Tuberculosis Classification and external resources
Chest X-ray of a patient suffering from tuberculosis
ICD-10	A15.-A19.
ICD-9	010-018
OMIM	607948
DiseasesDB	8515
MedlinePlus	000077 000624
eMedicine	med/2324  emerg/618 radio/411
MeSH	C01.252.410.040.552.846

Tuberculosis (abbreviated as TB for tubercle bacillus or Tuberculosis) is a common and deadly infectious disease caused by mycobacteria, mainly Mycobacterium tuberculosis. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic Mycobacterium is a Genus of Actinobacteria, given its own family the Mycobacteriaceae Mycobacterium tuberculosis is the Bacterium that causes most cases of Tuberculosis. Tuberculosis most commonly attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin. lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. The lymphatic system in Vertebrates is a network of conduits that carry a clear fluid called Lymph. This is an article about the rock music band "Circulatory System" In Anatomy, the genitourinary system is the Organ system of all the Reproductive organs and the Urinary system. Bones are rigid organs that form part of the Endoskeleton of Vertebrates They function to move support and protect the various organs of the body produce A joint is the location at which two or more Bones make contact The skin is the outer covering of living tissue of an animal (or plant Other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti can also cause tuberculosis, but these species do not usually infect healthy adults. See Tuberculosis Mycobacterium bovis is a slow-growing (16 to 20 hour generation time Aerobic bacterium and the causative Mycobacterium africanum is a species of Mycobacterium that is most commonly found in West African countries Mycobacterium canetti, a novel pathogenic taxon of the Mycobacterium tuberculosis complex was described in 1997 by D van Soolingen et al Mycobacterium microti Member of the Mycobacterium tuberculosis complex (MTBC Also known as the 'Vole bacillus' ^[1]

One-third of the world's current population has been infected by TB, and new infections occur at a rate of one per second. The world population is the total number of living Humans on Earth at a given time ^[2] Not everyone infected develops the full-blown disease; asymptomatic, latent infection is most common. However, one in ten latent infections will progress to active disease, which, if left untreated, kills more than half of its victims.

In 2004, mortality and morbidity statistics included 14. 6 million chronic active cases, 8. 9 million new cases, and 1. 6 million deaths, mostly in developing countries. Developing countries are countries that haven't reached Western-style standards of democratic government free market economy industrialization social programs and human rights guaranties ^[2] In addition, a rising number of people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse, or HIV/AIDS. The term developed country, or advanced country, is used to categorize countries with developed Economies in which the tertiary and quaternary sectors An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor For a list of immunosuppressive drugs see the Transplant rejection page. Substance abuse is the overindulgence in and dependence of a Drug or other chemical leading to effects that are detrimental to the individual's physical and mental health Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome

The rise in HIV infections and the neglect of TB control programs have enabled a resurgence of tuberculosis. ^[3] 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. Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics. Active Tuberculosis will kill about two of every three people affected if left untreated ^[4] TB incidence varies widely, even in neighboring countries, apparently because of differences in health care systems. ^[5] The World Health Organization 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. The Stop TB Partnership promotes The Global Plan to Stop TB which calls for a total of $56 billion between 2006 and 2015 to treat 50 million Tuberculosis patients and save 14 million ^[6]

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. Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained Pallor (also called pastiness or wanness) is a reduced amount of oxy Hemoglobin in Skin or Mucous membrane, a pale color which can 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. Scrofula ( scrophula or struma) is any of a variety of Skin diseases in particular a form of Tuberculosis, affecting the Lymph nodes ^[7][8] Miliary tuberculosis – now commonly known as disseminated TB – occurs when the infection invades the circulatory system resulting in lesions which have the appearance of millet seeds on X-ray. Miliary tuberculosis (or disseminated TB) is a form of Tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions The millets are a group of small- Seeded Species of Cereal crops or grains widely grown around the world for Food and Fodder ^[7][9]

Symptoms

Further information: Tuberculosis classification

When the disease becomes active, 75% of the cases are pulmonary TB. Main article Tuberculosis Tuberculosis classification system The current clinical classification system for tuberculosis (TB is based on lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Hemoptysis or haemoptysis (see American and British spelling differences) is the expectoration ( Coughing up of Blood or of blood-stained Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily. Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating ( Hyperhidrosis) during Sleep. Anorexia (deriving from the Greek "α(ν-" ( a(n-, a prefix that denotes absence + "όρεξη (orexe = appetite is the decreased sensation ^[2]

In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB more common in immunosuppressed persons and young children. Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system. Extrapulmonary infection sites include the pleura, 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. In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. The lymphatic system in Vertebrates is a network of conduits that carry a clear fluid called Lymph. Scrofula ( scrophula or struma) is any of a variety of Skin diseases in particular a form of Tuberculosis, affecting the Lymph nodes In Anatomy, the genitourinary system is the Organ system of all the Reproductive organs and the Urinary system. An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Miliary tuberculosis (or disseminated TB) is a form of Tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions Although extrapulmonary TB is not contagious, it may co-exist with pulmonary TB, which is contagious. ^[10]

Bacterial species

Main article: Mycobacterium tuberculosis

Scanning electron micrograph of Mycobacterium tuberculosis

The primary cause of TB, Mycobacterium tuberculosis, is an aerobic bacterium that divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour. Mycobacterium tuberculosis is the Bacterium that causes most cases of Tuberculosis. Mycobacterium tuberculosis is the Bacterium that causes most cases of Tuberculosis. Mycobacterium tuberculosis is the Bacterium that causes most cases of Tuberculosis. An aerobic organism or aerobe is an Organism that has an Oxygen based Metabolism. The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Cell division is a process by which a cell, called the parent cell divides into two or more cells called daughter cells. ^[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. Phospholipids are a class of Lipids and are a major component of all Biological membranes All phospholipids contain a Diglyceride, a Phosphate Bacteria, despite their apparent simplicity contain a well developed cell structure which is responsible for many of their unique biological properties Main article Tuberculosis Tuberculosis classification system The current clinical classification system for tuberculosis (TB is based on Gram-positive bacteria are those that are stained dark blue or violet by Gram staining. 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. Gram staining (or Gram's method) is an empirical method of differentiating bacterial species into two large groups ( Gram-positive and ^[12] MTB is a small rod-like bacillus that can withstand weak disinfectants and survive in a dry state for weeks. This page is about the bacterial genus For the class see Bacilli. Disinfectants are Antimicrobial agents that are applied to non-living objects to destroy Microorganisms, the process of which is known as disinfection. An endospore is a dormant, tough and non-reproductive structure produced by a small number of Bacteria from the Firmicute phylum In nature, the bacterium can grow only within the cells of a host organism, but M. In Biology, a host is an organism that harbors a Virus or Parasite, or a mutual or Commensal Symbiont, typically providing nourishment tuberculosis can be cultured in vitro. In vitro ( Latin: within the glass refers to the technique of performing a given experiment in a controlled environment outside of a living Organism ^[13]

Using histological stains on expectorate samples from phlegm (also called sputum), scientists can identify MTB under a regular microscope. Histology (from the Greek = 'tissue' is the study of the microscopic anatomy of cells and tissues of Plants and Phlegm ( is sticky Fluid secreted by the Mucous membranes of Humans and other Animals. Since MTB retains certain stains after being treated with acidic solution, it is classified as an acid-fast bacillus (AFB). Acid-fastness is a physical property of some bacteria referring to their resistance to decolorization by acids during staining procedures ^[12] The most common staining technique, the Ziehl-Neelsen stain, dyes AFBs a bright red that stands out clearly against a blue background. The Ziehl-Neelsen stain, also known as the acid-fast stain, was first described by two German doctors Franz Ziehl (1859 to 1926 a bacteriologist and Friedrich Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy. The auramine-rhodamine stain (AR also known as the Truant auramine-rhodamine stain, is a histological technique used to visualizee acid-fast bacilli A fluorescence microscope (colloquially synonymous with epifluorescent microscope) is a light Microscope used to study properties of organic or inorganic substances

The M. tuberculosis complex includes 3 other TB-causing mycobacteria: M. bovis, M. africanum and M. microti. Mycobacterium is a Genus of Actinobacteria, given its own family the Mycobacteriaceae See Tuberculosis Mycobacterium bovis is a slow-growing (16 to 20 hour generation time Aerobic bacterium and the causative Mycobacterium africanum is a species of Mycobacterium that is most commonly found in West African countries Mycobacterium microti Member of the Mycobacterium tuberculosis complex (MTBC Also known as the 'Vole bacillus' The first two only very rarely cause disease in immunocompetent people. Immunocompetence is the ability of the body to produce a normal Immune response (i On the other hand, although M. microti is not usually pathogenic, it is possible that the prevalence of M. A pathogen (from Greek πάθος pathos "suffering passion" and γἰγνομαι (γεν- gignomai (gen- "I give birth to" infectious In Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given microti infections has been underestimated. ^[14]

Other known pathogenic mycobacteria include Mycobacterium leprae, Mycobacterium avium and M. Mycobacterium is a Genus of Actinobacteria, given its own family the Mycobacteriaceae Mycobacterium leprae, also known as Hansen’s bacillus, mostly found in warm tropical countries is the Bacterium that causes Leprosy (Hansen's Mycobacterium avium complex (MAC is a group of Genetically -related Bacteria belonging to the genus Mycobacterium. kansasii. The last two are part of the nontuberculous mycobacteria (NTM) group. Nontuberculous mycobacteria (NTM also known as environmental mycobacteria, atypical mycobacteria and mycobacteria other than tuberculosis (MOTT are Nontuberculous mycobacteria cause neither TB nor leprosy, but they do cause pulmonary diseases resembling TB. Leprosy (from the Greek lepi (λέπι meaning scales on a fish or Hansen's disease, is a chronic disease caused by the bacterium ^[15]

Evolution

During its evolution, M. eVolution is the third Album by eLDee, it was due to be released in 2008 tuberculosis has lost numerous coding and non-coding regions in its genome, losses that can be used to distinguish between strains of the bacteria. In classical genetics the genome of a Diploid Organism including Eukarya refers to a full set of chromosomes or genes in a Gamete, thereby 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. ^[16]

Transmission

Further information: Transmission (medicine)

When people suffering from active pulmonary TB cough, sneeze, speak, or spit, they expel infectious aerosol droplets 0. In Medicine, transmission is the passing of a Disease from an infected individual or group to a previously uninfected individual or group Particulates, alternatively referred to as particulate matter (PM or fine particles, are tiny particles of solid or liquid suspended in a gas 5 to 5 µm in diameter. A micrometre ( American spelling: micrometer; symbol µm) is one millionth of a Metre, or equivalently one thousandth of a Millimetre A single sneeze, for instance, can release up to 40,000 droplets. ^[17] Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low and the inhalation of just a single bacterium can cause a new infection. ^[18]

Tuberculosis is spread by aerosols created by coughing or sneezing. Technically an aerosol is a suspension of fine solid particles or liquid droplets in a gas

People with prolonged, frequent, or intense contact are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis can infect 10–15 other people per year. ^[2] 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. In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome ^[19]

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. Virulence (also called pestiferousness) refers to the degree of Pathogenicity of a Microbe, or in other words the relative ability of a Microbe tuberculosis strain. In biology strain is a low-level Taxonomic rank used in three related ways ^[10] The chain of transmission can therefore be broken by isolating patients with active disease and starting effective anti-tuberculous therapy. After two weeks of such treatment, people with non-resistant active TB generally cease to be contagious. Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics. If someone does become infectous, then it will take at least from 21 days, or 3-4 weeks, before the new infectous person can transmit the disease to others. ^[20] TB can also be transmitted by eating meat if the cattle is infected with TB. Mycobacterium bovis causes TB in cattle. Details below.

Pathogenesis

Mycobacterium tuberculosis (stained red) in sputum

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. Mycobacterium tuberculosis is the Bacterium that causes most cases of Tuberculosis. However, if untreated, the death rate for these active TB cases is more than 50%. ^[21]

TB infection begins when the mycobacteria reach the pulmonary alveoli, where they invade and replicate within alveolar macrophages. An alveolus (plural alveoli, from Latin alveolus, "little cavity" is an anatomical structure that has the form of a hollow cavity Macrophages ( Greek: "big eaters" from makros "large" + phagein "eat" ( Mø) are cells within the tissues that ^[22] The primary site of infection in the lungs is called the Ghon focus. A Ghon focus is a primary lesion caused by mycobacterium Bacilli ( Tuberculosis) developed in the lung of a previously uninfected individual Bacteria are picked up by dendritic cells, which do not allow replication, although these cells can transport the bacilli to local (mediastinal) lymph nodes. Dendritic cells (DCs are Immune cells and form part of the Mammalian Immune system. The mediastinum is a non-delineated group of structures in the Thorax (chest surrounded by Loose connective tissue. A Lymph node ( lɪmf noʊd is an organ consisting of many types of cells and is a part of the Lymphatic system. Further spread is through the bloodstream to the more distant tissues and organs where secondary TB lesions can develop in lung apices, peripheral lymph nodes, kidneys, brain, and bone. ^[23] All parts of the body can be affected by the disease, though it rarely affects the heart, skeletal muscles, pancreas and thyroid. The heart is a muscular organ in all Vertebrates responsible for pumping Blood through the Blood vessels by repeated rhythmic Skeletal muscle is a type of Striated muscle, which usually attaches to tendons The pancreas is a Gland organ in the digestive and Endocrine system of Vertebrates. The thyroid is one of the largest Endocrine glands in the body ^[24]

Tuberculosis is classified as one of the granulomatous inflammatory conditions. In Medicine ( Anatomical pathology) a granuloma (classical Latin plural granulomata; modern anglicized plural granulomas, also accepted Macrophages, T lymphocytes, B lymphocytes and fibroblasts are among the cells that aggregate to form a granuloma, with lymphocytes surrounding the infected macrophages. Macrophages ( Greek: "big eaters" from makros "large" + phagein "eat" ( Mø) are cells within the tissues that T cells belong to a group of White blood cells known as Lymphocytes, and play a central role in Cell-mediated immunity. B cells are Lymphocytes that play a large role in the humoral immune response (as opposed to the cell-mediated immune response, which is governed by A fibroblast is a type of cell that synthesizes and maintains the Extracellular matrix of many Animal tissues In Medicine ( Anatomical pathology) a granuloma (classical Latin plural granulomata; modern anglicized plural granulomas, also accepted A lymphocyte is a type of White blood cell in the Vertebrate 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. Within the granuloma, T lymphocytes (CD4+) secrete cytokines such as interferon gamma, which activates macrophages to destroy the bacteria with which they are infected. Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular Interferon-gamma ( IFN-γ) is a Dimerized soluble Cytokine that is the only member of the type II class of Interferons This interferon was originally ^[25] T lymphocytes (CD8+) can also directly kill infected cells. ^[22]

Importantly, bacteria are not always eliminated within the granuloma, but can become dormant, resulting in a latent infection. Another feature of the granulomas of human tuberculosis is the development of cell death, also called necrosis, in the center of tubercles. Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. In anatomy a tubercle is a round Nodule, small Eminence, or Warty outgrowth found on Bones skin or within the lungs in Tuberculosis To the naked eye this has the texture of soft white cheese and was termed caseous necrosis. Caseous necrosis describes a form of Biological tissue death caseous meaning it has a cheese-like appearance Necrosis (in Greek Νεκρός = "dead" is the name given to unnatural Death of cells and living tissue. ^[26]

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. This severe form of TB disease is most common in infants and the elderly and is called miliary tuberculosis. Miliary tuberculosis (or disseminated TB) is a form of Tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions Patients with this disseminated TB have a fatality rate of approximately 20%, even with intensive treatment. ^[27]

In many patients the infection waxes and wanes. Tissue destruction and necrosis are balanced by healing and fibrosis. Fibrosis is the formation or development of excess fibrous Connective tissue in an organ or tissue as a reparative or reactive process as opposed to a formation of Fibrous ^[26] Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material. During active disease, some of these cavities are joined to the air passages bronchi and this material can be coughed up. A bronchus (plural bronchi, adjective bronchial) is a caliber of airway in the Respiratory tract that conducts air into the Lungs No Gas It contains living bacteria and can therefore pass on infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Upon cure, affected areas are eventually replaced by scar tissue. ^[26]

Diagnosis

For more details on this topic, see Tuberculosis diagnosis. See also Tuberculosis Tuberculosis is diagnosed by finding Mycobacterium tuberculosis bacteria in a clinical

Mantoux tuberculin skin test

Tuberculosis can be a difficult disease to diagnose, mainly due to the difficulty in culturing this slow-growing organism in the laboratory (4-12 weeks for blood culture). The Mantoux test (also known as the Mantoux screening test, Tuberculin Sensitivity Test, Pirquet test, or PPD test for Purified Protein A complete medical evaluation for TB must include a medical history, a chest X-ray, and a physical examination. Tuberculosis radiology is used in the diagnosis of TB. Main article Tuberculosis Radiology is used in the Diagnosis of Tuberculosis. It may also include a tuberculin skin test, a serological test, microbiological smears and cultures. The Mantoux test (also known as the Mantoux screening test, Tuberculin Sensitivity Test, Pirquet test, or PPD test for Purified Protein Serology is the scientific study of blood serum. In practice the term usually refers to the Diagnostic identification of antibodies in the serum 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. ^[10] Currently, latent infection is diagnosed in a non-immunized person by a tuberculin skin test, which yields a delayed hypersensitivity type response to purified protein derivatives of M. The Mantoux test (also known as the Mantoux screening test, Tuberculin Sensitivity Test, Pirquet test, or PPD test for Purified Protein tuberculosis. Those immunized for TB or with past-cleared infection will respond with delayed hypersensitivity parallel to those currently in a state of infection and thus the test must be used with caution, particularly with regard to persons from countries where TB immunization is common. ^[28] New TB tests are being developed that offer the hope of cheap, fast and more accurate TB testing. These use polymerase chain reaction detection of bacterial DNA and antibody assays to detect the release of interferon gamma in response to mycobacteria. Interferon-gamma ( IFN-γ) is a Dimerized soluble Cytokine that is the only member of the type II class of Interferons This interferon was originally ^[29] Rapid and inexpensive diagnosis will be particularly valuable in the developing world.

Progression

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. However, in the majority of cases, a latent infection occurs that has no obvious symptoms. These dormant bacilli can produce tuberculosis in 2% - 23% of these latent cases, often many years after infection. ^[30] The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In patients co-infected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year. ^[21]

Other conditions that increase risk include drug injection, mainly due to the lifestyle of IV drug users; recent TB infection or a history of inadequately treated TB; chest X-ray suggestive of previous TB, showing fibrotic lesions and nodules; diabetes mellitus; silicosis; prolonged corticosteroid therapy and other immunosuppressive therapy; head and neck cancers; hematologic and reticuloendothelial diseases, such as leukemia and Hodgkin's disease; end-stage kidney disease; intestinal bypass or gastrectomy; chronic malabsorption syndromes; or low body weight. "Shoot up" redirects here For the shooting video game genre see Shoot 'em up. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Silicosis (also known as Grinder's disease and Potter's rot) is a form of Occupational lung disease caused by inhalation of crystalline Silica Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. Hematology ( American English) or haematology ( British English) is the branch of biology (physiology Pathology, Clinical laboratory The reticuloendothelial system ( RES) part of the Immune system, consists of the phagocytic cells located in Reticular connective tissue, primarily Leukemia or leukaemia (Greek leukos λευκός, "white" aima αίμα, "blood" is a Cancer of the Blood Hodgkin's lymphoma, also known as Hodgkin's disease is a type of Lymphoma first described by Thomas Hodgkin in 1832 A gastrectomy is a partial or full surgical removal of the Stomach. Malabsorption is a state arising from abnormality in Digestion or Absorption of food nutrients across the gastrointestinal(GI tract. ^[10]

Twin studies in the 1950s showed that the course of TB infection was highly dependent on the genetics of the patient. Twin studies are one of a family of designs in Behavior genetics which aid the study of individual differences by highlighting the role of environmental and genetic At that time, it was rare that one identical twin would die and the other live. ^[31]

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. Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where Tumor necrosis factor ( TNF, cachexin or cachectin and formally known as Tumor necrosis factor-alpha) is a Cytokine involved in systemic Cytokines are a category of signalling Proteins and Glycoproteins that like Hormones and Neurotransmitters, are used extensively in cellular ^[32]

Treatment

For more details on this topic, see Tuberculosis treatment. Active Tuberculosis will kill about two of every three people affected if left untreated

Treatment for TB uses antibiotics to kill the bacteria. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa The two antibiotics most commonly used are rifampicin and isoniazid. Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group Isoniazid (also called isonicotinyl hydrazine or INH) is a first-line antituberculous medication used in the prevention and treatment of Tuberculosis 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 12 months) to entirely eliminate mycobacteria from the body. ^[10] 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. Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics. ^[33] People with these latent infections are treated to prevent them from progressing to active TB disease later in life. However, treatment using Rifampin and Pyrazinamide is not risk-free. The Centers for Disease Control and Prevention (CDC) notified healthcare professionals of revised recommendations against the use of rifampin plus pyrazinamide for treatment of latent tuberculosis infection, due to high rates of hospitalization and death from liver injury associated with the combined use of these drugs. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated ^[34]

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. ^[33] Drug-resistant TB is a public health issue in many developing countries, as treatment is longer and requires more expensive drugs. Multi-drug resistant TB (MDR-TB) is defined as resistance to the two most effective first line TB drugs: rifampicin and isoniazid. Multi-drug resistant Tuberculosis ( MDR-TB) is defined as TB that is resistant at least to isoniazid (INH and rifampicin (RMP. Rifampicin ( INN) (rɪˈfæmpəsɪn or rifampin ( USAN) is a Bactericidal Antibiotic drug of the Rifamycin group Isoniazid (also called isonicotinyl hydrazine or INH) is a first-line antituberculous medication used in the prevention and treatment of Tuberculosis Extensively drug-resistant TB (XDR-TB) is also resistant to three or more of the six classes of second-line drugs. Extensively drug-resistant Tuberculosis ( XDR-TB) is a form of TB caused by bacteria that is resistant to the most effective anti-TB drugs ^[4]

In ancient times, available treatments focused more on dietary parameters. 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". Gaius or Caius Plinius Secundus, ( AD 23 – August 25, AD 79 better known as Pliny the Elder, was an ancient Author Naturalis Historia ( Latin for "Natural History" is an Encyclopedia written Circa AD 77 by Pliny the Elder. ^[35] While these particular remedies haven't been tested scientifically, it has been demonstrated that malnourished mice receiving a 2% protein diet suffer far higher mortality from tuberculosis than those receiving 20% protein receiving the same infectious challenge dose, and the progressively fatal course of the illness could be reversed by restoring the mice to the normal diet. ^[36] Moreover, statistics for immigrants in South London reveal an 8. 5 fold increased risk of tuberculosis in (primarily Hindu Asian) lacto vegetarians, who frequently suffer protein malnutrition, compared to those of similar cultural backgrounds who ate meat and fish daily. A Hindu ( Devanagari: हिन्दू is an adherent of the philosophies and scriptures of Hinduism, a set of religious, Philosophical A lactovegetarian diet is a vegetarian diet which includes Dairy products such as Milk, Cheese, Yogurt, Butter, Cream ^[37]

Prevention

TB prevention and control takes two parallel approaches. In the first, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. In the second approach, children are vaccinated to protect them from TB. Vaccination is the administration of Antigenic material (the Vaccine) to produce immunity to a disease Unfortunately, no vaccine is available that provides reliable protection for adults. A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease However, in tropical areas where the levels of other species of mycobacteria are high, exposure to nontuberculous mycobacteria gives some protection against TB. Nontuberculous mycobacteria (NTM also known as environmental mycobacteria, atypical mycobacteria and mycobacteria other than tuberculosis (MOTT are ^[38]

Vaccines

Many countries use BCG vaccine as part of their TB control programs, especially for infants. Bacillus Calmette-Guérin (or Bacille Calmette-Guérin, BCG) is a vaccine against Tuberculosis that is prepared from a strain of the attenuated This was the first vaccine for TB and developed at the Pasteur Institute in France between 1905 and 1921. The Pasteur Institute (Institut Pasteur is a French Non-profit private foundation dedicated to the study of Biology, Micro-organisms Diseases This article is about the country For a topic outline on this subject see List of basic France topics. ^[39] However, mass vaccination with BCG did not start until after World War II. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including ^[40] The protective efficacy of BCG for preventing serious forms of TB (e. g. 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%. Meningitis is Inflammation of the protective membranes covering the Brain and Spinal cord, known collectively as the Meninges. ^[41]

In South Africa, the country with the highest prevalence of TB, BCG is given to all children under the age of three. The Republic of South Africa (also known by other official names) is a country located at the southern tip of the continent of Africa ^[42] 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 Epidemiology, the prevalence of a Disease in a Statistical population is defined as the total number of cases of the disease in the population at a given In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria:^[10]

• 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. Multidrug resistance is a condition enabling a disease-causing organism to resist distinct Drugs or chemicals of a wide variety of structure and function targeted at eradicating
• 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. 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. ^[43]

Several new vaccines to prevent TB infection are being developed. The first recombinant tuberculosis vaccine entered clinical trials in the United States in 2004, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices National Institute of Allergy and Infectious Diseases (NIAID is a component of the National Institutes of Health (NIH which is an agency of the United States Department ^[44] 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. DNA vaccination is a technique for protecting an Organism against disease by injecting it with Genetically engineered DNA to produce an Immunological Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. ^[45] A very promising TB vaccine, MVA85A, is currently in phase II trials in South Africa by a group led by Oxford University,^[46] and is based on a genetically modified vaccinia virus. MVA85A (modified Vaccinia Ankara 85A is a new-generation vaccine against Tuberculosis developed by researchers at Oxford University. In health care clinical trials are conducted to allow safety and Efficacy data to be collected for new drugs or devices The University of Oxford (informally "Oxford University" or simply "Oxford" located in the city of Oxford, Oxfordshire, England is the Vaccinia virus ( VACV or VV) is a large complex enveloped Virus belonging to the Poxvirus family Many other strategies are also being used to develop novel vaccines. In order to encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and advance market commitments. An advance market commitment is a binding contract typically offered by a Government or other financial entity used to guarantee a viable market if a Vaccine or ^[47][48]

The Bill and Melinda Gates Foundation has been a strong supporter of new TB vaccine development. The Bill & Melinda Gates Foundation (B&MGF is the largest transparently operated Private foundation in the world founded by Bill and Melinda Most recently, they 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. The Aeras Global TB Vaccine Foundation is a non-profit Product Development Partnership (PDP dedicated to the development of effective Tuberculosis Vaccine regimens ^[49]

Epidemiology

Annual number of new reported TB cases. Data from WHO. ^[50]

World TB incidence. Cases per 100,000; Red = >300, orange = 200–300; yellow = 100–200; green 50–100; blue = <50 and grey = n/a. Data from WHO, 2006. ^[50]

According to the World Health Organization (WHO), nearly 2 billion people—one–third of the world's population—have been exposed to the tuberculosis pathogen. ^[51] Annually, 8 million people become ill with tuberculosis, and 2 million people die from the disease worldwide. ^[52] In 2004, around 14. 6 million people had active TB disease with 9 million new cases. The annual incidence rate varies from 356 per 100,000 in Africa to 41 per 100,000 in the Americas. Incidence is a measure of the risk of developing some new condition within a specified period of time The Americas are the lands of the Western hemisphere or New World, consisting of the Continents of North America and South America ^[2] Tuberculosis is the world's greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/AIDS. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome ^[53]

In 2005, the country with the highest estimated incidence of TB was Swaziland, with 1262 cases per 100,000 people. The Kingdom of Swaziland is a country located in Southern Africa centred at approximately 26o49'S 31o38'E India has the largest number of infections, with over 1. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country 8 million cases. ^[54] In developed countries, tuberculosis is less common and is mainly an urban disease. In the United Kingdom, TB incidences range from 40 per 100,000 in London to less than 5 per 100,000 in the rural South West of England;^[55] the national average is 13 per 100,000. London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. The highest rates in Western Europe are in Portugal (42 per 100,000) and Spain (20 per 100,000). Western Europe at its most general meaning means 'all the countries in the West of Europe ' Portugal, officially the Portuguese Republic (República Portuguesa is a country on the Iberian Peninsula. Spain () or the Kingdom of Spain (Reino de España is a country located mostly in southwestern Europe on the Iberian Peninsula. These rates compare with 113 per 100,000 in China and 64 per 100,000 in Brazil. Tuberculosis is a major Public health problem in China. China has the world's second largest Tuberculosis epidemic (after India |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld In the United States, the overall tuberculosis case rate was 4. 9 per 100,000 persons in 2004. ^[52]

The incidence of TB varies with age. In Africa, TB primarily affects adolescents and young adults. ^[56] 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. ^[57]

There are a number of known factors that make people more susceptible to TB infection: worldwide the most important of these is HIV. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Co-infection with HIV is a particular problem in Sub-Saharan Africa, due to the high incidence of HIV in these countries. Sub-Saharan Africa is a geographical term used to describe the area of the African continent which lies south of the Sahara, or those African countries ^[50][58] Smoking more than 20 cigarettes a day also increases the risk of TB by two- to four-times. A cigarette ( French "small Cigar " from cigar + -ette) is a product consumed through Smoking and manufactured ^[59][60] Diabetes mellitus is also an important risk factor that is growing in importance in developing countries. ^[61]

History

Tubercular decay has been found in the spines of Egyptian mummies. This article is about the country of Egypt For a topic outline on this subject see List of basic Egypt topics. A mummy is a Corpse whose Skin and Flesh have been preserved by either intentional or Incidental exposure to Chemicals extreme Pictured: Egyptian mummy in the British Museum

Tuberculosis has been present in humans since antiquity. "Ancient" redirects here For other uses see Ancient_(disambiguation. The earliest unambiguous detection of Mycobacterium tuberculosis is in the remains of bison dated 18,000 years before the present. ^[62] However, whether tuberculosis originated in cattle and then transferred to humans, or diverged from a common ancestor, is currently unclear. ^[63] Skeletal remains show prehistoric humans (4000 BC) had TB, and tubercular decay has been found in the spines of mummies from 3000-2400 BC. A mummy is a Corpse whose Skin and Flesh have been preserved by either intentional or Incidental exposure to Chemicals extreme ^[64] 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. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca ^[65] Genetic studies suggest that TB was present in South America for about 2,000 years. South America is a Continent of the Americas, situated entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a ^[66] In South America, the earliest evidence of tuberculosis is associated with the Paracas-Caverna culture (circa 750 BC to circa 100 AD). ^[67]

Folklore

Before the Industrial Revolution, tuberculosis may sometimes have been regarded as vampirism. The Industrial Revolution was a period in the late 18th and early 19th centuries when major changes in agriculture manufacturing and transportation had a profound effect on the Vampires are mythological or folkloric revenants who subsist by feeding on the blood of the living When one member of a family died from it, the other members that were infected would lose their health slowly. People believed that this was caused by the original victim draining the life from the other family members. Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits. 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. ^[68] 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. A fairy (also fay, fey, fae, faerie; collectively wee folk, good folk, people of peace, fair ^[69] 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. ^[69]

TB was romanticized in the nineteenth century. Many people believed TB produced feelings of euphoria referred to as "Spes phthisica" or "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 which made women more beautiful and men more creative. ^[70] In the early 20th century, some believed TB to be caused by masturbation. Masturbation refers to Sexual stimulation especially of one's own genitals ( self masturbation) and often to the point of Orgasm, which ^[71]

Study and treatment

The study of tuberculosis dates back to The Canon of Medicine written by Ibn Sina (Avicenna) in the 1020s. The Canon of Medicine ( Arabic: القانون في الطب Al-Qanun fi al-Tibb " The Law of Medicine " Persian TemplateInfobox Muslim scholars --> ( Persian /ابو علی الحسین ابن عبدالله ابن سینا (born 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. An infectious disease is a clinically evident Disease resulting from the presence of Pathogenic microbial agents including Pathogenic viruses Pathogenic Soil, often typeset as SOiL, is a four piece rock band from Chicago Illinois United States founded by Shaun Glass Tom Schofield Tim King and Adam Zadel Water is a common Chemical substance that is essential for the survival of all known forms of Life. ^[72][73] He developed the method of quarantine in order to limit the spread of tuberculosis. For other uses see Quarantine (disambiguation Quarantine is voluntary or compulsory isolation typically to contain the spread of something ^[74]

Although it was established that the pulmonary form was associated with 'tubercles' by Dr Richard Morton in 1689,^[75][76] 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. Richard Morton (1637-1698 was an English physician who was the first to state that tubercles were always present in the Tuberculosis disease of the lungs Johann Lukas Schönlein ( November 30, 1793 - January 23, 1864) was a German professor of medicine born in Bamberg. ^[77] 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. Mammoth Cave National Park is a US National Park in central Kentucky, encompassing portions of Mammoth Cave the longest Cave system known in the ^[78] The first TB sanatorium opened in 1859 in Görbersdorf, Germany (today Sokołowsko, Poland) by Hermann Brehmer. A sanatorium (also sanitorium, sanitarium) is a medical facility for long-term illness typically Tuberculosis. Sokołowsko (Görbersdorf is a Village and climatic Health resort situated in a deep forest-covered valley in Gmina Mieroszów, within Wałbrzych Sokołowsko (Görbersdorf is a Village and climatic Health resort situated in a deep forest-covered valley in Gmina Mieroszów, within Wałbrzych ^[79]

In regard to this claim, The Times for January 15, 1859, page 5, column 5, carries an advertisement seeking funds for the Bournemouth Sanatorium for Consumption, referring to the balance sheet for the past year, and offering an annual report to prospective donors, implying that this sanatorium was in existence at least in 1858. Events 588 BC - Nebuchadrezzar II of Babylon lays siege to Jerusalem under Zedekiah 's reign Year 1859 ( MDCCCLIX) was a Common year starting on Saturday (link will display the full calendar of the Gregorian calendar (or a Common

Dr. Robert Koch discovered the tuberculosis bacilli.

The bacillus causing tuberculosis, Mycobacterium tuberculosis, was identified and described on March 24, 1882 by Robert Koch. Events 1401 - Mongol emperor Timur sacks Damascus. 1603 - James VI of Scotland Year 1882 ( MDCCCLXXXII) was a Common year starting on Sunday (link will display the full calendar of the Gregorian calendar (or a Common Heinrich Hermann Robert Koch ( December 11 1843 – May 27 1910) was a German Physician. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. The Nobel Prize in Physiology or Medicine (Nobelpriset i fysiologi eller medicin is awarded once a year by the Swedish Karolinska Institute. ^[80] Koch did not believe that bovine (cattle) and human tuberculosis were similar, which delayed the recognition of infected milk as a source of infection. Later, this source was eliminated by the pasteurization process. Pasteurization is the process of heating Liquids for the purpose of destroying bacteria, Protozoa, Molds and Yeasts The process was 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. ^[81]

The first genuine success in immunizing against tuberculosis was developed from attenuated bovine-strain tuberculosis by Albert Calmette and Camille Guérin in 1906. Léon Charles Albert Calmette ( July 12, 1863 &ndash October 29, 1933) was a French Jean-Marie Camille Guérin ( December 22, 1872, Poitiers, France – June 9, 1961, It was called 'BCG' (Bacillus of Calmette and Guérin). Bacillus Calmette-Guérin (or Bacille Calmette-Guérin, BCG) is a vaccine against Tuberculosis that is prepared from a strain of the attenuated The BCG vaccine was first used on humans in 1921 in France,^[39] but it wasn't until after World War II that BCG received widespread acceptance in the USA, Great Britain, and Germany. This article is about the country For a topic outline on this subject see List of basic France topics. World War II, or the Second World War, (often abbreviated WWII) was a global military conflict which involved a majority of the world's nations, including The United States of America —commonly referred to as the See also Kingdom of Great Britain Great Britain (Breatainn Mhòr Prydain Fawr Breten Veur Graet Breetain is the larger of the two main islands Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. ^[40]

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. In Epidemiology, an Infection is said to be endemic (from Greek en- in or within + demos people in a Population when 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. The twentieth century of the Common Era began on ^[82] 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 "encouraged" to enter sanatoria that resembled prisons; the sanatoria for the middle and upper classes offered excellent care and constant medical attention. A notifiable disease is any disease that is required by law to be reported to government authorities A sanatorium (also sanitorium, sanitarium) is a medical facility for long-term illness typically Tuberculosis. ^[79] 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). ^[79]

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. Christmas Seals are Adhesive labels placed on Mail during the Christmas season to raise funds and awareness for Tuberculosis programs It expanded to the United States and Canada in 1907–08 to help the National Tuberculosis Association (later called the American Lung Association). The American Lung Association ( ALA) is a Non-profit organization that "fights lung disease in all its forms with special emphasis on Asthma,

In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into spittoons. A spittoon (or spitoon) is a receptacle made for Spitting into especially by users of chewing tobacco.

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, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research. The Medical Research Council (MRC is a UK organisation dedicated to "promot the balanced development of medical and related biological research ^[83]

It was not until 1946 with the development of the antibiotic streptomycin that effective treatment and cure became possible. Streptomycin is an Antibiotic drug the first of a class of drugs called Aminoglycosides to be discovered and was the first antibiotic remedy for Tuberculosis Prior to the introduction of this drug, the only treatment besides sanatoria were surgical interventions, including the pneumothorax technique—collapsing an infected lung to "rest" it and allow lesions to heal—a technique that was of little benefit and was largely discontinued by the 1950s. ^[84] The emergence of multidrug-resistant TB has again introduced surgery as part of the treatment for these infections. 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, and is therefore thought to increase the effectiveness of the chemotherapy. ^[85]

Hopes that the disease could be completely eliminated have been dashed since the rise of drug-resistant strains in the 1980s. Antibiotic resistance is the ability of a Microorganism to withstand the effects of Antibiotics. 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. ^[86] Due to the elimination of public health facilities in New York and the emergence of HIV, there was a resurgence in the late 1980s. ^[87] The number of those failing to complete their course of drugs is high. NY had to cope with more than 20,000 "unnecessary" TB-patients with multidrug-resistant strains (resistant to, at least, both Rifampin and Isoniazid). Multidrug resistance is a condition enabling a disease-causing organism to resist distinct Drugs or chemicals of a wide variety of structure and function targeted at eradicating The resurgence of tuberculosis resulted in the declaration of a global health emergency by the World Health Organization in 1993. ^[88]

Infection of other animals

Main article: Mycobacterium bovis

Tuberculosis can be carried by mammals; domesticated species, such as cats and dogs, are generally free of tuberculosis, but wild animals may be carriers. See Tuberculosis Mycobacterium bovis is a slow-growing (16 to 20 hour generation time Aerobic bacterium and the causative Mammals ( class Mammalia) are a class of Vertebrate Animals characterized by the presence of Sweat glands, including sweat glands In some places, regulations aiming to prevent the spread of TB restrict the ownership of novelty pets; for example, the U.S. state of California forbids the ownership of pet gerbils. An exotic pet is a rare or unusual animal kept as a Pet, or an animal kept as a pet which is not commonly thought of as a pet The United States of America —commonly referred to as the California ( is a US state on the West Coast of the United States, along the Pacific Ocean. A gerbil is a small mammal of the order Rodentia Once known simply as " desert rats " the gerbil subfamily includes about 110 species of African ^[89]

Mycobacterium bovis causes TB in cattle. See Tuberculosis Mycobacterium bovis is a slow-growing (16 to 20 hour generation time Aerobic bacterium and the causative An effort to eradicate bovine tuberculosis from the cattle and deer herds of New Zealand is underway. New Zealand is an Island country in the south-western Pacific Ocean comprising two main landmasses (the North Island and the South Island 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. In Epidemiology, a vector is an Organism that does not cause Disease itself but which transmits Infection by conveying Pathogens from A possum is any of about 64 small to medium-sized Arboreal Marsupial Species native to Australia, New Guinea, and Sulawesi Livestock is the term used to refer (singularly or plurally to a Domesticated Animal intentionally reared in an agricultural setting to produce such as Food ^[90] 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.

In the Republic of Ireland and the United Kingdom, badgers have been identified as one vector species for the transmission of bovine tuberculosis. Ireland ( Irish: Éire, ˈeːrʲə is a country in north-western Europe. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located 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. ^[91][92][93] A 9-year scientific study by an Independent Study Group of the likely efficacy of badger culling reported on 18 June 2007 that it was unlikely to be effective and could actually increase the spread of TB. Events 618 - Coronation of the Chinese governor Li Yuan as Emperor Gaozu of Tang, the new Emperor of China, initiating three centuries Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. The Independent Study Group was chaired by Sir John Bourne and included two statisticians, Professor Cristl Donnelly and Sir David Cox, the most distinguished statistician in the United Kingdom. Sir David Roxbee Cox FRS (born 1924 in Birmingham England) is an English Statistician. Donnelly and Cox produced a sophisticated stochastic model of the badger population which was used to make detailed quantitative predictions about the effects of various policies. The recommendations of the Bourne report^[94] came as a surprise to Ministers. The UK Government's Chief Scientific Adviser, Sir David King convened a committee to re-examine the Bourne report. The UK Government 's Chief Scientific Adviser (CSA is the personal adviser on science and technology-related activities and policies to the Prime Minister and the Sir David A King ScD FRS (born August 12, 1939) is the Director of the Smith School of Enterprise and the Environment at the University of Oxford King's committee produced a report on 30 July, only one month after the publication of Bourne's 9-year study, whose conclusions flatly contradicted those of the Bourne report and recommended badger culling. Events 1419 - First Defenestration of Prague. 1502 - Christopher Columbus lands at Guanaja in the Bay Islands off ^[95] The King committee did not include any statisticians and did not make use of the Donnelly & Cox statistical model. As a result, the issue of badger culling remains hugely controversial in the United Kingdom.

See also

References

Further reading

External links

• Tuberculosis at the Open Directory Project
• Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination. The Open Directory Project ( ODP) also known as dmoz (from directory The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated Core Curriculum on Tuberculosis: What the Clinician Should Know. 4th edition (2000). Updated August 2003.
• Central Asia Health Review (CAHR). The Central Asia Health Review (CAHR is a New York based independent online magazine covering public health and Human rights issues in Central Asia. High Prevalence of Multi-Drug Resistant Tuberculosis in Uzbekistan
• (CDC) - Division of Tuberculosis Elimination News and updates.
• (CDC) - Questions and Answers About TB, 2007.
• Health Protection Agency, England
• BioHealthBase Bioinformatics Resource Center. Database of Mycobacterium tuberculosis genome sequences and related information.
• Kaiser Family Foundation. Tuberculosis. Globalhealthfacts. org.
• The Nobel Prize Website. Tuberculosis Educational Game
• United States Agency for International Development (USAID). The Nobel Prize (Nobelpriset (Nobelprisen is a Swedish prize established in the 1895 will of Swedish chemist Alfred Nobel; it was first awarded in Peace, Literature The United States Agency for International Development (or USAID) is the United States federal government organization responsible for most non- military The Tuberculosis Coalition for Technical Assistance (TBCTA).
• World Health Organization (WHO). Tuberculosis.
• Tuberculosis and HIV: HIV InSite Knowledge Base chapter and related resources.