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Tuberculosis has been around since neolithic times, but for a long time, nobody knew how to treat it. Robert Koch discovered the cause of the condition in 1882, but there was long lapse in time before scientist actually knew how to combat the disease. Rest, eating healthy foods, and a plethora of bizarre remedies such as fish oil, vinegar messages, being touched by royalty, and inhaling different herbs, were all recommended at some point in time. Antibiotics were a major advancement in the health care community in general, and they were the first step in treating tuberculosis. Streptomycin was developed by a group of scientists (including by Selman Waksman) in 1943, and it showed promising activity against tuberculosis. The discoveries of para-aminosalicylic acid, isoniazid, ethambutol, and rifampicin all followed and enabled us to combat the disease in much less time than before. Many new technologies have been applied to this disease over time. The method of staining that Koch used to identify the causative agent of the condition was invented only six years beforehand in 1876. Today, we use skin tests, blood tests, x-rays and other advanced methods to diagnose tuberculosis. We have developed a medication regimen that is effective at treating the disease in months and there is even a vaccine for the disease.

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The most revealing information that I learned about tuberculosis was revealed in my research for Assignment 4: Virulence. The various defense mechanisms that mycobacterium can employ to avoid the human immune system helped me to understand why the disease is so hard to treat / get rid of. A regimen of multiple drugs over the course of months is required to resolve this condition. It has evolved to be more virulent over time, and we have not yet figured a way around this.

One thing that surprised me about tuberculosis is that it has existed for over 5,000 years and is still one of the most problematic infectious diseases in the world. Even with treatments that work and a vaccine for the illness, millions of people contract the disease yearly.  What's worse is that over 500 people in The United States alone and over a million people die from it each year. We have come a long way from the initial epidemic peak of the disease in the 1800s, but we are nowhere near solving this issue. Access to healthcare and adhering to the complex drug regimen it takes to cure the disease are only two of a multitude of factors that contribute to this failure to eradicate tuberculosis.

Something that I believe could have been an additional Padlet assignment is how the disease of choice is diagnosed and whether it is treatable or not. I think describing the new methods we have to diagnose illnesses and the drugs we have developed to combat them would make an interesting excerpt to read. For example, tuberculosis can be diagnosed by skin tests, blood tests, x-ray, and a few other methods. Moreover, it can be cured, usually with a variety of drugs such as isoniazid, rifampin, pyrazinamide and ethambutol.

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Factors affecting virulence in normal circumstances.

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The word virulence describes the ability of a pathogen or microorganism to cause damage to its host once infected.  There are a variety of factors that contribute to virulence levels. Motility, ability to compete for nutrients, and how well the microorganism adheres to host cells are only a few variables that are taken into consideration. From my research, I determined that the microorganism that causes tuberculosis has a relatively high virulence. Mycobacterium tuberculosis does not have exact classical virulence factors, but we can analyze the mycobacterium tuberculosis complex and  identify things that affect the pathogens interaction with its host. Mycobacterial cell walls are rich in lipids, giving them a strong impermeability. The microorganisms also have lipoproteins that perform varying functions; some induce macrophage apoptosis and some aid in cell wall homeostasis and nutrient uptake. In addition, MTB actually has the ability to infect and reside within immune cells. It can live in the environment of macrophage phagosomes and use a plethora of strategies (phagosome-lysosome fusion being one) to evade the mechanisms of macrophages. All in all, the mycobacterial pathogens in question have a great ability to survive the immune response in humans and cause damage (specifically lung damage) to the host. The virulence of MTB has indeed changed with time; it has evolved over thousands of years to more effectively resist the immune response and have a higher rate of survival and transmission to other hosts.

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In addition to physical symptoms, tuberculosis can have many sociological effects on people. There is definitely a stigma surrounding the disease that paints affected people as unwanted or tainted in some way. Some TB patients report have issues in the workplace, their social and romantic lives due to their illness. I do not believe that many society behaviors have changed due to this disease. It is possible that once it spread across the country, people fed into the idea that tuberculosis only affected the impoverished and malnourished much less, as the contrary was happening right before their eyes. There is not much evidence that people globally have learned from the physical effects of tuberculosis, as millions of individuals still contract the disease each year. The United States shows significant progress that might indicate otherwise. However, there are still upwards of 5,00 new cases every year in this country.

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The popular idea is that tuberculosis can be dated back to early hominids in East Africa or Egyptian mummies in the year 2400 BC. However, a study published in 2008 detailed evidence of tuberculosis infection in Atilt Yam, a Neolithic settlement off the coast of Israel that existed 9,000 years ago. It was first described in written records in India and China 2,300-3,3000 years ago. The first pathological and anatomical descriptions of the disease was written by Sylvius de la Boe in 1679. The suspected infectious agent was bacteria. Benjamin Marten hypothesized that it was caused by "minute living creatures" in the 1700's. It was considered an emerging infectious disease, which can be defined as an infection that either newly appears or is rapidly spreading in a population. There is a zoonotic (meaning an infection that spreads between people and animals) strain of TB, caused by Mycobacterium bovis.

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Before the late 1800's, not much about tuberculosis was done by leadership because people did not know much about the origin of the disease. There was not much they could do or change. After the discovery of its bacterial cause, many ideas about controlling the spread of the disease and possible holistic treatments were shared. Extensive research on the pathology of the disease and developing effective treatments did not happen until the mid 1900's. In 1921, a tuberculosis vaccine was first administered, and vaccination was highly encouraged following World War 1. In 1993, the World Health Organization declared tuberculosis as a world-wide health emergency and a number of innovative lobal initiatives have launched since. These include the Global Fund to Fight AIDS, Tuberculosis, and Malaria established n 2002 and World tuberculosis Day, which started in 2018. These programs are aimed at advancing research and increasing access to the necessary health services in order to end this epidemic.  Promoting more research, experiments, and clinical trials earlier on would have been a good idea to jumpstart combatting the disease. Implementing more control interventions, providing more education on the disease and affordable access to health care services such as testing and vaccination are all things that would still help improve the TB response today.

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The first mentions of tuberculosis are thought to have been in Africa or Asia thousands of years ago. By the middle ages it had spread to Europe and South America. It was in the 18th century that it reached significant epidemic levels. In the mid to late 1800's, we saw mortality rates peak. It was reported that the disease killed one out of every seven people living in the United States and Europe. Tuberculosis has since spread all over the world. According to the World Health Organization, in modern times "about half of all people with TB can be found in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa". Today, the disease and its related complications kill over a million people a year.

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The disease I chose to research for my Padlet project is tuberculosis. It is caused by the bacterium Mycobacterium tuberculosis. These are gram-positive rod-shaped bacteria. This pathogen is exceptional at adapting to surviving inside human hosts. Tuberculosis affects millions of people worldwide, and is often fatal.