Tuberculosis VTPB 221 exam 3

when is the World TB day

March 24

The biggest killer

TB has killed more than any other infectious disease in history

one person becomes infected every _____

second with TB

how many people fall ill every year with TB

8-10M

Every hear how many people die from TB

1.5M

how many people are infected with TB

2 bilion

After COVID-19 __ is the second leading infectious disease killer

TB

Is TB curable

yes, and its preventable

tuberculosis is caused by 2 species of bacteria

1. mycobacterium tuberculosis

2. mycobacterium bovis

typical TB symptoms

lack of appetite, weight loss, chest pain, low fever, a constant cough with mucus and sometimes blood and night sweats

how is Tb spread

inhalation of aerosols of infected person. ex sneezing, coughing or talking and zoonotic infection by ingesting contaminated cow milk or meat

which TB mycobacterium is zoonotic

Mycobacterium bovis

how is TB treated

multidrug antimicrobial therapy for 5-6 months

which 8 countries account for 2/3rd of all global TB cases

• india

• indonesia

• china

• the philippines

• pakistan

• nigeria

• bangladesh

• DRC

have tb cases decreased

yes, 3.1 per 100,000 in 2024

US state with most cases in 2024

California then TX then NY then FL

TB hospital in TX

hospital dedicated to treating TB in San Antonio, TX

is tb cases more prevalent in US born or non US born people

Non US born

3 Ethnicity that TB is most common in

Asian> Hispanic> black

how long has TB been around

term coined in 1832 but has been around for 3M years

Who coined Tuberculosis term

Johann Schonlein in 1832

manifestations and names troughout history

phthisis: greek origin, chronic wasting

consumption: chronic wasting

king’s evil

lung sickness

lupus vulgaris

pott’s disease

white plague

kings evil

TB of lymph nodes of neck

lung sickness

TB of the lung disease

lupus vulgaris

TB of the skin

Pott’s disease

TB of the spine

White plague

TB

Scrofula- “The kings evil”

More common in medieval Europe than respiratory form. people believed to be healed by gold on neck.

who placed gold on PPLs neck.

Edward the Confessor to Queen Anne

mummies had what type of TB

Potts disease (spine)

romantic disease

TB, pale skin, thin waist and flushed lips and cheeks from long term fevers.

Europes Industrial Revolution

agrarian to urban lifestyle shift

increase in population density

squalor and malnutrition

pollution (coal smoke)

in 1780 england deaths from TB were

1,120/100,000

when did death peak

early 19th centru america (1800’s)

what percentage of american city dwellers died with Tb

25%

Baron Georges Haussmann

represented urban renewal in europe

increased sanitation

other cities followed this model.

what caused TB decline in late 19th century

improved public health

Robert Koch (german physician)

postulated the bacterium “tubercule bacillus” as the cause

on what date did Robert Koch postualte bacteria for TB

March 24, 1822

TB in the US

predominately rural

increased Tb cases w/ immigrants

Tb spread in tenements (multi family living)

NY had 6-7/1,000 in 1800 declining to

4/1,000 in 1860-1870

public health education

public service announcements

laws

testing

1907

legislation barred sick immigrants

Ellis Island

island in NY were immigrants were checked and kept

sanatorium movement

romans=sea voyages

english=sea-bathing

germans established sanitoria

sanatorium movement in the US

Edward Trudeau (american physician)

Edward Trudeau

contracted TB from brother

1st research lab in US in Sanatorium, Lake saranc, NY

Supported fresh air and good nutrition

climatotherapy

was established in 2nd half of 19th century.

statistics does not support this therapy

move people to areas with diff climate to relieve the disease

when did sanatorium movement end

1940s tB dropped bc of drugs

Characteristics of Mycobacteria

complex cell walls which in glycoproteins

unique wall resists phagocytosis

generation time of mycobacteria

12-36 hrs on laboratory media

most is 15min-1hr

Mycobacteria bovis transmission

cow to cow

cow to human

human to cow

human to human

mycobacteria avium

AIDS

4 factors determination of infection

# of organism expelled into air

concentration of organism

length of time of exposure

immune status of exposed individual

latent vs active

latent: doesnt grow or make paeople sick CANNOT spread person to person

active: spread and disease

tb diagnosing

skin test

chest x-ray

skin test

PPD (purified protein derivative) injected ID test is read 48-72 hrs after

15mm< HIV-

5mm< HIV+ or immunocompromised

the bigger the rash the less exposure you’ve had

PPD

also for cows

Reasons for Return in the U.S.

The human immunodeficiency virus (HIV) epidemic • Increases in immigration from endemic areas • Increases in urban homelessness, drug abuse, correctional facilities • The deterioration and dismantling of the public health infrastructure for the control of TB • Increase and spread of multidrug-resistant TB

TB is #1 killer of people with

HIV

who isolated streptomycin

Selman Waksman (1888-1973), American (Russian) chemist

Antimicrobial drugs

Isoniazid – 1951

Pyrazinamide - 1954

• Ethambutol - 1962

• Rifampicin – 1963

“cocktails”

drug used in combination

long term therapy (6mo to 1yr)

treatment challenges

Tubercles prevent efficient penetration of agents

Because of prolonged treatment, bacilli have longer time to develop resistance

DOTS

Direct Observed Treatment Short Course

DOTS approach

Started in 1990, prior to this, in 1986, 26% of patients became drug resistant. Usually 6 months duration

Patients maintained in clinics or medicated by health authorities with clinic visits or at home

BCG vaccine (Bacille Calmette-Guerin)

attenuated live mycobacterium bovis ;developed in 1921

first and only vaccine

TB vaccine

Used to vaccinate newborn babies in highly endemic countries - Protection against extra-pulmonary form of TB - Duration of immunity: approximately 10 years - Also provides protection against leprosy Protection against pulmonary

TB vaccine for adults

Protection against pulmonary TB in adults vary 0%-80%

Better vaccines for TB in adults are needed