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The most revealing aspect I learned about this disease is the fact that its origin went much further than I imagined. I thought tuberculosis manifested in the late 1800s but evidence suggest that it dates back to ancient times, thousands of years ago. I was also surprised to learn that tuberculosis affects other parts of the body, not just the lungs. TB can affect the brain, kidneys, spine and much more. I've come to understand that TB typically settles in the lungs because individuals are more likely to breathe in the bacterium. One thing I wish I mentioned in my Padlet assignments was the other type of TB condition which is the latent TB infection. Individuals with latent TB do not have any symptoms and cannot spread TB, however they are able to develop active TB in the future if they do not get treated.

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Beyond the physical effects tuberculosis made a significant societal and sociological impact on the world. In many societies, individuals with tuberculosis were seen as damaged goods and unmarriageable. Not only were they perceived this way but they tend to be rejected from family, friends and in some cases employment. As a result, these affected individuals develop anxiety, depression and reduction in their quality of life. In history, Tuberculosis was always closely linked with poverty; it became known as the disease of the poor. The reason was because the poor typically lived in overcrowded conditions, making transmission of the disease accessible. Due to the lack of health care, food and hygienic conditions, the poor are more likely to die of TB or receive inconsistent treatment.

Societal behaviors have changed due to the intervention of governments and leadership. Some of these interventions knowns as "social protection" have included cash transfers for treatment adherence, food vouchers and transportation vouchers. Society did learn from the physical effect of the disease. Society learned the signs and symptoms related to be TB and have implemented the use of informal health providers. These health attendants are used in rural villages to be the first point of contact on health any health concerns. This effort prompts speedy diagnoses and treatment to individuals affected with TB.

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The U.S. government did not get involved in global efforts to control tuberculosis until the late 1990s. And it wasn't until 1993 that the World Health Organization declared tuberculosis a global health emergency. At that point mortality rates were falling but TB was still a major problem. The U.N. General Assembly held their first meeting on tuberculosis in 2018 in order to discuss progress towards this epidemic. Thankfully the U.S has funded global efforts on combatting tuberculosis and continues to be the largest donor to this day. Some of the innovative initiatives used in combatting tuberculosis included early diagnosis via sputum-smear microscopy, preventative treatment such as vaccination for high risk groups and systematic screening for and management of TB. Personally I believe leadership should have intervened sooner in response to the disease. Tuberculosis was well known since the discovery of the bacteria back in 1882 and I think the sooner the intervention the better the response would have been. Meaning maybe transmission rates could have decrease etc.

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As I previously mentioned in an older post, tuberculosis was not always handled properly my the community, especially those in healthcare.  Physicians were recommending what would now seem extreme treatment options; artificial pneumothorax, thoracoplasty, plombage and lung resection. Besides that, they advised TB patient to rest, eat well and exercise. Physician were the most curious members of the healthcare community and set forth to identify the pathogen. Despite those times, policies and procedures are now in place in health care settings to control TB. The infection control program is currently based on 3 subject matters; administrative measures, environmental controls, and use of respiratory protective equipment. Administration manages health care personnel, implements proper work practices, and ensures education and training of TB disease. Environmental controls prevent the spread and reduce infectious environment through ventilation and cleaning. Finally healthcare personnel are required to use personal protective equipment to reduce the risk of exposure to themselves and others.

The most significant medical advances used to combat this disease is vaccination and antibiotics. The BCG (Bacille Calmette-Guerin) live vaccine developed in 1921 has been by far the only vaccine ever administered to treat TB. The treatment for active TB is a combination of antibacterial medications, isoniazid INH and other drugs' such as rifampin, pyrazinamide and ethambutol. Furthermore, new technologies are being applied to this disease, like the way its detected. Current TB test are time consuming, expensive and lacks sensitivity, while not even being able to differentiate between active and latent TB. The way to detect it is by measuring epitope-specific IgG in seum. But this technology has not been made public yet due to funding.

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Virulence is the harm a pathogen/bacteria does to its host following an infection. In the case of tuberculosis, harm can mean the signs and symptoms. Symptoms can range from weakness, to weight loss, to chest pain and a prolonged cough. Some tuberculosis strain are more virulent than others because of their increasing transmissibility and the higher cases of morbidity associated with said individuals. However, we cannot measure the virulence of M. tuberculosis because of the limited knowledge we have on how the disease is caused to a person in the first place. TB is highly variable, especially in humans therefore the virulence has been difficult to measure. What has been discovered, however, is the virulence-associated genes of the mycobacterium tuberculosis complex. Phthiocerol dimycocerosate (PDIM) and phenolic glycolipids (PGL) are molecules required for bacteria duplication during an infection's acute phase. These two molecules PDIM and PGL protect pathogenic mycobacteria from macrophages via their cell wall barrier. Although M. tuberculosis does not have established virulence reports, progress is being made everyday and at least virulence associated gene have been identified.

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Evolution of Incidence in Tuberculosis cases worldwide.

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Countries with the highest rates of TB (2021).

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Tuberculosis is assumed to have originated in East Africa. All of the current major strains of Tuberculosis can be found in East Africa today. Although archeological evidence of the disease is lacking in East Africa, there was evidence of Tuberculosis in Egyptian mummies about 5000 years ago. Since people began to move out of Africa as early as 1.7 million years ago, we can infer that they took many things with them, including disease. TB had been identified from scripture from India around 1550 BC and medical text from China around 2700 BC. As these migrants reached Europe and Asia, the disease spread and reached epidemic proportions. The disease peaked in England in 1780; the death rate was 1,120 per 100,000 individuals annually. By the end of the 18th century, one in every four individuals had died of the disease. Many European people moved to distant colonies such as South Africa during this time to escape the disease.

Scientists desperate for answers began dissecting dead patients and investigating this disease. One man noticed that TB was more frequent in soldiers stationed for long times in barracks than among those in the field. The spread continued across America. In the 19th century, the death rate was 7 million per 50 million people openly infected. Between 1810 and 1815, 25% of deaths resulted from TB in New York City. By the 20th century, TB began to decline, and in 1921 the BCG vaccine was developed by Albert Calmette and Camille Guerin. Tuberculosis is now widely controlled; there have been only 2.5 cases per 100,000 in the united states this past year. However, Tb is still a problem in many other countries. The most incidence of TB is in sub-Saharan Africa, Eastern Europe, and Asia.

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Tuberculosis has been around since the beginning of time. The early variant of M. Tuberculosis is said to originate in East Africa 3 million years ago. Over the centuries, this disease has been given many names; consumption, the white plague, psithisis. It wasn't until 1679 that a scientist named, Sylvius de la Boe, identified the pathological and anatomical manifestation of TB. However, the term 'Tuberculosis' wasn't coined until 1834 by Johann Schonlein. This infectious agent was a bacteria initially found in soil like many other actimomycetes. It eventually evolved to live in mammals and now it's one of the most common diseases in South-East Asia. TB is an obligate pathogen because it requires a host to live for all if not most of their lifecycle. TB has a tropism for phagocytic cells, immune cells that are responsible for destroying other foreign or dead cells.