formed on the side of his face. .This is an example of other body parts being effected by Tuberculosis.^ Reactions caused by infection with mycobacteria other than M. tuberculosis (cross-reactions) commonly occur in many parts of the world.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

Mechanism

Transmission

.When people suffering from active pulmonary TB cough, sneeze, speak, or spit, they expel infectious aerosol droplets 0.5 to 5 µm in diameter.^ Droplet nuclei are produced when persons with pulmonary tuberculosis cough, sneeze, speak, or sing.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Human TB is typically acquired by inhalation of aerosols carrying tubercle bacilli fowwoing exposure to a person with active pulmonary infection; non-tuberculous species of mycobacteria are acquired from environmental sources.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ Aerosol transmission of Tuberculosis ( Core Curriculum on Tuberculosis (2000) ): Description: Tuberculosis is spread by droplet nuclei which are expelled when a person with infectious TB coughs, sneezes, speaks, or sings ( Core Curriculum on Tuberculosis (2000) ) Disease Information: Tuberculosis (i.e., Active Tuberculosis) : Pathogenesis Mechanism: The pathogenesis begins when a droplet nucleus, generated by an index case, is inhaled by a contact and is carried via the airstream to a site in the lung.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.A single sneeze can release up to 40,000 droplets.^ A single sneeze, for instance, can release up to 40,000 droplets.

^ Sneezing generates the most droplet nuclei by far, which can spread to individuals up to 10 feet away.

[32] .Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low and inhaling less than ten bacteria may cause an infection.^ Latest Research : Infectious Diseases : Tuberculosis Ancient origins of tuberculosis-causing bacteria .

^ Although more than 3 billion doses of the BCG vaccine have been administered to fight tuberculosis, the ability of the BCG vaccine to protect adults is very limited, as is its efficacy against newly emerging isolates.

^ Infection Process: Infectious Dose: Very low, 1-5 tubercle bacilli ( Balasubramanian et al., 1994 ) Description: Tuberculosis is spread from person to person through the air by droplet nuclei, particles 1 to 5 um in diameter that contain M. tuberculosis complex.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[33][34]
.People with prolonged, frequent, or intense contact are at particularly high risk of becoming infected, with an estimated 22% infection rate.^ People at high risk include those (2): 1.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ Increased risk of becoming infected with M.Tb: .

^ HIV-infected people (documented or high risk behavior) .

.A person with active but untreated tuberculosis can infect 10–15 other people per year.^ M. tuberculosis first infected humans 10,000-15,000 years ago.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ A person can have active or inactive tuberculosis.
  • Tuberculosis, also known as TB 28 January 2010 1:01 UTC www.avert.org [Source type: FILTERED WITH BAYES]

^ People can be infected with tuberculosis only from a person who has active disease.
  • Tuberculosis: Infections: Merck Manual Home Edition 20 September 2009 21:55 UTC www.merck.com [Source type: FILTERED WITH BAYES]

[4] .Others at risk include people in areas where TB is common, people who inject drugs using unsanitary needles, residents and employees of high-risk congregate settings, medically under-served and low-income populations, high-risk racial or ethnic minority populations, children exposed to adults in high-risk categories, patients immunocompromised by conditions such as HIV/AIDS, people who take immunosuppressant drugs, and health care workers serving these high-risk clients.^ A risk to patients and health care workers.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Cavitation is common, except in immunocompromised patients.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Sepkowitz KA. AIDS, tuberculosis, and the health care worker.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[35]
.Transmission can only occur from people with active — not latent — TB [1].^ On a global level, 80% of the 8 million TB cases occurring annually are in only 22 countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In 50 to 80% of those who develop active disease, TB reactivates within the 1st 2 yr, but it can occur decades later.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ People with diabetes mellitus are at increased risk of developing active tuberculosis (TB), according to an analysis published in PLoS Medicine.

.The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the virulence of the M. tuberculosis strain.^ The infectious agent of tuberculosis, Mycobacterium tuberculosis, is carried on airborne droplet nuclei.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

^ Techniques that reduce the number of droplet nuclei in the room air are effective in preventing the airborne transmission of tuberculosis.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[9] .The chain of transmission can, therefore, be broken by isolating patients with active disease and starting effective anti-tuberculous therapy.^ Discuss the goals of therapy for patients with clinically active disease.
  • TUBERCULOSIS 20 September 2009 21:55 UTC www.uic.edu [Source type: Academic]

^ Effective method of therapy of tuberculous peritonitis.

^ The chain of transmission can be stopped by isolating patients with active disease and starting effective anti-tuberculous therapy.
  • Tuberculosis 20 September 2009 21:55 UTC www.night-sweats.net [Source type: FILTERED WITH BAYES]
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

.After two weeks of such treatment, people with non-resistant active TB generally cease to be contagious.^ Treatment generally consists of INH unless resistance is suspected (eg, in exposure to a known INH-resistant case).
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Although non-adherence was associated with poor treatment outcomes (OR: 2.4; 95% CI: 1.1-5.5), it was not associated with the acquisition of multi-drug resistance during the course of therapy.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

^ The identification of risk groups also helps to target strategies for early detection of people in need of TB treatment.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

.If someone does become infected, then it will take at least 21 days, or three to four weeks, before the newly infected person can transmit the disease to others.^ Even if someone becomes infected with tuberculosis, that does not mean they will get TB disease.
  • Tuberculosis - American Lung Association - Central States 28 January 2010 1:01 UTC breathehealthy.org [Source type: FILTERED WITH BAYES]

^ It usually takes lengthy contact with someone with active tuberculosis before a person can become infected.

^ The incubation period (the time it takes for a person to become infected after being exposed) varies from weeks to years, depending on the individual and whether the infection is primary, progressive, or reactivation TB. .
  • Tuberculosis 2007-11-01 00:00:00.0 28 January 2010 1:01 UTC www.devoschildrens.org [Source type: FILTERED WITH BAYES]

[36] .TB can also be transmitted by eating meat infected with TB. Mycobacterium bovis causes TB in cattle.^ "The other TB" Mycobacterium bovis .

^ Mycobacterium bovis causes TB in cattle.

^ Mycobacterium bovis is cause of bovine TB .

.(See details below.^ Another test, called a PPD, is usually administered to anyone suspected of having TB. See the section below labeled "Prevention" for more details.
  • Tuberculosis -- eCureMe.com 28 January 2010 1:01 UTC www.ecureme.com [Source type: FILTERED WITH BAYES]

)

Pathogenesis

.About 90% of those infected with Mycobacterium tuberculosis have asymptomatic, latent TB infection (sometimes called LTBI), with only a 10% lifetime chance that a latent infection will progress to TB disease.^ TB properly refers only to disease caused by Mycobacterium tuberculosis .
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Tuberculosis can develop through progression of recently acquired infection (primary disease), reactivation of latent infection, or exogenous reinfection.

[1] .However, if untreated, the death rate for these active TB cases is more than 50%.^ However, if untreated, the death rate for these active TB cases is more than 50%.

^ However, one in 10 will become sick with active TB in his or her lifetime due primarily to a weakened immune system.
  • FACTBOX-Tuberculosis: A leading killer disease By Reuters 28 January 2010 1:01 UTC www.forexpros.com [Source type: News]

^ In March 2009, the WHO said more money and better science are urgently needed to address the growing threat of drug-resistant TB. The WHO estimates there were more than half a million cases of multidrug-resistant TB around the world in 2007, resulting in 130,000 deaths.
  • CBC News - Health - Anatomy of a killer 28 January 2010 1:01 UTC www.cbc.ca [Source type: News]

[37]
.TB infection begins when the mycobacteria reach the pulmonary alveoli, where they invade and replicate within the endosomes of alveolar macrophages.^ If the bacilli reach the pulmonary alveoli, they may be ingested by alveolar macrophages, the first line of defense against M tuberculosis .

^ Calcified hilar nodes may be present; they may result from primary TB infection but also may result from histoplasmosis in areas where histoplasmosis is endemic (eg, the Ohio River Valley).
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Importantly, they are often negative in patients with remote TB infection.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

[1][38] .The primary site of infection in the lungs is called the Ghon focus, and is generally located in either the upper part of the lower lobe, or the lower part of the upper lobe[1].^ Upper lobe infiltrates and cavities are the typical findings in reactivation tuberculosis, whereas intrathoracic lymphadenopathy and lower lobe disease are seen in primary tuberculosis.

^ Infectious foci may leave fibronodular scars in the apices of one or both lungs (Simon foci), calcified scars from the primary infection (Ghon foci), or calcified hilar lymph nodes.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ The spine is the most frequent site of osseous involvement in tuberculosis ( 24 ), with the upper lumbar and lower thoracic spine being involved most frequently.

.Bacteria are picked up by dendritic cells, which do not allow replication, although these cells can transport the bacilli to local (mediastinal) lymph nodes.^ During the initial infection, regional, hilar, and mediastinal lymph nodes are always seeded with bacilli, and other lymph nodes may be seeded also.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ The differential diagnosis for mediastinal lymph node calcification includes histoplasmosis, silicosis, and treated lymphoma.

^ Axial contrast-enhanced CT scan demonstrates multiple enlarged mediastinal lymph nodes with central areas of low attenuation and peripheral enhancement (arrows).

.Further spread is through the bloodstream to other tissues and organs where secondary TB lesions can develop in other parts of the lung (particularly the apex of the upper lobes), peripheral lymph nodes, kidneys, brain, and bone.^ TB is spread through air.
  • Mycobacterium Tuberculosis, Tuberculosis Symptoms, Causes & Treatment 28 January 2010 1:01 UTC www.ayushveda.com [Source type: FILTERED WITH BAYES]

^ The other external lymph-nodes were not enlarged.
  • Tuberculosis Acquired Through Ritual Circumcision 28 January 2010 1:01 UTC www.cirp.org [Source type: FILTERED WITH BAYES]

^ Extrapulmonary TB - TB disease in any part of the body other than the lungs (for example, the kidney or lymph nodes).

[1][39] .All parts of the body can be affected by the disease, though it rarely affects the heart, skeletal muscles, pancreas and thyroid.^ The disease process begins in the anterior part of the vertebral body adjacent to either the superior or inferior end plates ( 29 ).

[40]
Tuberculosis is classified as one of the granulomatous inflammatory conditions. Macrophages, T lymphocytes, B lymphocytes and fibroblasts are among the cells that aggregate to form a granuloma, with lymphocytes surrounding the infected macrophages. .The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system.^ The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system.
  • Tuberculosis 20 September 2009 21:55 UTC www.night-sweats.net [Source type: FILTERED WITH BAYES]
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ Because this location provides the organisms with access to the outside environment and because liquefaction necrosis often occurs, airborne dissemination of infectious particles is likely.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Tuberculosis Symptoms Between two to eight weeks after being infected with M. tuberculosis, a person's immune system responds to the tuberculosis germ by walling off infected cells.

.Within the granuloma, T lymphocytes secrete cytokines such as interferon gamma, which activates macrophages to destroy the bacteria with which they are infected.^ Again, if the macrophages are activated, the bacteria are killed.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ If these macrophages are activated, the mycobacteria containing phagosomes fuse with lysosomes, and the bacteria are killed.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The organisms are slowly engulfed by macrophages, but they may remain viable and even multiply within the cells.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[41] .Cytotoxic T cells can also directly kill infected cells, by secreting perforin and granulysin.^ Furthermore, in an otherwise healthy, previously infected person, any organisms that are deposited in the alveoli are likely to be killed by the cell-mediated immune response.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[38]
.Importantly, bacteria are not always eliminated within the granuloma, but can become dormant, resulting in a latent infection.^ This is when the latent TB infection becomes a TB disease.

^ Importantly, bacteria are not always eliminated within the granuloma, but can become dormant, resulting in a latent infection.

^ This causes the bacteria to become dormant.
  • Tuberculosis 28 January 2010 1:01 UTC www.uptodate.com [Source type: FILTERED WITH BAYES]

[1] .Another feature of the granulomas of human tuberculosis is the development of cell death, also called necrosis, in the center of tubercles.^ Raviglione MC, Narain JP, Kochi A. HIV-associated tuberculosis in developing countries: clinical features, diagnosis, and treatment.

^ Although tuberculosis can be a relatively early manifestation of HIV-1 infection, it is important to note that the risk of developing tuberculosis, and of disseminated infection, increases as the CD4 T-cell count decreases.

^ The radiologic differential diagnosis for renal tuberculosis includes other causes of papillary necrosis, transitional cell carcinoma, and other infections.

To the naked eye this has the texture of soft white cheese and was termed caseous necrosis.[42]
.If TB bacteria gain entry to the bloodstream from an area of damaged tissue they spread through the body and set up many foci of infection, all appearing as tiny white tubercles in the tissues.^ TB is spread through air.
  • Mycobacterium Tuberculosis, Tuberculosis Symptoms, Causes & Treatment 28 January 2010 1:01 UTC www.ayushveda.com [Source type: FILTERED WITH BAYES]

^ Remember, TB is spread through the air.
  • Tuberculosis 28 January 2010 1:01 UTC www.tjclarkminerals.com [Source type: FILTERED WITH BAYES]
  • http://www.milwaukee.gov/TuberculosisFAQs.htm 28 January 2010 1:01 UTC www.milwaukee.gov [Source type: FILTERED WITH BAYES]

^ After this, the bacteria can then spread through the blood.

.This severe form of TB disease is most common in infants and the elderly and is called miliary tuberculosis.^ Miliary TB is most common among children < 4 yr, immunocompromised people, and the elderly.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Latest Research : Infectious Diseases : Tuberculosis Tuberculin skin tests not sensitive in detecting latent TB .

^ In immunocompetent patients with drug-susceptible pulmonary TB, even severe disease and large cavities usually heal if appropriate therapy is instituted and completed.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

.Patients with this disseminated TB have a fatality rate near 100% if untreated.^ Disseminated TB and TB meningitis may be fatal in up to 25% of cases despite optimal treatment.
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Treatment regimens: Treatment of all patients with new, previously untreated TB should consist of a 2-mo initial, intensive phase 4- or 7-mo continuation phase .
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ From 1991 to 1998, the incidence of TB in Latvia increased, reaching a rate of 74 per 100,000 inhabitants.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.However, If treated early, the fatality rate is reduced to near 10%.^ Treatment with INH significantly reduced the rate of tuberculosis compared with placebo (10.0 vs. A placebo-controlled study in Uganda compared four treatment arms: placebo for 6 months, INH for 6 months, INH and rifampin for 3 months, and INH, rifampin, and pyrazinamide for 3 months.

[43]
.In many patients the infection waxes and wanes.^ In many patients the infection waxes and wanes.

^ Many patients with hepatitis B virus infection fail standard therapy.
  • Preventive Strategies in Chronic Liver Disease - November 1, 2001 - American Family Physician 19 November 2009 18:10 UTC www.aafp.org [Source type: Academic]

^ Immune function declines with age, and as patients live longer, many suffer recurrences of latent infections often acquired in early adulthood.

Tissue destruction and necrosis are balanced by healing and fibrosis.[42] .Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material.^ Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material.

^ Affected areas are eventually replaced by scar tissue.
  • Tuberculosis 20 September 2009 21:55 UTC www.night-sweats.net [Source type: FILTERED WITH BAYES]
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ Upon cure, affected areas are eventually replaced by scar tissue.

.During active disease, some of these cavities are joined to the air passages bronchi and this material can be coughed up.^ The patient should be informed that nasopharyngeal discharge and saliva are not sputum; rather, the material brought up from the lungs after a productive cough constitutes the material desired.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ The infection in these nodes may progress directly to clinical disease, may become active after many years, or may never become apparent.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ With many persons it commenced during the winter, and of these some were confined to bed, and others bore up on foot; the most of those died early in spring who were confined to bed; of the others, the cough left not a single person, but it became milder through the summer; during the autumn, all these were confined to bed, and many of them died, but in the greater number of cases the disease was long protracted.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

.It contains living bacteria and can therefore pass on infection.^ It contains living bacteria and can pass on infection.
  • Tuberculosis 20 September 2009 21:55 UTC www.night-sweats.net [Source type: FILTERED WITH BAYES]
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ It contains living bacteria and can therefore pass on infection.

^ People live in the same house with a person who has active TB. This increases the chance of inhaling TB-causing bacteria and developing an infection.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

Treatment with appropriate antibiotics kills bacteria and allows healing to take place. .Upon cure, affected areas are eventually replaced by scar tissue.^ Upon cure, affected areas are eventually replaced by scar tissue.

^ Affected areas are eventually replaced by scar tissue.

^ Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material.

[42]
.If untreated, infection with Mycobacterium tuberculosis can become lobar pneumonia.^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Hoop, 2002: Hoop RK Mycobacterium tuberculosis infection in a canary (Serinus canana L.) and a blue-fronted Amazon parrot (Amazona amazona aestiva).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Exogenous reinfection with multidrug-resistant Mycobacterium tuberculosis in patients with advanced HIV infection.

[44]

Diagnosis

Mycobacterium tuberculosis (stained red) in sputum
.Tuberculosis is diagnosed definitively by identifying the causative organism (Mycobacterium tuberculosis) in a clinical sample (for example, sputum or pus).^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Alveolar macrophages, which sample the alveolar mucosa for foreign organisms, ingest the M. tuberculosis bacilli and enclose them in phagosomes.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The situation becomes worse if the disease is caused by drug-resistant Mycobacterium tuberculosis isolates.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.When this is not possible, a probable - although sometimes inconclusive[2] - diagnosis may be made using imaging (X-rays or scans) and/or a tuberculin skin test (Mantoux test).^ There may not always be a positive reaction to a tuberculin skin test.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Slovis BS, Plitman JD, and Haas DW. The case against anergy testing as a routine adjunct to tuberculin skin testing.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Latest Research : Infectious Diseases : Tuberculosis Tuberculin skin tests not sensitive in detecting latent TB .

.The main problem with tuberculosis diagnosis is the difficulty in culturing this slow-growing organism in the laboratory (it may take 4 to 12 weeks for blood or sputum culture).^ M. tuberculosis is a very slow-growing, intracellular organism.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ If bacteria are growing, this positive culture confirms the diagnosis of tuberculosis.

^ Sputum induction for the diagnosis of tuberculosis.
  • Tuberculosis in Children: Abstract and Introduction 28 January 2010 1:01 UTC www.medscape.com [Source type: Academic]

.A complete medical evaluation for TB must include a medical history, a physical examination, a chest X-ray, microbiological smears, and cultures.^ Physical findings may include tubercles seen on examination of the optic fungi, hepatomegaly, splenomegaly, and generalized lymphadenopathy.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy may be useful in the evaluation of an abnormal chest radiograph when sputum smears are negative.

^ Latest Research : Infectious Diseases : Tuberculosis Chest X rays not Effective in Determining when TB is Acquired .

.It may also include a tuberculin skin test, a serological test.^ There may not always be a positive reaction to a tuberculin skin test.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Slovis BS, Plitman JD, and Haas DW. The case against anergy testing as a routine adjunct to tuberculin skin testing.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Latest Research : Infectious Diseases : Tuberculosis Tuberculin skin tests not sensitive in detecting latent TB .

.The interpretation of the tuberculin skin test depends upon the person's risk factors for infection and progression to TB disease, such as exposure to other cases of TB or immunosuppression.^ A person with both latent TB infection and HIV infection is at very high risk for TB disease.

^ Risk factors for developing TB include: .
  • Tuberculosis 28 January 2010 1:01 UTC www.umm.edu [Source type: Academic]

^ Discuss the factors that determine progression of infection to clinical disease.
  • TUBERCULOSIS 20 September 2009 21:55 UTC www.uic.edu [Source type: Academic]

[9]
.Currently, latent infection is diagnosed in a non-immunized person by a tuberculin skin test, which yields a delayed hypersensitivity type response to an extract made from M. tuberculosis.^ Unfortunately, not all persons infected with M. tuberculosis or M. bovis will have a delayed hypersensitivity reaction to a tuberculin skin test.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ The tuberculin skin test has been the traditional method of demonstrating infection with M. tuberculosis.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ Reliability of anergy skin testing in persons with HIV infection.

[1] .Those immunized for TB or with past-cleared infection will respond with delayed hypersensitivity parallel to those currently in a state of infection, so the test must be used with caution, particularly with regard to persons from countries where TB immunization is common.^ A person with TB infection will have no symptoms.
  • Tuberculosis - American Lung Association - Central States 28 January 2010 1:01 UTC breathehealthy.org [Source type: FILTERED WITH BAYES]

^ Those immunized for TB or with past-cleared infection will respond with parallel delayed hypersensitivity to those currently in a state of infection and thus must be used with caution, particularly with regard to persons from countries where TB immunization is common.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ TB skin tests are suggested for those: .
  • Tuberculosis (TB), Robert Wood Johnson University Hospital, New Brunswick, NJ, 08903 28 January 2010 1:01 UTC www.rwjuh.edu [Source type: Academic]

[45] .Tuberculin tests have the disadvantage of producing false negatives, especially when the patient is co-morbid with sarcoidosis, Hodgkins lymphoma, malnutrition, or most notably active tuberculosis disease.^ Tuberculosis of the central airways: CT findings of active and fibrotic disease.

^ Given the low prevalence of drug-resistant M. tuberculosis in most parts of the United States, the cost of routine testing of all initial isolates is difficult to justify.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ OCR for page 158 Tuberculosis in the Workplace ATS/CDC. Targeted tuberculin testing and treatment of latent tuberculosis infection.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[1] The newer interferon release assays (IGRAs) overcome many of these problems. .IGRAs are in vitro blood tests that are more specific than the skin test.^ Tests using highly purified antigens not widely available have been found to be more specific than those using PPD or other unpurified antigens.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ The only published report of which we are aware comparing the original and enhanced versions of the MTD indicated that the E-MTD was more sensitive than the original test (i.e., 94.7 versus 83% overall) and just as specific (i.e., 100% for both assays).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Although currently available tuberculin skin tests are substantially less than 100% sensitive and specific for detection of infection with M. tuberculosis, no better diagnostic methods have yet been devised.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

.IGRAs detect the release of interferon gamma in response to mycobacterial proteins such as ESAT-6.^ The test is based on the quantification of interferon-gamma (IFN-) released from sensitized lymphocytes in whole blood incubated overnight with purified protein derivative (PPD) from M. tuberculosis and control antigens ( CDC - Guidelines for safely working with M. tb ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Genetic polymorphisms in vitamin D receptor, vitamin D-binding protein, Toll-like receptor 2, nitric oxide synthase 2, and interferon-gamma genes and its association with susceptibility to tuberculosis.

^ Several new techniques have been developed to detect specific components produced either by the mycobacterial cells or by the diseased host in response to mycobacterial infection.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[46] .These are not affected by immunization or environmental mycobacteria, so generate fewer false positive results.^ Blumberg HM, White N, Parrott P, Gordon W, Hunter M, and Ray S. False-positive tuberculin skin test results among health care workers.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[47]There is also evidence that the T-SPOT.TB IGRA is more sensitive than the skin test[48]
.New TB tests are being developed that offer the hope of cheap, fast and more accurate TB testing.^ New tests are being developed.
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ Several new vaccines to prevent TB infection are being developed.

^ New TB tests are being developed that offer the hope of offering cheaper, faster and more accurate TB testing.

.These include polymerase chain reaction assays for the detection of bacterial DNA. The development of a rapid and inexpensive diagnostic test would be particularly valuable in the developing world.^ Kurabachew et al., 2004: Kurabachew M, Enger O, Sandaa RA, Skuce R, Bjorvatn B A multiplex polymerase chain reaction assay for genus-, group- and species-specific detection of mycobacteria.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The Mantoux test with 5 TU PPD may be used as a diagnostic aid to detect tuberculous infection and to determine the prevalence of infection in groups of people.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

^ To improve the diagnostic yield in children, diagnostic algorithms and point scoring systems are often used, particularly in less developed countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[49]

Prevention

.TB prevention and control takes two parallel approaches.^ TB prevention and control takes two parallel approaches.

^ In response to the emergence of XDR-TB, the WHO has published recommendations for its prevention and control [15].
  • NaTHNaC | TB Information Sheet, Health Professionals 28 January 2010 1:01 UTC www.nathnac.org [Source type: Academic]

^ It is essential to take all TB medication exactly as prescribed in order to cure TB and prevent drug resistance.
  • Tuberculosis 28 January 2010 1:01 UTC www.umm.edu [Source type: Academic]

.In the first, people with TB and their contacts are identified and then treated.^ In the first, people with TB and their contacts are identified and then treated.

^ In the 1940s, scientists discovered the first of several drugs now used to treat TB. As a result, TB slowly began to disappear in the United States.

^ TB disease finding and evaluating persons who have been in contact with TB patients to determine whether they have TB infection or disease, and treating them appropriately, and testing high-risk groups for TB infection to identify candidates for treatment of latent infection and to ensure the completion of treatment.

.Identification of infections often involves testing high-risk groups for TB. In the second approach, children are vaccinated to protect them from TB. No vaccine is available that provides reliable protection for adults.^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Therefore, after a positive skin test, active tuberculosis must be ruled out before providing treatment for latent infection.

^ Annual chest radiographs should be considered in this high-risk group.

However, in tropical areas where the levels of other species of mycobacteria are high, exposure to nontuberculous mycobacteria gives some protection against TB.[50]
.The World Health Organization (W.H.O.) declared TB a global health emergency in 1993, and the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between 2006 and 2015.[51] Since humans are the only host of Mycobacterium tuberculosis, eradication would be possible.^ Human macrophage host defense against Mycobacterium tuberculosis.

^ Geneva: World Health Organization, 2000a.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ A possible link between vitamin D deficiency and impaired host defence to Mycobacterium tuberculosis.

This goal would be helped greatly by an effective vaccine.[52]

Vaccines

.Many countries use Bacillus Calmette-Guérin (BCG) vaccine as part of their TB control programmes, especially for infants.^ Geographic latitude and the efficacy of bacillus Calmette-Guérin vaccine.

^ Applying experiences from trials of bacille Calmette-Guérin vaccine.

^ Trend analysis has also confirmed that MDR-TB is not a major problem in countries implementing tuberculosis control according to international guidelines for several years.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.According to the W.H.O., this is the most often used vaccine worldwide, with 85% of infants in 172 countries immunized in 1993.[53] This was the first vaccine for TB and developed at the Pasteur Institute in France between 1905 and 1921.[54] However, mass vaccination with BCG did not start until after World War II.^ They recommend greater use of ‘negative vaccination' in drug design, to prevent the West from developing TB vaccines destined to fail in Asia, Africa and Latin America, where an effective vaccine is most needed.

^ Scientists from UCL (University College London) warn that vaccines designed in the developed world do not take into account differences in immune systems across the globe.

^ However, delayed hypersensitivity to tuberculin, once it has been established by infection with any species of mycobacteria or by BCG vaccination, may gradually wane over the years, resulting in reactions that are negative.
  • Diagnostic Standards and Classification of Tuberculosis 28 January 2010 1:01 UTC wonder.cdc.gov [Source type: Academic]

[55] .The protective efficacy of BCG for preventing serious forms of TB (e.g.^ It is the one form of TB believed to be prevented in childhood by vaccination with BCG. .
  • Tuberculosis (TB): Mycobacteria: Merck Manual Professional 28 January 2010 1:01 UTC www.merck.com [Source type: Academic]

^ Efficacy of BCG vaccination in the prevention of tuberculosis.

^ The protective efficacy of BCG for preventing serious forms of TB (e.g.
  • Tuberculosis 20 September 2009 21:55 UTC www.night-sweats.net [Source type: FILTERED WITH BAYES]
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

.meningitis) in children is greater than 80%; its protective efficacy for preventing pulmonary TB in adolescents and adults is variable, ranging from 0 to 80%.^ However, the protective efficacy for preventing pulmonary TB in adolescents and adults is variable, from 0 to 80%.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ The protective efficacy of BCG for preventing serious forms of TB (e.g.
  • Tuberculosis 20 September 2009 21:55 UTC www.night-sweats.net [Source type: FILTERED WITH BAYES]
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ Vaccination can prevent severe TB in children.
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

[56]
.In South Africa, the country with the highest prevalence of TB, BCG is given to all children under age three.^ Of the 10 countries with the highest incidence, nine are in Africa.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The situation is compounded by the fact that on average, 30-40% of the TB cases in Africa are HIV positive, this figure reaching 70% in some countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Healthcare : South Africa XDR TB in South Africa traced to lack of drug susceptibility testing .

[57] .However, BCG is less effective in areas where mycobacteria are less prevalent; therefore BCG is not given to the entire population in these countries.^ The effectiveness of BCG is much lower than in areas where mycobacteria are much less prevalent.

^ The effectiveness of BCG is much lower in areas where mycobacteria are less prevalent .
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ However, the effectiveness of BCG is lower in areas where mycobacteria are less prevalent, therefore BCG is not given to the entire population in these countries.

In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria:[9]
  • Infants or children with negative skin test results who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to multidrug-resistant TB.
  • Healthcare workers considered on an individual basis in settings in which a high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and were not successful.
.BCG provides some protection against severe forms of pediatric TB, but has been shown to be unreliable against adult pulmonary TB, which accounts for most of the disease burden worldwide.^ BCG vaccine offers protection in children against the most severe forms of the disease, including meningeal and miliary TB [21].
  • NaTHNaC | TB Information Sheet, Health Professionals 28 January 2010 1:01 UTC www.nathnac.org [Source type: Academic]

^ Most TB disease is pulmonary.

^ However, it does not protect against TB in adults.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

Currently, there are more cases of TB on the planet than at any other time in history and most agree there is an urgent need for a newer, more effective vaccine that would prevent all forms of TB—including drug resistant strains—in all age groups and among people with HIV.[58]
.Several new vaccines to prevent TB infection are being developed.^ New tests are being developed.
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ CDC. Development of new vaccines for tuberculosis.
  • Tuberculosis: eMedicine Pediatrics: General Medicine 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

^ Several new vaccines to prevent TB infection are being developed.

.The first recombinant tuberculosis vaccine rBCG30, entered clinical trials in the United States in 2004, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID).^ Control of tuberculosis in the United States.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Tuberculosis morbidity - United States, 1992.

^ Reported Tuberculosis in the United States, 1999.

[59] .A 2005 study showed that a DNA TB vaccine given with conventional chemotherapy can accelerate the disappearance of bacteria as well as protect against re-infection in mice; it may take four to five years to be available in humans.^ This model is also likely to be useful for studying vaccines against tuberculosis, as well as for drug studies, particularly those drugs that might affect bacilli during latent infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Scientists have shown that a single 2.5mg dose of vitamin D may be enough to boost the immune system to fight against tuberculosis (TB) and similar bacteria for at least 6 weeks.

^ Comparative abilities of various metabolites of vitamin D to protect cultured human macrophages against tubercle bacilli.

[60] .A very promising TB vaccine, MVA85A, is currently in phase II trials in South Africa by a group led by Oxford University,[61] and is based on a genetically modified vaccinia virus.^ Healthcare : South Africa XDR TB in South Africa traced to lack of drug susceptibility testing .

^ Tuberculosis (TB) vaccines currently on trial at a cost of hundreds of millions of dollars will fail to protect populations living close to the Equator, warns a review published in Nature Reviews Immunology .

.Many other strategies are also being used to develop novel vaccines,[62] including both subunit vaccines (fusion molecules composed of two recombinant proteins delivered in an adjuvant) such as Hybrid-1, HyVac4 or M72, and recombinant adenoviruses such as Ad35.[63][64][65][66] Some of these vaccines can be effectively administered without needles, making them preferable for areas where HIV is very common.^ They recommend greater use of ‘negative vaccination' in drug design, to prevent the West from developing TB vaccines destined to fail in Asia, Africa and Latin America, where an effective vaccine is most needed.

^ In some instances earlier, and in others later, inflammations with pain seized sometimes one of the testicles, and sometimes both; some of these cases were accompanied with fever and some not; the greater part of these were attended with much suffering.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

^ Quotidian, nocturnal, and wandering fevers attacked many persons, some of whom continued to keep up, and others were confined to bed.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

[67] All of these vaccines have been successfully tested in humans and are now in extended testing in TB-endemic regions. .To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and advance market commitments.^ Latest Research : Infectious Diseases : Tuberculosis TB vaccines will fail in developing countries .

^ New mathematical model aids Big Bang supercomputer research .

[68][69]
.The Bill and Melinda Gates Foundation has been a strong supporter of new TB vaccine development.^ Latest Research : Infectious Diseases : Tuberculosis TB vaccines will fail in developing countries .

.Most recently, it announced a $200 million grant to the Aeras Global TB Vaccine Foundation for clinical trials on up to six different TB vaccine candidates currently in the pipeline.^ On a global level, 80% of the 8 million TB cases occurring annually are in only 22 countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Tuberculosis (TB) vaccines currently on trial at a cost of hundreds of millions of dollars will fail to protect populations living close to the Equator, warns a review published in Nature Reviews Immunology .

^ Mycobacterium tuberculosis is one of most successful pathogens of mankind, infecting one-third of the global population and claiming two million lives every year.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[70]

Screening

.Mantoux tuberculin skin tests are often used for routine screening of high risk individuals.^ Slovis BS, Plitman JD, and Haas DW. The case against anergy testing as a routine adjunct to tuberculin skin testing.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Latest Research : Infectious Diseases : Tuberculosis Tuberculin skin tests not sensitive in detecting latent TB .

^ Ozuah PO, Burton W, Lerro KA, Rosenstock J, and Mulvihill M. Assessing the validity of tuberculin skin test readings by trained professionals and patients.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[71]
.Interferon-γ release assays are blood tests used in the diagnosis of some infectious diseases.^ Latest Research : Infectious Diseases : Tuberculosis Tuberculin skin tests not sensitive in detecting latent TB .

^ Latest Research : Infectious Diseases : Tuberculosis Blood-based TB test matches up to old skin test .

^ The test is based on the quantification of interferon-gamma (IFN-) released from sensitized lymphocytes in whole blood incubated overnight with purified protein derivative (PPD) from M. tuberculosis and control antigens ( CDC - Guidelines for safely working with M. tb ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

There are currently two interferon-γ release assays available for the diagnosis of tuberculosis:
.Chest photofluorography has been used in the past for mass screening for tuberculosis.^ Identifying genetic susceptibility factors for tuberculosis in Africans: a combined approach using a candidate gene study and a genome-wide screen.

Treatment

.Treatment for TB uses antibiotics to kill the bacteria.^ UCL scientists have found a protein that could unlock the secret to quicker, more effective treatment of TB by waking TB bacteria in the body.

^ Once the TB bacteria are active again, the disease becomes treatable using common drugs like antibiotics.

.Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which makes many antibiotics ineffective and hinders the entry of drugs.^ Drug Resistance: The treatment of patients whose organisms are resistant to standard drugs or who do not tolerate them is difficult.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[72][73][74][75] .The two antibiotics most commonly used are rifampicin and isoniazid.^ Periodic surveys have shown that more than 10% of new tuberculosis cases in Estonia, Latvia, and some parts of Russia are multi-drug resistant ie, resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ PREGNANCY: Isoniazid, rifampicin, pyrazinamide, and ethambutol are not teratogenic, and WHO recommends their use in women who are pregnant.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ At least two bactericidal drugs, isoniazid and rifampicin, are necessary in the initial phase.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.However, instead of the short course of antibiotics typically used to cure other bacterial infections, TB requires much longer periods of treatment (around 6 to 24 months) to entirely eliminate mycobacteria from the body.^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ All major organisations agree that some forms of disease, such as meningitis, may benefit from a longer treatment course.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The finding could help scientists develop ways to treat dormant TB infections, and suggests a strategy for drug development against other bacteria as well.

[9] .Latent TB treatment usually uses a single antibiotic, while active TB disease is best treated with combinations of several antibiotics, to reduce the risk of the bacteria developing antibiotic resistance.^ Once the TB bacteria are active again, the disease becomes treatable using common drugs like antibiotics.

^ Contraindicator: Same as those from Active Pulmonary disease ( Frieden et al., 2003 ) Complication: Same as those from Active Pulmonary disease ( Frieden et al., 2003 ) Drug Resistance: Same as those from Active Pulmonary disease ( Frieden et al., 2003 ) Antibiotics for Latent TB Infection (LTBI) : Although a 9-mo regimen of isoniazid is the preferred regimen for the treatment of LTBI, a 6-mo regimen also provides substantial protection and has been shown to be superior to placebo in both HIV-negative and HIV-positive persons.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[76] .People with latent infections are treated to prevent them from progressing to active TB disease later in life.^ People with latent TB don't have symptoms unless the disease becomes active.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

^ Many people who have latent tuberculosis infection never develop active tuberculosis disease.
  • Tuberculosis - Medpedia 28 January 2010 1:01 UTC wiki.medpedia.com [Source type: Academic]

^ What is latent TB infection?

.Drug resistant tuberculosis is transmitted in the same way as regular TB. Primary resistance occurs in persons who are infected with a resistant strain of TB. A patient with fully susceptible TB develops secondary resistance (acquired resistance) during TB therapy because of inadequate treatment, not taking the prescribed regimen appropriately, or using low quality medication.^ If drug susceptibility testing is not available, standard retreatment regimens can be used.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Drug Resistance: The treatment of patients whose organisms are resistant to standard drugs or who do not tolerate them is difficult.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Drug Resistance: Contacts of patients with isoniazid-resistant tuberculosis.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[76] .Drug-resistant TB is a public health issue in many developing countries, as treatment is longer and requires more expensive drugs.^ Drug treatment is an individual and public health measure.

^ Treatment of resistant TB, especially MDRTB, is frequently unsuccessful, requiring the use of more toxic, expensive drugs, surgery, or both.

^ TB that is resistant to multiple-drug therapy.
  • Tuberculosis (TB) - Revolution Health 28 January 2010 1:01 UTC www.revolutionhealth.com [Source type: FILTERED WITH BAYES]

.Multi-drug-resistant tuberculosis (MDR-TB) is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid.^ Drug Resistance: Contacts of patients with isoniazid-resistant tuberculosis.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

^ They recommend greater use of ‘negative vaccination' in drug design, to prevent the West from developing TB vaccines destined to fail in Asia, Africa and Latin America, where an effective vaccine is most needed.

.Extensively drug-resistant TB (XDR-TB) is also resistant to three or more of the six classes of second-line drugs.^ In South Africa, the 2001 implementation of the World Health Organizations anti-tuberculosis program may have inadvertently helped to create a new strain of extensively drug-resistant tuberculosis (XDR TB).

^ Most Americans think of tuberculosis as a disease of the past, but with HIV and drug-resistant strains fueling epidemics in India and Africa, TB kills someone every six seconds across the world.

^ Healthcare : South Africa XDR TB in South Africa traced to lack of drug susceptibility testing .

[77] .The DOTS (Directly Observed Treatment Short-course) strategy of tuberculosis treatment recommended by WHO was based on clinical trials done in the 1970s by Tuberculosis Research Centre, Chennai, India.^ Protein fractions of blood serum in the course of skin tuberculosis treatment.

^ Improved vitamin D status despite allocation to placebo in a tuberculosis treatment trial: contamination bias?

^ Patients with infectious tuberculosis who are imprisoned and those who are released from prison before treatment completion may play an important role in the disease epidemiology.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.The country in which a person with TB lives can determine what treatment they receive.^ Persons with LTBI who are included among those at increased risk for TB should be offered treatment.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The transient nature of a homeless persons life often interferes with the timely diagnosis and successful treatment of TB ( McElroy et al., 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.This is because multidrug-resistant tuberculosis is resistant to most first-line medications, the use of alternative treatments, often referred to as "second-line" antituberculosis medications, is necessary to cure the patient.^ A nosocomial outbreak of multidrug-resistant tuberculosis.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ OCR for page 161 Tuberculosis in the Workplace CDC. Updated guidelines for the use of rifabutin or rifampin for the treatment and prevention of tuberculosis among HIV-infected patients taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Most Americans think of tuberculosis as a disease of the past, but with HIV and drug-resistant strains fueling epidemics in India and Africa, TB kills someone every six seconds across the world.

.However, the price of these medications is high; thus poor people in the developing world have no or limited access to these treatments.^ New findings from a Dartmouth Medical School collaboration in Tanzania may alter assumptions about the diagnosis of tuberculosis in HIV-infected people, and prompt a major change in way TB testing is routinely done in the developing world.

^ Directly observed treatment, in which a trained observer personally observes each dose of medication being swallowed by the patient, can ensure high rates of treatment completion, reduce development of acquired drug resistance, and prevent relapse.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[78]

Recurrence

.Studies utilizing DNA fingerprinting of M. tuberculosis strains have shown that reinfection contributes more substantially to recurrent TB than previously thought,[79] with between 12% and 77% of cases attributable to reinfection (instead of reactivation).^ Periodic surveys have shown that more than 10% of new tuberculosis cases in Estonia, Latvia, and some parts of Russia are multi-drug resistant ie, resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ RFLP of IS6110 for strain typing : Ontology : UMLS:xxx Time to Perform : more-than-7-days Description: The insertion sequence IS6110 is present in different copy numbers (between 0 and 25 copies) in the M. tuberculosis complex and is integrated at various chromosomal sites.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In a new study published in the December 1 issue of Clinical Infectious Diseases, currently available online, researchers tracked the developing drug resistance of one particular strain of Mycobacterium tuberculosis over 12 years.

[80]

Prognosis

.Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and begin to multiply.^ They are stopped from multiplying by the immune system.
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ In some people, the tubercle bacilli overcome the defenses of the immune system and begin to multiply, resulting in the advancement to active TB disease.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and begin to multiply.

.In primary TB disease—1–5% of cases—this occurs soon after infection.^ Infection progressing into active TB disease - occurs in some cases .
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

^ TB infection is not considered a case of TB disease.

^ In primary TB disease—1 to 5% of cases—this occurs soon after infection.

[1] .However, in the majority of cases, a latent infection occurs that has no obvious symptoms[1].^ This failure of containment may occur in either latent or recently acquired tuberculous infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In the phrenitic cases, all the symptoms which have been described did not occur, but in them the disease mostly came to a crisis on the eleventh day, and in some on the twentieth.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

.These dormant bacilli can produce tuberculosis in 2–23% of these latent cases, often many years after infection.^ This is called latent tuberculosis infection.
  • Tuberculosis - Medpedia 28 January 2010 1:01 UTC wiki.medpedia.com [Source type: Academic]

^ It is likely that many of these cases acquired infection in their country of origin.
  • NaTHNaC | TB Information Sheet, Health Professionals 28 January 2010 1:01 UTC www.nathnac.org [Source type: Academic]

^ People with latent tuberculosis infection: .
  • Tuberculosis - Medpedia 28 January 2010 1:01 UTC wiki.medpedia.com [Source type: Academic]

[81] .The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV.^ HIV infection accounts for much of the recent increase in the global tuberculosis burden.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Because of HIV or other causes of immunosuppression, the organism proliferates and disseminates throughout the body.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The increase in tuberculosis incidence in Africa is strongly associated with the prevalence of HIV infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.In patients co-infected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year.^ Pulmonary tuberculosis in HIV-infected patients in Zaire.

^ In HIV infected persons with TB infection, the risk increases to 10% each year instead of 10% over a lifetime.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ In patients co-infected with M. tuberculosis and HIV , the risk of reactivation increases to 10% per year.

[1][37]

Epidemiology

.
Age-standardized death from tuberculosis per 100,000 inhabitants in 2004.[82]
     no data      ≤ 10      10-25      25-50      50-75      75-100      100-250      250-500      500-750      750-1000      1000-2000      2000-3000      ≥ 3000
World map with sub-Saharan Africa in various shades of yellow, marking prevalences above 300 per 100,000, and with the U.S., Canada, Australia, and northern Europe in shades of deep blue, marking prevalences around 10 per 100,000. Asia is yellow but not quite so bright, marking prevalences around 200 per 100,000 range.</span><span class=^ Gemsbok ( Website 25 ): Ontology: UMLS:xxx GenBank Taxonomy No.: 9958 Scientific Name: Oryx gazella ( Website 25 ) Description: Mycobacterium tuberculosis produced progressive disease in 2 oryxes and was the apparent cause of the death of 1 of the animals.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Complication: ( American Thoracic Society et al., 2000 ) Two recent studies reviewed data on patients who received prophylaxis according to the 1983 guidelines and found that the rate of fatal hepatitis was 1 to 1.7 per 100,000 for persons of all ages and approximately 2 per 100,000 for persons older than 35 years of age.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In 2000, the incidence and mortality associated with tuberculosis in Russian prisons were 3174 cases and 171 deaths per 100,000 prisoners, respectively.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

South America is a darker yellow." src="http://images-mediawiki-sites.thefullwiki.org/09/2/6/9/97867932156455974.png" width="220" height="97" class="thumbimage" />
.
In 2007, the prevalence of TB per 100,000 people was highest in sub-Saharan Africa, and was also relatively high in Asia.
^ However, in regions of the world such as sub-Saharan Africa where adult TB is increasing, this trend is likely occurring among children as well.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ By contrast, there have been striking increases in countries of the former Soviet Union and in sub-Saharan Africa.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Sub-Saharan Africa has the highest incidence rate (290 per 100000 population), but the most populous countries of Asia have the largest numbers of cases: India, China, Indonesia, Bangladesh, and Pakistan together account for more than half the global burden.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[83]
.
Annual number of new reported TB cases.
^ On a global level, 80% of the 8 million TB cases occurring annually are in only 22 countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Just over one million new sputum smear-positive cases were notified under DOTS in 2000, approximately the same number that was registered for treatment in 2000.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

Data from WHO.[84]
.Roughly a third of the world's population has been infected with M. tuberculosis, and new infections occur at a rate of one per second.^ A. Outbreak Locations: Tuberculosis in Africa has reached epidemic proportions, with an estimated 2 million new cases occurring annually, increasing at a rate of 10% each year, largely as a result of HIV co-infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Evaluation of infection control measures in preventing nosocomial transmission of multidrugresistant Mycobacterium tuberculosis in a New York City hospital.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Rates of HIV infection among tuberculosis patients are correspondingly high, exceeding 60% in Botswana, South Africa, Zambia, and Zimbabwe.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[4] .However, not all infections with M. tuberculosis cause TB disease and many infections are asymptomatic.^ The ability of the bacteria to persist in the form of a long-term asymptomatic infection, referred to as latent tuberculosis, is central to the biology of the disease ( Stewart et al., 2003 ) Approximately eight million people develop active tuberculosis (TB) every year, with two million dying from the disease.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The radiologic differential diagnosis for renal tuberculosis includes other causes of papillary necrosis, transitional cell carcinoma, and other infections.

[85] .In 2007, an estimated 13.7 million people had active TB disease, with 9.3 million new cases and 1.8 million deaths; the annual incidence rate varied from 363 per 100,000 in Africa to 32 per 100,000 in the Americas.^ A. Outbreak Locations: Tuberculosis in Africa has reached epidemic proportions, with an estimated 2 million new cases occurring annually, increasing at a rate of 10% each year, largely as a result of HIV co-infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Overall mortality among cases during the outbreak period was 69.2% (9 / 13); five cases had received less than 2 weeks of treatment for MDR-TB at the time of death ( Conover et al., 2001 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ On a global level, 80% of the 8 million TB cases occurring annually are in only 22 countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[5] .Tuberculosis is the world's greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/AIDS.^ Tuberculosis is the world's second commonest cause of death from infectious disease, after HIV/AIDS. There were an estimated 89 million new cases of tuberculosis in 2000, fewer than half of which were reported; 34 million cases were sputum-smear positive, the most infectious form of the disease.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Consequently, the numbers of TB cases in Africa are projected to double in the next decade because of the HIV epidemic and under-funding of effective strategies against TB. TB is the world's leading killer among infectious diseases, with one person dying of it every 15 s across the globe.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In addition to this already huge burden of disease, it is estimated that up to two billion people have been infected with the causative agent, Mycobacterium tuberculosis .
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[86]
.The rise in HIV infections and the neglect of TB control programs have enabled a resurgence of tuberculosis.^ The rise in HIV infections and the neglect of TB control programs have enabled a resurgence of tuberculosis.

^ HIV/AIDS, the neglect of TB control programs, and immigration have caused a resurgence of tuberculosis.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ Blumberg, HM. Tuberculosis infection control.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[87] .The emergence of drug-resistant strains has also contributed to this new epidemic with, from 2000 to 2004, 20% of TB cases being resistant to standard treatments and 2% resistant to second-line drugs.^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

^ Periodic surveys have shown that more than 10% of new tuberculosis cases in Estonia, Latvia, and some parts of Russia are multi-drug resistant ie, resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ At the same time, drug resistance among TB patients in Latvia seems to be the highest in the world, with primary multidrug resistance found in 8.6% of new cases and in 34.5% of all TB patients in the year 2000 ( Tracevska et al., 2002 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[77] .The rate at which new TB cases occur varies widely, even in neighboring countries, apparently because of differences in health care systems.^ TB incidence varies widely, even in neighboring countries, apparently because of differences in health care systems.

^ The incidence of TB has been declining since the early 20th century because various factors, including basic infection-control practices (isolation).
  • Tuberculosis: eMedicine Infectious Diseases 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

^ The secondary lesions caused by milliary TB can occur at almost any anatomical location, but usually involve the genitourinary system, bones, joints, lymph nodes and peritoneum.

[88]
.In 2007, the country with the highest estimated incidence rate of TB was Swaziland, with 1200 cases per 100,000 people.^ On a global level, 80% of the 8 million TB cases occurring annually are in only 22 countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Of the 10 countries with the highest incidence, nine are in Africa.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The situation is compounded by the fact that on average, 30-40% of the TB cases in Africa are HIV positive, this figure reaching 70% in some countries.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.India had the largest total incidence, with an estimated 2.0 million new cases.^ A. Outbreak Locations: Tuberculosis in Africa has reached epidemic proportions, with an estimated 2 million new cases occurring annually, increasing at a rate of 10% each year, largely as a result of HIV co-infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Just over one million new sputum smear-positive cases were notified under DOTS in 2000, approximately the same number that was registered for treatment in 2000.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[5] .The Philippines ranks fourth in the world for the number of cases of tuberculosis and has the highest number of cases per head in Southeast Asia.^ In 2000, the incidence and mortality associated with tuberculosis in Russian prisons were 3174 cases and 171 deaths per 100,000 prisoners, respectively.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Sub-Saharan Africa has the highest incidence rate (290 per 100000 population), but the most populous countries of Asia have the largest numbers of cases: India, China, Indonesia, Bangladesh, and Pakistan together account for more than half the global burden.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.Almost two thirds of Filipinos have tuberculosis, and up to an additional five million people are infected yearly [89].^ In addition to this already huge burden of disease, it is estimated that up to two billion people have been infected with the causative agent, Mycobacterium tuberculosis .
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ About two million people died of tuberculosis in 2000; about 13% of these people were also infected with HIV ( Frieden et al., 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ CT appearances in macronodular hepatosplenic tuberculosis: a review with five additional new cases.

.In developed countries, tuberculosis is less common and is mainly an urban disease.^ In developed countries, tuberculosis is less common and is mainly an urban disease.

^ In developing countries, it is a disease of young adults.
  • Tuberculosis: Infections: Merck Manual Home Edition 20 September 2009 21:55 UTC www.merck.com [Source type: FILTERED WITH BAYES]

^ Intestine: Intestinal tuberculosis occurs mainly in developing countries.
  • Tuberculosis: Infections: Merck Manual Home Edition 20 September 2009 21:55 UTC www.merck.com [Source type: FILTERED WITH BAYES]

.In the United Kingdom, the national average was 15 per 100,000 in 2007, and the highest incidence rates in Western Europe were 30 per 100,000 in Portugal and Spain.^ We used the value of 47 cases annually per 100,000 reactors; this value is the mean of the higher (65 cases per 100,000) and lower (28 cases per 100,000) rates reported ( Taylor et al., 1981 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In 2000, the incidence and mortality associated with tuberculosis in Russian prisons were 3174 cases and 171 deaths per 100,000 prisoners, respectively.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ From 1991 to 1998, the incidence of TB in Latvia increased, reaching a rate of 74 per 100,000 inhabitants.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.These rates compared with 98 per 100,000 in China and 48 per 100,000 in Brazil.^ We used the value of 47 cases annually per 100,000 reactors; this value is the mean of the higher (65 cases per 100,000) and lower (28 cases per 100,000) rates reported ( Taylor et al., 1981 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In 2000, the incidence and mortality associated with tuberculosis in Russian prisons were 3174 cases and 171 deaths per 100,000 prisoners, respectively.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ From 1991 to 1998, the incidence of TB in Latvia increased, reaching a rate of 74 per 100,000 inhabitants.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.In the United States, the overall tuberculosis case rate was 4 per 100,000 persons in 2007.[83] In Canada tuberculosis is still endemic in some rural areas.^ Control of tuberculosis in the United States.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ We used the value of 47 cases annually per 100,000 reactors; this value is the mean of the higher (65 cases per 100,000) and lower (28 cases per 100,000) rates reported ( Taylor et al., 1981 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Geiter L. Defining tuberculosis elimination in the United States?
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[90]
.The incidence of TB varies with age.^ The incidence of TB varies with age.

^ The incidence of TB is known to vary with age.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ The incidence of TB has been declining since the early 20th century because various factors, including basic infection-control practices (isolation).
  • Tuberculosis: eMedicine Infectious Diseases 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

.In Africa, TB primarily affects adolescents and young adults.^ In Africa, TB primarily affects adolescents and young adults.

^ In endemic areas, TB is a disease that primarily affects adolescents and young adults (hence the UK policy until recently was to vaccinate with BCG at the age of 12).
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ However, in regions of the world such as sub-Saharan Africa where adult TB is increasing, this trend is likely occurring among children as well.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[91] .However, in countries where TB has gone from high to low incidence, such as the United States, TB is mainly a disease of older people, or of the immunocompromised [1][92].^ However, in regions of the world such as sub-Saharan Africa where adult TB is increasing, this trend is likely occurring among children as well.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Applicable: Treatment of LTBI is an essential part of the strategy to eliminate TB in the United States.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Etkind SC and Veen J. Contact follow-up in high- and low-prevalence countries.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

.There are a number of known factors that make people more susceptible to TB infection: worldwide the most important of these is HIV.^ But these things were more formidable in appearance than dangerous; for when the concoction in these cases turned to a these cases turned to a suppuration, most of them recovered; but when the inflammation and erysipelas disappeared, and when no abscess was formed, a great number of these died.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

^ In the first place, tenesmus, accompanied with pain, attacked many, but more especially children, and all who had not attained to puberty; and the most of these died.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

^ The crisis, however, changed, and happened to the greater number on the fifth day from the commencement, left them for four days and relapsed; and after the return, there was a crisis on the fifth day, making in all fourteen days.
  • Of The Epidemics, by Hippocrates 16 September 2009 0:26 UTC ebooks.adelaide.edu.au [Source type: Original source]

.Co-infection with HIV is a particular problem in Sub-Saharan Africa, due to the high incidence of HIV in these countries.^ HIV/AIDS co-infection PUBLICATIONS .
  • Southeastern National Tuberculosis Center 28 January 2010 1:01 UTC sntc.medicine.ufl.edu [Source type: Academic]

^ The countries with the highest TB/HIV co-infection rates continue to be in Sub-saharan Africa, where HIV is ravaging the population.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ Co-infection with HIV is a particular problem in Sub-Saharan Africa, due to the high incidence of HIV in these countries.

[93][94] .Smoking more than 20 cigarettes a day also increases the risk of TB by two to four times.^ Smoking more than 20 cigarettes a day also increases the risk of TB by two- to four-times.

^ Increased risk of becoming infected with M.Tb: .

^ SETTING: It has been well documented that smoking increases the risk of tuberculosis (TB).
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

[95][96] .Diabetes mellitus is also an important risk factor that is growing in importance in developing countries.^ Diabetes mellitus is also an important risk factor that is growing in importance in developing countries.

^ Other risk factors include diabetes mellitus, renal failure, coexistent malignancies, malnutrition, silicosis, immunosuppressive therapies (including steroids and anti-TNF drugs), and TNF-α receptor, IFN-γ receptor, or IL-12 β 1 receptor defects.

^ Design Case-control study of exposure to a variety of risk factors before and during the development of pulmonary tuberculosis.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

[97] .Other disease states that increase the risk of developing tuberculosis are Hodgkin lymphoma, end-stage renal disease, chronic lung disease, malnutrition, and alcoholism.^ In addition to immunocompromised individuals, other population groups who are at increased risk include minorities, the poor, alcoholics, immigrants from third-world countries, prisoners, the aged, nursing home residents, and the homeless.

^ International Journal of Tuberculosis and Lung Disease 4:308–313, 2000.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

^ Coeliac disease and risk of tuberculosis: a population based cohort study.

[1]
Diet may also modulate risk. .For example, among immigrants in London from the Indian subcontinent, vegetarian Hindu Asians were found to have an 8.5 fold increased risk of tuberculosis, compared to Muslims who ate meat and fish daily.^ Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians.

^ In addition to immunocompromised individuals, other population groups who are at increased risk include minorities, the poor, alcoholics, immigrants from third-world countries, prisoners, the aged, nursing home residents, and the homeless.

^ Comparable specificity of 2 commercial tuberculin reagents in persons at low risk for tuberculosis infections.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

[98] .Although a causal link is not proved by this data,[99] this increased risk could be caused by micronutrient deficiencies: possibly iron, vitamin B12 or vitamin D.[98] Further studies have provided more evidence of a link between vitamin D deficiency and an increased risk of contracting tuberculosis.^ A possible link between vitamin D deficiency and impaired host defence to Mycobacterium tuberculosis.

^ Evaluation of vitamin D deficiency in pulmonary tuberculosis.

^ Tuberculosis and vitamin D deficiency.

[100][101] .Globally, the severe malnutrition common in parts of the developing world causes a large increase in the risk of developing active tuberculosis, due to its damaging effects on the immune system.^ The risk of reactivation increases if the immune system is weakened for any reason.
  • Tuberculosis -- eCureMe.com 28 January 2010 1:01 UTC www.ecureme.com [Source type: FILTERED WITH BAYES]

^ Severely weakened immune system.
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

^ In parts of the world where tuberculosis is common, tuberculous pericarditis is a common cause of heart failure.
  • Tuberculosis: Infections: Merck Manual Home Edition 20 September 2009 21:55 UTC www.merck.com [Source type: FILTERED WITH BAYES]

[102][103] .Along with overcrowding, poor nutrition may contribute to the strong link observed between tuberculosis and poverty.^ Exploring the relationship between tuberculosis and nutrition .
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ Between August 1996 and May 2000, Mycobacterium tuberculosis was isolated form 18 of 539 elephants in North America, indicating an estimated prevalence of 3.3%.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ There is increasing evidence of a link between tuberculosis and smoking.
  • CORK Bibliography: Tuberculosis 28 January 2010 1:01 UTC www.projectcork.org [Source type: Academic]

[104][105]

History

Tuberculosis has been present in humans since antiquity. .The earliest unambiguous detection of Mycobacterium tuberculosis is in the remains of bison dated 18,000 years before the present.^ The earliest unambiguous detection of Mycobacterium tuberculosis is in the remains of bison dated 17,000 years before the present.

^ Between August 1996 and May 2000, Mycobacterium tuberculosis was isolated form 18 of 539 elephants in North America, indicating an estimated prevalence of 3.3%.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ Molecular evidence of endogenous reactivation of Mycobacterium tuberculosis after 33 years of latent infection.
  • PLoS Pathogens: Ancient Origin and Gene Mosaicism of the Progenitor of Mycobacterium tuberculosis 16 September 2009 0:26 UTC www.plospathogens.org [Source type: Academic]

[106] .Whether tuberculosis originated in cattle and then transferred to humans, or diverged from a common ancestor infecting a different species, is currently unclear.^ However, whether tuberculosis originated in cattle and then transferred to humans, or diverged from a common ancestor, is currently unclear.

^ The Mycobacterium tuberculosis forms a complex with other higher related bacteria called the M. tuberculosis complex that consists of 6 members: Mycobacterium tuberculosis and Mycobacterium africanmum , which infect humans; Mycobacterium microti , which infects vole; Mycobacterium bovis , which infects other mammalian species as well as humans; M. bovis BCG , a variant of Mycobacterium bovis and Mycobacterium canettii , a pathogen that infects humans.
  • Mycobacterium tuberculosis - MicrobeWiki 28 January 2010 1:01 UTC microbewiki.kenyon.edu [Source type: Academic]

^ Before milk was routinely pasteurised cattle infected with ‘’M. bovis’’, the bovine variant of tuberculosis could pass disease to humans who drank infected milk.
  • Tuberculosis - Medpedia 28 January 2010 1:01 UTC wiki.medpedia.com [Source type: Academic]

[107] .However, it is clear that M. tuberculosis is not directly descended from M. bovis, which seems to have evolved relatively recently.^ However, these indirect methods for TB diagnosis have not been proven valid in most exotic species susceptible to Mycobacterium tuberculosis complex (which includes M. bovis ) infection.
  • Tuberculosis (TB) in Elephants 28 January 2010 1:01 UTC www.elephantcare.org [Source type: Academic]

^ Pulmonary tuberculosis, however, is a disease that is relatively easy to diagnose in its lethal stages.
  • Tuberculosis 20 September 2009 21:55 UTC www.bikupan.se [Source type: Academic]

[108]
Tubercular decay has been found in the spines of Egyptian mummies. Pictured: Egyptian mummy in the British Museum
.Skeletal remains from a Neolithic Settlement in the Eastern Mediterranean show prehistoric humans (7000 BC) had TB,[109] and tubercular decay has been found in the spines of mummies from 3000–2400 BC.[110] Phthisis is a Greek term for tuberculosis; around 460 BC, Hippocrates identified phthisis as the most widespread disease of the times involving coughing up blood and fever, which was almost always fatal.^ Peritoneal involvement in tuberculosis is rare and is usually associated with widespread abdominal disease involving lymph nodes or bowel ( 52 , 58 ).

^ Tuberculosis of the liver and spleen is most likely secondary to hematogenous dissemination of the primary form of the disease.

^ Two or more segments are involved in most cases, and bilateral upper lobe disease may be present.

[111] .In South America, the earliest evidence of tuberculosis is associated with the Paracas-Caverna culture (circa 750 BC to circa 100 AD).^ Association of HLA-DR, -DQ, and vitamin D receptor alleles and haplotypes with tuberculosis in the Venda of South Africa.

^ In 2000, the incidence and mortality associated with tuberculosis in Russian prisons were 3174 cases and 171 deaths per 100,000 prisoners, respectively.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[112][113]

Other names

.In the past, tuberculosis has been called consumption, because it seemed to consume people from within, with a bloody cough, fever, pallor, and long relentless wasting.^ It should be noted, however, that fever from tuberculosis may persist for as long as 2 months after therapy has been initiated.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.Other names included phthisis (Greek for consumption) and phthisis pulmonalis; scrofula (in adults), affecting the lymphatic system and resulting in swollen neck glands; tabes mesenterica, TB of the abdomen and lupus vulgaris, TB of the skin; wasting disease; white plague, because sufferers appear markedly pale; king's evil, because it was believed that a king's touch would heal scrofula; and Pott's disease, or gibbus of the spine and joints.^ Treatment of lupus vulgaris with calciferol alone; results after five years of observation.

^ Active tuberculosis in pregnancy must be treated, because untreated disease will harm the mother and the unborn child more than standard drugs would.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Because tuberculosis demonstrates a variety of clinical and radiologic findings and has a known propensity for dissemination from its primary site, it can mimic numerous other disease entities.

[114][115]
Dr. Robert Koch discovered the tuberculosis bacillus.
.Miliary tuberculosis—now commonly known as disseminated TB—occurs when the infection invades the circulatory system, resulting in millet-like seeding of TB bacilli in the lungs as seen on an X-ray.^ Mazurek and Villarino, 2003: Mazurek GH, Villarino ME Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Central airway involvement in tuberculosis can be the result of direct extension from tuberculous lymph nodes, endobronchial spread of infection, or lymphatic dissemination to the airway ( 15 ).

^ A. Outbreak Locations: Tuberculosis in Africa has reached epidemic proportions, with an estimated 2 million new cases occurring annually, increasing at a rate of 10% each year, largely as a result of HIV co-infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[114][116] TB is also called Koch's disease, after the scientist Robert Koch.[117]

Folklore

.Before the Industrial Revolution, tuberculosis may sometimes have been regarded as vampirism.^ Patients with infectious tuberculosis who are imprisoned and those who are released from prison before treatment completion may play an important role in the disease epidemiology.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.When one member of a family died from it, the other members that were infected would lose their health slowly.^ When one member of a family died from it, the other members that were infected would lose their health slowly.

^ Proved effective over and over ever since on myself and on many others including all of my family members I wrote it down in e-book.
  • Tuberculosis Home Remedies - Tuberculosis Treatment - Natural Remedies & Cure for Tuberculosis 28 January 2010 1:01 UTC www.natural-homeremedies.org [Source type: FILTERED WITH BAYES]

^ The World Health Organization (WHO) estimates that one-third of the world's population is infected with Mycobacterium tuberculosis , resulting in an estimated 8 million new cases of tuberculosis and nearly 2 million deaths each year.

.People believed that this was caused by the original victim draining the life from the other family members.^ People believed that this was caused by the original victim draining the life from the other family members.

^ People believed that the cause of this was the original victim draining the life from the other family members.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ Proved effective over and over ever since on myself and on many others including all of my family members I wrote it down in e-book.
  • Tuberculosis Home Remedies - Tuberculosis Treatment - Natural Remedies & Cure for Tuberculosis 28 January 2010 1:01 UTC www.natural-homeremedies.org [Source type: FILTERED WITH BAYES]

.Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits.^ Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits.

^ People who work in these rooms must wear a special face mask to protect themselves from TB bacteria.

^ People who have spent time with someone sick with MDR TB disease can become infected with TB bacteria that are resistant to several drugs.

.People with TB often have symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin, extremely low body heat, a weak heart and coughing blood, suggesting the idea that the only way for the afflicted to replenish this loss of blood was by sucking blood.^ People with TB often have symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin and coughing blood, suggesting the idea that the only way for the afflicted to replenish this loss of blood was by sucking blood.

^ Often, there is coughing up of blood.
  • Tuberculosis -- eCureMe.com 28 January 2010 1:01 UTC www.ecureme.com [Source type: FILTERED WITH BAYES]

^ People with TB often had symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin and coughing blood (which people often thought needed to be replenished, so they figured the only way for the afflicted to get blood back was by sucking blood).
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

[118] .Another folk belief told that the affected individual was being forced, nightly, to attend fairy revels, so that the victim wasted away owing to lack of rest; this belief was most common when a strong connection was seen between the fairies and the dead.^ Parenchymal disease in primary tuberculosis affects the areas of greatest ventilation; the most common sites are the middle lobe, the lower lobes, and the anterior segment of the upper lobes ( 5 ).

[119] .Similarly, but less commonly, it was attributed to the victims being "hagridden"—being transformed into horses by witches (hags) to travel to their nightly meetings, again resulting in a lack of rest.^ Similarly, but less commonly, it was attributed to the victims being "hagridden"—being transformed into horses by witches (hags) to travel to their nightly meetings, again resulting in a lack of rest.

^ Another folk belief attributed it to being forced, nightly, to attend fairy revels, so that the victim wasted away owing to lack of rest; this belief was most common when a strong connection was seen between the fairies and the dead.

^ The main factor at altitude (or in certain pulmonary diseases) is a reduction in arterial PO2 which decreases the driving force for oxygen diffusion into the blood and results in less oxygen being transported to the tissues.
  • LimitationsMaximumOxygenConsumption 19 November 2009 18:10 UTC faculty.css.edu [Source type: FILTERED WITH BAYES]

[119]
.TB was romanticized in the nineteenth century.^ TB was romanticized in the nineteenth century.

^ In the UK, active TB was common in the nineteenth century (the old 'consumption').
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

Many people believed TB produced feelings of euphoria referred to as Spes phthisica ("hope of the consumptive"). It was believed that TB sufferers who were artists had bursts of creativity as the disease progressed. It was also believed that TB sufferers acquired a final burst of energy just before they died that made women more beautiful and men more creative.[120] .In the early 20th century, some believed TB to be caused by masturbation.^ The incidence of TB has been declining since the early 20th century because various factors, including basic infection-control practices (isolation).
  • Tuberculosis: eMedicine Infectious Diseases 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

^ Tuberculosis, or 'consumption' as it was commonly known, caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor.

^ Dormant TB bacteria may start to multiply and cause active TB if the body's immune system becomes weaker for some reason.
  • Tuberculosis | Health | Patient UK 28 January 2010 1:01 UTC www.patient.co.uk [Source type: FILTERED WITH BAYES]

[121]

Study and treatment

.The study of tuberculosis, sometimes known as phthisiatry, dates back to The Canon of Medicine written by Ibn Sina (Avicenna) in the 1020s.^ The studies to date strongly indicate that the monkey model can recapitulate various important aspects of human tuberculosis, including primary disease as well as latent infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.He was the first physician to identify pulmonary tuberculosis as a contagious disease, the first to recognise the association with diabetes, and the first to suggest that it could spread through contact with soil and water.^ A tuberculous empyema is usually associated with evident pulmonary parenchymal disease on chest films and air may be seen in the pleural space.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Chest wall tuberculosis is usually secondary to pleural disease and empyema or due to hematogenous spread of disease.

^ Peritoneal involvement in tuberculosis is rare and is usually associated with widespread abdominal disease involving lymph nodes or bowel ( 52 , 58 ).

[122][123] .He developed the method of quarantine in order to limit the spread of tuberculosis.^ The susceptible rabbits developed a hematogenously spread tuberculosis resembling that found in infants and immunosuppressed adults (including those with AIDS).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The resistant rabbits developed a cavitary-type of tuberculosis with bronchogenic spread, resembling that found in immunocompetent human beings ( McMurray et al., 1996 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[124] In ancient times, treatments focused on sufferers' diets. Pliny the Elder described several methods in his Natural History: "wolf's liver taken in thin wine, the lard of a sow that has been fed upon grass, or the flesh of a she-ass taken in broth".[125]
.Although it was established that the pulmonary form was associated with "tubercles" by Dr Richard Morton in 1689,[126][127] due to the variety of its symptoms, TB was not identified as a single disease until the 1820s and was not named "tuberculosis" until 1839 by J. L. Schönlein.^ A tuberculous empyema is usually associated with evident pulmonary parenchymal disease on chest films and air may be seen in the pleural space.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Study on the association of two polymorphisms of the vitamin D receptor (VDR) gene with the susceptibility to pulmonary tuberculosis (PTB) in Chinese Tibetans.

^ As of September 30, 2003, PH-SKC had identified 44 outbreak-associated TB patients with dates of diagnosis during May 2002-September 2003 ( MMWR, 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[128] During the years 1838 – 1845, Dr. John Croghan, the owner of Mammoth Cave, brought a number of tuberculosis sufferers into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; they died within a year.[129] The first TB sanatorium opened in 1854 in Görbersdorf, Germany (today Sokołowsko, Poland) by Hermann Brehmer.[130]
.The bacillus causing tuberculosis, Mycobacterium tuberculosis, was identified and described on 24 March 1882 by Robert Koch.^ Ontology : UMLS:xxx From: Humans (at lifecycle stage: Bacilli ), To: Birds (at lifecycle stage: Bacilli ) Mechanism: This report describes a macaw with active tuberculosis caused by M. tuberculosis .
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ The situation becomes worse if the disease is caused by drug-resistant Mycobacterium tuberculosis isolates.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In addition to this already huge burden of disease, it is estimated that up to two billion people have been infected with the causative agent, Mycobacterium tuberculosis .
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

He received the Nobel Prize in physiology or medicine in 1905 for this discovery.[131] .Koch did not believe that bovine (cattle) and human tuberculosis were similar, which delayed the recognition of infected milk as a source of infection.^ Koch did not believe that bovine (cattle) and human tuberculosis were similar, which held back the recognition of infected milk as a source of infection.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ Koch did not believe that bovine (cattle) and human tuberculosis were similar, which delayed the recognition of infected milk as a source of infection.

^ Failure to identify non-bovine reservoirs of Mycobacterium bovis in a region with a history of infected dairy-cattle herds.
  • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

Later, this source was eliminated by the pasteurization process. .Koch announced a glycerine extract of the tubercle bacilli as a remedy for tuberculosis in 1890, calling it "tuberculin". It was not effective, but was later adapted as a test for pre-symptomatic tuberculosis.^ Among children, important diagnostic clues are a history of previous exposure to an individual with tuberculosis or evidence of tuberculosis infection (eg, a positive tuberculin skin test).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ American Thoracic Society et al., 2000: Targeted tuberculin testing and treatment of latent tuberculosis infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In a typical contact investigation, approximately 20 to 30 percent of the close contacts have positive tuberculin skin tests and in only 1 or 2 percent does active tuberculosis develop.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[132]
.The first genuine success in immunizing against tuberculosis was developed from attenuated bovine-strain tuberculosis by Albert Calmette and Camille Guérin in 1906. It was called "BCG" (Bacillus of Calmette and Guérin).^ Geographic latitude and the efficacy of bacillus Calmette-Guérin vaccine.

^ Brewer, 2000: Brewer TF Preventing tuberculosis with bacillus Calmette-Guerin vaccine: a meta-analysis of the literature.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Symptomatic HIV-infected patients who are immunized with BCG vaccine have developed the devastating complication of disseminated disease ( Talbot et al., 1997 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.The BCG vaccine was first used on humans in 1921 in France,[54] but it was not until after World War II that BCG received widespread acceptance in the USA, Great Britain, and Germany.^ The other concern about BCG vaccination is the degree to which it can be safely used in countries with a high burden of HIV/AIDS. Traditionally, BCG vaccines have been considered among the safest in use.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ BCG vaccines have been given to billions of people since 1921, more than any other vaccine.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[55]
.Tuberculosis, or "consumption" as it was commonly known, caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor.^ Tuberculosis, or 'consumption' as it was commonly known, caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor.

^ The incidence of TB has been declining since the early 20th century because various factors, including basic infection-control practices (isolation).
  • Tuberculosis: eMedicine Infectious Diseases 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

^ Experiments in the late 19th century sought to define the host specificity of the causative agents of tuberculosis in mammals.
  • Tuberculosis Pulmonary | HIV ATLAS 28 January 2010 1:01 UTC www.hivatlas.org [Source type: Academic]

[133] .In 1815, one in four deaths in England was of consumption; by 1918 one in six deaths in France were still caused by TB. In the 20th century, tuberculosis killed an estimated 100 million people.^ Death-rate of Tuberculosis per million living in England and Wales.

^ In the 1900s, TB was one of the leading causes of death in the United States.

^ Every year tuberculosis kills almost 2 million people.
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

[134] .After the establishment in the 1880s that the disease was contagious, TB was made a notifiable disease in Britain; there were campaigns to stop spitting in public places, and the infected poor were pressured to enter sanatoria that resembled prisons; the sanatoria for the middle and upper classes offered excellent care and constant medical attention.^ Parenchymal disease in primary tuberculosis affects the areas of greatest ventilation; the most common sites are the middle lobe, the lower lobes, and the anterior segment of the upper lobes ( 5 ).

[130] .Whatever the purported benefits of the fresh air and labor in the sanatoria, even under the best conditions, 50% of those who entered were dead within five years (1916).^ Whatever the purported benefits of the fresh air and labor in the sanatoria, even under the best conditions, 50% of those who entered were dead within five years (1916).

^ Whatever the purported benefits of the fresh air and labor in the sanatoria, 75% of those who entered were dead within five years (1908).
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

^ It should be remembered that the benefits of fresh air a,re not confined to sanatoria.

[130]
Public health campaigns tried to halt the spread of TB
The promotion of Christmas Seals began in Denmark during 1904 as a way to raise money for tuberculosis programs. It expanded to the United States and Canada in 1907 – 1908 to help the National Tuberculosis Association (later called the American Lung Association).
.In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into spittoons.^ Patients with infectious tuberculosis who are imprisoned and those who are released from prison before treatment completion may play an important role in the disease epidemiology.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics.^ CDC - Guidelines for safely working with M. tb: Goals for Working Safely with Mycobacterium tuberculosis in Clinical, Public Health, and Research Laboratories [ http://www.cdc.gov/od/ohs/tb/tbdoc2.htm ].
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In 2000, the incidence and mortality associated with tuberculosis in Russian prisons were 3174 cases and 171 deaths per 100,000 prisoners, respectively.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ From 1991 to 1998, the incidence of TB in Latvia increased, reaching a rate of 74 per 100,000 inhabitants.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

The disease remained such a significant threat to public health, that when the Medical Research Council was formed in Britain in 1913, its initial focus was tuberculosis research.[135]
It was not until 1946 with the development of the antibiotic streptomycin that effective treatment and cure became possible. .Prior to the introduction of this drug, the only treatment besides sanatoria were surgical interventions, including the pneumothorax or plombage technique — collapsing an infected lung to "rest" it and allow lesions to heal — a technique that was of little benefit and was mostly discontinued by the 1950s.^ Pyrazinamide given in the initial intensive phase allows the duration of treatment to be reduced from 9 to 6 months, but it offers no benefit if given past the second month to patients with drug susceptible tuberculosis.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Plombage was a type of pulmonary collapse therapy used for treatment of tuberculosis prior to the advent of antituberculous drugs and consisted of the insertion of plastic packs, Lucite balls ( Fig 19 ), or polythene spheres in the pleural space.

^ TB Pathogenesis Description: Studies of tissues from infected asymptomatic individuals have shown viable M. tuberculosis in primary lesions in the lung, and also in lesion-free areas of lung and lymph nodes.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[136] .The emergence of multidrug-resistant TB has again introduced surgery as part of the treatment for these infections.^ The emergence of multidrug-resistant TB has again introduced surgery as part of the treatment for these infections.

^ Multidrug-resistant TB (MDR TB).
  • Tuberculosis 28 January 2010 1:01 UTC www.cnn.com [Source type: General]

^ Farmer P, Kim JY. Community based approaches to the control of multidrug resistant tuberculosis: introducing "DOTS-plus".
  • Tuberculosis: eMedicine Pediatrics: General Medicine 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

Here, surgical removal of chest cavities will reduce the number of bacteria in the lungs, as well as increasing the exposure of the remaining bacteria to drugs in the bloodstream. It is therefore thought to increase the effectiveness of the chemotherapy.[137]
.Hopes that the disease could be completely eliminated have been dashed since the rise of drug-resistant strains in the 1980s.^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

^ When devising a regimen for suspected or confirmed drug-resistant disease, several important principles must be followed.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Findings on host resistance genes for infectious diseases are pointing the way to drugs, vaccines.

For example, tuberculosis cases in Britain, numbering around 117,000 in 1913, had fallen to around 5,000 in 1987, but cases rose again, reaching 6,300 in 2000 and 7,600 cases in 2005.[138] Due to the elimination of public health facilities in New York and the emergence of HIV, there was a resurgence of TB in the late 1980s.[139] The number of patients failing to complete their course of drugs is high. .New York had to cope with more than 20,000 TB patients with multidrug-resistant strains (resistant to, at least, both Rifampin and Isoniazid).^ In prisons in some regions of Russia, the prevalence of resistance to 1 drug among new cases was 35% to 44%, and the prevalence of multidrug resistance (MDR; i.e., resistance to at least rifampin and isoniazid) among new cases varied from 15% to 22% ( Toungoussova et al., 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Periodic surveys have shown that more than 10% of new tuberculosis cases in Estonia, Latvia, and some parts of Russia are multi-drug resistant ie, resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ At the same time, drug resistance among TB patients in Latvia seems to be the highest in the world, with primary multidrug resistance found in 8.6% of new cases and in 34.5% of all TB patients in the year 2000 ( Tracevska et al., 2002 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

.The resurgence of tuberculosis resulted in the declaration of a global health emergency by the World Health Organization (WHO) in 1993.[140] Every year, nearly half a million new cases of multidrug-resistant tuberculosis (MDR-TB) are estimated to occur worldwide.^ A. Outbreak Locations: Tuberculosis in Africa has reached epidemic proportions, with an estimated 2 million new cases occurring annually, increasing at a rate of 10% each year, largely as a result of HIV co-infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Tuberculosis is the world's second commonest cause of death from infectious disease, after HIV/AIDS. There were an estimated 89 million new cases of tuberculosis in 2000, fewer than half of which were reported; 34 million cases were sputum-smear positive, the most infectious form of the disease.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Prognosis: Globally, of the 1.23 million cases of tuberculosis registered by the WHO in 2000, 69.8% were cured, 9.6% completed treatment with no laboratory confirmation of cure, 4.2% died, and 16.4% did not complete treatment or were lost to followup ( World Health Organization, 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[141]

Evolution

.Tuberculosis has co-evolved with humans for many thousands of years, and perhaps for several million years.^ A. Outbreak Locations: Tuberculosis in Africa has reached epidemic proportions, with an estimated 2 million new cases occurring annually, increasing at a rate of 10% each year, largely as a result of HIV co-infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Trend analysis has also confirmed that MDR-TB is not a major problem in countries implementing tuberculosis control according to international guidelines for several years.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Mycobacterium tuberculosis is one of most successful pathogens of mankind, infecting one-third of the global population and claiming two million lives every year.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

[142] The oldest known human remains showing signs of tuberculosis infection are 9,000 years old.[143] .During this evolution, M. tuberculosis has lost numerous coding and non-coding regions in its genome, losses that can be used to distinguish between strains of the bacteria.^ Identifying genetic susceptibility factors for tuberculosis in Africans: a combined approach using a candidate gene study and a genome-wide screen.

.The implication is that M. tuberculosis strains differ geographically, so their genetic differences can be used to track the origins and movement of each strain.^ The implication is that M. tuberculosis strains differ geographically, so their genetic differences can be used to track the origins and movement of each strain.

^ Infections with these strains are often difficult to treat and require the use of combination drug therapies, sometimes involving the use of five different agents.
  • tuberculosis (TB) (pathology) -- Britannica Online Encyclopedia 28 January 2010 1:01 UTC www.britannica.com [Source type: Academic]

^ Identifying genetic susceptibility factors for tuberculosis in Africans: a combined approach using a candidate gene study and a genome-wide screen.

[144]

Society and culture

.Through its affecting important historical figures, tuberculosis has influenced particularly European history, and become a theme in art – mostly literature, music, and film.^ This model is also likely to be useful for studying vaccines against tuberculosis, as well as for drug studies, particularly those drugs that might affect bacilli during latent infection.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Among children, important diagnostic clues are a history of previous exposure to an individual with tuberculosis or evidence of tuberculosis infection (eg, a positive tuberculin skin test).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

Public health

Tuberculosis is one of the three primary diseases of poverty along with AIDS and malaria.[145] .The Global Fund to Fight AIDS, Tuberculosis and Malaria was started in 2002 to raise finances to address these infectious diseases.^ Adrenal atrophy with calcification may be seen in patients with healed prior tuberculosis, and these patients may present with Addison disease ( 81 ).

^ Patients with infectious tuberculosis who are imprisoned and those who are released from prison before treatment completion may play an important role in the disease epidemiology.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ MMWR, 2003: Centers for Disease Control and Prevention (CDC) Public health dispatch: tuberculosis outbreak among homeless persons--King County, Washington, 2002-2003.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

Globalization has led to increased opportunities for disease spread. .In 2007, a tuberculosis scare occurred when Andrew Speaker flew on a transatlantic flight infected with multi-drug-resistant tuberculosis.^ Since that time, however, there has been a resurgence of tuberculosis due to the acquired immunodeficiency syndrome (AIDS) epidemic and the increasing number of drug-resistant strains of Mycobacterium tuberculosis ( 1 ).

[146]
.In the United States, the National Center for HIV, STD, and TB Prevention, as part of the Center for Disease Control and Prevention (CDC), is responsible for public health surveillance and prevention research.^ Likewise, in developed countries with long history of tuberculosis control such as Australia, Canada, Denmark, France, the Netherlands, the United States, and the United Kingdom trends suggest that MDR-TB is not a major public health issue but problem limited to specific groups including immigrants, refugees, and homeless ( Espinal et al., 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ MMWR, 2003: Centers for Disease Control and Prevention (CDC) Public health dispatch: tuberculosis outbreak among homeless persons--King County, Washington, 2002-2003.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ In January 2001, the US Centers for Disease Control and Prevention (CDC) assisted the Wichita-Sedgwick County Department of Health and the Kansas Department of Health and Environment in investigating a cluster of 22 TB patients diagnosed between 1994 and 2001.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

Notable victims

Research

.The Mycobacterium Tuberculosis Structural Genomics Consortium is a global consortium of scientists conducting research regarding the diagnosis and treatment of tuberculosis.^ It is feasible to perform BSL3 M. tuberculosis research on monkeys, and to use this model to test hypotheses regarding the pathogenesis and immunology of this disease ( Flynn et al., 2003 ).
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Mycobacterium tuberculosis is one of most successful pathogens of mankind, infecting one-third of the global population and claiming two million lives every year.
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

^ Website 7: Mycobacterium tuberculosis CDC1551, complete genome [ http://www.ncbi.nlm.nih.gov/genomes/framik.cgi?db=genome&gi=181 ].
  • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

They are attempting to determine the 3-dimensional structures of proteins from M. Tuberculosis.[citation needed]

In other animals

Tuberculosis can be carried by mammals; domesticated species, such as cats and dogs, are generally free of tuberculosis, but wild animals may be carriers.
Mycobacterium bovis causes TB in cattle. An effort to eradicate bovine tuberculosis from the cattle and deer herds of New Zealand is underway. It has been found that herd infection is more likely in areas where infected natural reservoir such as Australian brush-tailed possums come into contact with domestic livestock at farm/bush borders.[147] .Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a "two-pronged" approach to ridding New Zealand of the disease.^ Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a "two-pronged" approach to ridding New Zealand of the disease.

^ It has been found that herd infection is more likely in areas where infected vector species such as Australian brush-tailed possums come into contact with domestic livestock at farm/bush borders.

^ According to the Centers for Disease Control and Prevention (CDC), a total of 13,767 new cases were reported in the United States in 2006.
  • Tuberculosis: eMedicine Pediatrics: General Medicine 28 January 2010 1:01 UTC emedicine.medscape.com [Source type: Academic]

.In the Republic of Ireland and the United Kingdom, badgers have been identified as one vector species for the transmission of bovine tuberculosis.^ The effect of ultraviolet B-induced vitamin D levels on host resistance to Mycobacterium tuberculosis: a pilot study in immigrant Asian adults living in the United Kingdom.

.As a result, governments have come under pressure from some quarters, primarily dairy farmers, to mount an active campaign of eradication of badgers in certain areas with the purpose of reducing the incidence of bovine TB. The effectiveness of culling on the incidence of TB in cattle is a contentious issue, with proponents and opponents citing their own studies to support their position.^ As a result, governments have come under pressure from some quarters, primarily dairy farmers, to mount an active campaign of eradication of badgers in certain areas with the purpose of reducing the incidence of bovine TB. The UK government has not committed itself on the issue, not least because it fears public opinion: badgers are a protected species.

^ The effectiveness of culling on the incidence of TB in cattle is a contentious issue, with proponents and opponents citing their own studies to support their position.

^ It remains a contentious issue, with proponents and opponents of the scheme citing their own studies to support their position.
  • Tuberculosis at AllExperts 28 January 2010 1:01 UTC en.allexperts.com [Source type: FILTERED WITH BAYES]

[148][149][150] .For instance, a study by an Independent Study Group on badger culling reported on 18 June 2007 that it was unlikely to be effective and would only make a “modest difference” to the spread of TB and that "badger culling cannot meaningfully contribute to the future control of cattle TB"; in contrast, another report concluded that this policy would have a significant impact.^ The effectiveness of culling on the incidence of TB in cattle is a contentious issue, with proponents and opponents citing their own studies to support their position.

^ Transmission can only occur from people with active—not latent—TB. The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the virulence of the M. tuberculosis strain.

^ Although less than ideal, studies have consistently shown its effectiveness in reducing fatal or severe forms of TB in infants and young children—miliary TB or meningitis.

[151] On 4 July 2008, the UK government decided against a proposed random culling policy.[152]

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Further reading

External links

.
  • General information, public health websites and epidemiology
    • World Health Organization (WHO) - Tuberculosis
    • Tuberculosis at the Open Directory Project
    • The Stop TB Partnership - established in 2000 with the goal of eliminating tuberculosis as a public health problem
    • Tuberculosis in Europe factsheet from European Centre for Disease Prevention and Control, agency of European Union
    • Central Asia Health Review (CAHR).^ Likewise, in developed countries with long history of tuberculosis control such as Australia, Canada, Denmark, France, the Netherlands, the United States, and the United Kingdom trends suggest that MDR-TB is not a major public health issue but problem limited to specific groups including immigrants, refugees, and homeless ( Espinal et al., 2003 ).
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      ^ MMWR, 2003: Centers for Disease Control and Prevention (CDC) Public health dispatch: tuberculosis outbreak among homeless persons--King County, Washington, 2002-2003.
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      ^ The International Union Against Tuberculosis and Lung Disease (IUATLD) and WHO recommend the Ziehl-Neelsen method under most circumstances ( Frieden et al., 2003 ) Symptom Information : General Description: Tuberculosis involving any site may produce symptoms and findings that are not specifically related to the organ or tissue involved but, rather, are systemic in nature.
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      .High Prevalence of Multi-Drug Resistant Tuberculosis in Uzbekistan
    • Tuberculosis on the CDC website
    • Tuberculosis information from the Health Protection Agency in the UK
    • Kaiser Family Foundation.^ Periodic surveys have shown that more than 10% of new tuberculosis cases in Estonia, Latvia, and some parts of Russia are multi-drug resistant ie, resistant to at least isoniazid and rifampicin, the two most effective anti-tuberculosis drugs.
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      ^ The addition of ethambutol benefits the regimen when initial drug resistance may be present or the burden of organisms is high.
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      ^ Strains of the Beijing/W genotype family of Mycobacterium tuberculosis have caused large outbreaks of tuberculosis, sometimes involving multidrug resistance.
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      Tuberculosis. Globalhealthfacts.org.
    • United States Agency for International Development (USAID). .The Tuberculosis Coalition for Technical Assistance (TBCTA).
    • Tuberculosis and HIV: HIV InSite Knowledge Base chapter and related resources.
  • Professional information and scientific research
    • Tuberculosis Database is an integrated platform for tuberculosis research, hosting genomic and gene expression data for Mycobacterium tuberculosis and other related species.
    • Mycobacterium tuberculosis in the BioHealthBase (TB genomics and proteomics database)
    • Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination.^ A. Taxonomy Information Species: Mycobacteria tuberculosis ( Website 1 ): Ontology: UMLS:C0026926 GenBank Taxonomy No.: 1773 Description: The Mycobacterium tuberculosis belongs to the genus Mycobacterium, which are aerobic, nonmotile, and rod-shaped bacteria with two distinguishing characteristics: acid-fastness and slow growth ( Grange, 1998a ).
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      ^ C. Genome Summary: Genome of Mycobacteria tuberculosis Mycobacterium tuberculosis ( Website 8 ): GenBank Accession Number: NC_000962,NC_002755 Size: 4411532 bp ( Camus et al., 2002 ) 4403837 bp ( Website 6 ) Gene Count: 4056 ( Camus et al., 2002 ) Description: The original sequence and annotation of Mycobacterium tuberculosis strain H37Rv identified 3974 genes (Cole et al., 1998).
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      ^ The problem centers in four orders: Primates, Proboscidea, Perissodactyla, and Artiodactyla ( Montali et al., 2002 ) Asiatic elephant ( Website 11 ): Ontology: UMLS:xxx GenBank Taxonomy No.: 9783 Scientific Name: Elephas maximus ( Website 11 ) Description: Tuberculosis (TB) has been recognized for over 2,000 yr as a disease of elephants.
      • Mycobacterium tuberculosis 20 September 2009 1:01 UTC staff.vbi.vt.edu [Source type: Academic]

      .Core Curriculum on Tuberculosis: What the Clinician Should Know.^ CDC. Core Curriculum on Tuberculosis: What Every Clinician Should Know, 4th ed., 2000a last reviewed April 5, 2000, (http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.htm, accessed May 9, 2000).
      • Tuberculosis in the Workplace 28 January 2010 1:01 UTC search.nap.edu [Source type: Academic]

      4th edition (2000). Updated August 2003.
    • Tuberculosis 2007 - a textbook that focuses on research, diagnosis and treatment of tuberculosis
    • Tuberculosis: A Persistent Threat to Global Health on-line lecture by John McKinney
  • Sir John Crofton - Daily Telegraph obituary

1911 encyclopedia

Up to date as of January 14, 2010
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From LoveToKnow 1911

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Simple English

File:Mycobacterium tuberculosis 8438
TB bacteria, shown as 15549x larger under an electron microscope.

Tuberculosis (also known as TB, formerly consumption) is an infectious disease caused by bacteria which make 10% of people get sick who catch it. People who suffer from tuberculosis generally cough a lot and have trouble breathing. They feel pain in their chest. They also feel very tired. Unless they get medicine, half of the sick have died (5% who catch it).

Throughout history, many millions of people have died of tuberculosis. In the early 1900s, it was still called "consumption" because it seemed people were consumed from inside. The oldest signs of tuberculosis that have been found are in the spines of Egyptian mummies which date to 2400 BC. Nowadays, the diseases can be treated with anti-biotic drugs for several months. However, many people still die from this disease every year, particularly in countries where there is a shortage of food.

Contents

How it is spread

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis. Its symptoms include a long-lasting bad cough, pain in the chest, coughing up blood or sputum (gooey saliva).[1], weakness and tiredness, weight loss, being not hungry, chills, fever, and sweating at night.

TB is contagious, which means it can be spread from person to person. The disease is carried on the tiny droplets of water that come out of a person's lungs when they breathe. If the person who has TB coughs, sneezes or spits without covering their mouth, they spread the bacteria more widely. People become infected by breathing in the droplets spread by an infected person. If a person lives with someone who has TB, there is a 22% chance that they will also be infected with the disease. [[File:|right|thumb|270px|A chart showing symptoms of tuberculosis, with coughing, fever and chest pain.]]

Many people have TB in their system, but they do not know it because it is not making them sick. This is called "latent" tuberculosis. If a person becomes infected with TB, there is a 90% chance that it will be a latent TB infection, meaning that they will not become sick or infect other people. However, there is a 10% chance that the latent TB infection will turn into Active Tuberculosis Disease at some time in the person's life. People who have a latent TB infection can not spread the disease to other people. The disease only becomes infectious when the person becomes sick.

The most common type of tuberculosis is an infection of the lungs. This is called Pulmonary Tuberculosis. This type affects 75% of TB patients. There is another form called Miliary Tuberculosis that causes lesions (infections or scars) on the lungs, which are shaped like little seeds of millet (a type of grain). This type of infection spreads to the heart and then to other organs such as the liver and brain. This most commonly affects people with conditions such as HIV, as well as small children. Tuberculosis can also affect the bones and the skin, and other organs.

Signs and symptoms

A world-wide problem

File:World
A map of tuberculosis cases around the world. Cases per 100,000 people; Red = >300, orange = 200-300; yellow = 100-200; green 50-100 and grey <50.

During the late 20th century, in developed countries, doctors had very good success is controlling this disease. But the disease continues to spread in countries where there are many poor people without enough food. In 2004, the World Health Organization said there were 14.6 million people sick with the disease, there were 8.9 million new cases, and 1.6 million deaths.

In developed countries there is now a larger number of people sick with tuberculosis because of HIV/AIDS, substance and taking "immunosuppressive" drugs to treat some other illness. (Immuno-suppressant means something that stops the person's system from fighting disease.)

Another big problem is that there are now new "strains" of tuberculosis which are resistant to the usual drugs that doctors use to treat it. About 20% of new cases are resistant to drugs. In 1993, the World Health Organization declared that tuberculosis was a global health emergency.

Other pages

References

  1. "Sputum", Glossary, CDC.gov, October 2010, webpage: Spu.

Other websites

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Citable sentences

Up to date as of December 07, 2010

Here are sentences from other pages on Tuberculosis, which are similar to those in the above article.








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