Tuberculosis ( TB ) is an infectious disease that is usually caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections have no symptoms, in this case known as latent tuberculosis. About 10% of latent infections develop into active disease which, if left untreated, kills about half of those infected. The classic symptom of active TB is a chronic cough with phlegm containing blood, fever, night sweats, and weight loss. The historical term " consumption " came about because of weight loss. Other organ infections can cause various symptoms.
Tuberculosis spreads through the air when people who have active TB in their lungs cough, spit, talk, or sneeze. People with latent TB do not spread the disease. Active infection is more common in people with HIV/AIDS and in those who smoke. The diagnosis of active tuberculosis is based on chest x-ray, as well as microscopic examination and body fluid cultures. The diagnosis of latent TB depends on the tuberculin skin test (TST) or blood test.
TB prevention involves screening those at high risk, early detection and treatment of cases, and vaccinations with bacillus vaccine Calmette-GuÃÆ'Â © rin (BCG). High-risk people include households, workplaces, and social contacts of people with active TB. Treatment requires the use of some antibiotics over a long period of time. Antibiotic resistance is a growing problem with the increasing levels of multi-drug resistant TB (MDR-TB) and broadly drug-resistant tuberculosis (XDR-TB).
Currently, one third of the world's population is suspected of being infected with TB. New infections occur in about 1% of the population each year. By 2016, there are more than 10 million active TB cases resulting in 1.3 million deaths. This makes it the number one cause of death from infectious diseases. More than 95% of deaths occur in developing countries, and more than 50% in India, China, Indonesia, Pakistan and the Philippines. The number of new cases each year has declined since 2000. About 80% of people in many Asian and African countries test positive while 5-10% of people in the United States test positive with tuberculin test. Tuberculosis has been present in humans since ancient times.
Video Tuberculosis
Signs and symptoms
Tuberculosis can infect any part of the body, but is most common in the lungs (known as pulmonary tuberculosis). Extrapulmonary TB occurs when tuberculosis develops outside the lungs, although extrapulmonary tuberculosis can coexist with pulmonary TB.
Common signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue. Significant nail clubbing can also occur.
Lung
If tuberculosis infection becomes active, most often it involves the lungs (about 90% of cases). Symptoms may include chest pain and prolonged cough producing sputum. Approximately 25% of people may have no symptoms (ie they remain "asymptomatic"). Occasionally, people can cough up small amounts of blood, and in very rare cases, the infection can erode into the pulmonary artery or Rasmussen aneurysm, resulting in massive bleeding. Tuberculosis can be a chronic disease and cause extensive scarring of the upper lobe of the lung. The upper lobe is more commonly affected by tuberculosis than the lower one. The reason for the difference is not clear. This may be due to better airflow, or poor lymph drainage in the upper lung.
Extrapulmonary
In 15-20% of active cases, the infection spreads outside the lungs, causing other types of TB. This is collectively denoted as "extrapulmonary tuberculosis". Extrapulmonary TB occurs more often in people with weakened immune systems and children. In those with HIV, this occurs in more than 50% of cases. Famous outside lung infection sites include pleura (in TB pleuritis), central nervous system (in tuberculosis meningitis), lymphatic system (in skrofula neck), genitourinary system (in urogenital tuberculosis), and bone and joints (in Pott's disease of the spine ), among others. A potentially more serious and widespread form of TB is called "disseminated tuberculosis", also known as mild tuberculosis. TB miliaries currently make up about 10% of extrapulmonary cases.
Maps Tuberculosis
Cause
Mycobacteria
The main causes of TB are Mycobacterium tuberculosis (MTB), small bacillus, aerobic, nonmotile. High lipid content of this pathogen account for many of its unique clinical characteristics. It divides every 16 to 20 hours, which is a very slow rate compared to other bacteria, which usually divide in less than an hour. Mycobacteria have an outer layer of lipid bilayer. If Gram staining is performed, the MTB is either very weakly stained "Gram-positive" or does not retain the dye as a result of high lipids and mycolic acid content from its cell wall. MTB can withstand weak disinfectants and survive dry for weeks. In nature, bacteria can grow only within the cells of host organisms, but M. tuberculosis can be bred in the laboratory.
Using histologic stains on samples extracted from sputum (also called "sputum"), scientists were able to identify MTB under a microscope. Because MTB retains certain stains even after treated with acidic solutions, it is classified as an acid-resistant bacillus. The most common fast-acid-coloring techniques are the staining of Ziehl-Neelsen and Kinyoun dyes, which bleach the bright red-colored bacillus protruding with a blue background. Auramine-rhodamine staining and fluorescence microscopy are also used.
The complex M. tuberculosis (MTBC) includes four other causes of TB mycobacteria: M. bovis , M. africanum , M. canetti , and M. microti . M. africanum is not widespread, but this is a significant cause of tuberculosis in some parts of Africa. M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk almost completely eliminates this as a public health problem in developed countries. M. canetti is rare and seems limited to the Horn of Africa, although some cases have been seen in African emigrants. M. microti is also rare and is seen almost exclusively in immunodeficiency people, although its prevalence may be significantly underestimated.
Other known pathogens of mycobacteria include M. leprae, M. avium and M. kansasii. The last two species were classified as "mycobacteria nontuberculous" (NTM). NTM does not cause TB or leprosy, but they cause a lung disease that resembles TB.
Risk factors
A number of factors make people more vulnerable to TB infection. The most important risk factor globally is HIV; 13% of all people with TB are infected by the virus. This is a particular problem in sub-Saharan Africa, where HIV rates are high. People without HIV infected with tuberculosis, about 5-10% develop active disease during their lifetime; on the contrary, 30% of those coinfected with HIV develop active disease.
Tuberculosis is closely related to population density and malnutrition, making it one of the major diseases of poverty. High-risk people include: people who inject drugs, residents and local employees where vulnerable people are congregated (eg prisons and homeless shelters), medically and poorly resourced communities, ethnic groups high-risk minorities, children in close contact with high-patient category categories, and health care providers serving these patients.
Chronic lung disease is another significant risk factor. Silicosis increases risk by about 30-fold. Those who smoked had nearly twice the risk of TB compared with nonsmokers.
Other diseases may also increase the risk of developing tuberculosis. These include alcoholism and diabetes mellitus (threefold increase).
Certain drugs, such as corticosteroids and infliximab (anti-TNF monoclonal antibodies), are becoming increasingly important risk factors, especially in developed countries.
Genetic susceptibility also exists, where overall interests remain undefined.
Mechanism
Transmission
When people with active pulmonary TB cough, sneeze, talk, sing, or spit, they release infectious aerosol drops from 0.5 to 5.0 Âμm. One sneeze can release up to 40,000 droplets. Each of these droplets can transmit the disease, because the dose of tuberculosis infection is very small (inhalation of less than 10 bacteria can cause infection).
Persons with prolonged, frequent, or close contact with people with TB are at greatest risk for infection, with an estimated rate of 22%. A person with active but untreated tuberculosis can infect 10-15 (or more) other people per year. Transmission should occur only from people with active TB - those with latent infection are considered non-infectious. The likelihood of transmission from one person to another depends on several factors, including the number of carrier-released droplets, the effectiveness of ventilation, the duration of exposure, the virulence of M. tuberculosis, the level of immunity in uninfected persons, and others. People-to-person waves can be circumvented by separating them from active ("open") TB and placing them on an anti-TB drug regimen. After about two weeks of effective treatment, subjects with non-resistant active infection generally do not remain transmitted to others. If a person becomes infected, it usually takes three to four weeks before the newly infected person becomes infectious enough to transmit the disease to another person.
Pathogenesis
About 90% of those infected with M. tuberculosis have an asymptomatic latent TB infection (sometimes called LTBI), with only a 10% chance of a lifetime that latent infection will develop into active and active TB disease. In those with HIV, the risk of developing active TB increases to nearly 10% per year. If effective treatment is not given, the mortality rate for active TB cases is up to 66%.
TB infection begins when mycobacteria reaches the alveolar lung air sacs, where they attack and replicate in the endosom of alveolar macrophages. Macrophages identify bacteria as foreign substances and try to eliminate them with phagocytosis. During this process, the bacteria are enveloped by macrophages and stored temporarily in membrane-bound vesicles called phagosomes. The phagosome then joins the lysosome to create phagolisosomes. In phagolysosome, cells try to use reactive oxygen species and acids to kill bacteria. However, M. tuberculosis has a thick wax microbic acid capsule that protects it from these toxic substances. M. tuberculosis is capable of reproducing in macrophages and eventually killing immune cells.
The main site of infection in the lungs, known as the "Ghon focus", is generally located at the top of the lower lobe, or lower part of the upper lobe. Tuberculosis of the lungs can also occur through infection from the bloodstream. This is known as the focus of Simon and is usually found at the top of the lungs. This hematogenic transmission can also spread the infection to more distant places, such as peripheral lymph nodes, kidneys, brain, and bone. All parts of the body can be affected by the disease, although for unknown reasons it seldom affects the heart, skeletal muscle, pancreas, or thyroid.
Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages, T lymphocytes, B lymphocytes, and fibroblast aggregates form granulomas, with lymphocytes in the vicinity of infected macrophages. When other macrophages invade infected macrophages, they join together to form giant multinucleated cells in the alveolar lumen. Granulomas can prevent the spread of mycobacteria and provide a localized environment for the interaction of immune system cells. However, recent evidence suggests that bacteria use granulomas to avoid destruction by the host's immune system. Macrophages and dendritic cells in granulomas can not present antigen to lymphocytes; thus the immune response is suppressed. Bacteria in the granuloma can become dormant, resulting in latent infection. Another feature of granuloma is the development of abnormal cell death (necrosis) in the tubercle center. For the naked eye, it has a soft texture, white cheese and is called caseous necrosis.
If TB bacteria enter the bloodstream from the damaged tissue area, they can spread throughout the body and regulate many focal infections, all appearing as small white tubercles in the tissues. This form of severe TB disease, most common in young children and people with HIV, is called miliary tuberculosis. People with this disseminated TB have a high mortality rate even with treatment (about 30%).
In many people, infection occurs and decreases. The destruction of tissue and necrosis is often offset by healing and fibrosis. The affected tissue is replaced by scar tissue and a cavity filled with a necrotic case of caseosa. During active disease, some of these cavities join the airways (bronchi) and this material can cough. It contains live bacteria, and thus can spread the infection. Treatment with the proper antibiotics kills the bacteria and allows healing to take place. Once healed, the affected area was eventually replaced by scar tissue.
Diagnosis
Tuberculosis is active
Diagnosing active tuberculosis on the basis of signs and symptoms is difficult, such as diagnosing illness in those with weak immune systems. The diagnosis of TB should, however, be considered to them with signs of lung disease or constitutional symptoms lasting more than two weeks. Chest X-ray and some sputum cultures for acid-resistant bacilli are usually part of the initial evaluation. Interferon-? test releases and tuberculin skin tests are not widely used in developing countries. The gamma interferon release test (IGRA) has similar limitations in those with HIV.
The exact diagnosis of TB is made by identifying M. tuberculosis in a clinical sample (eg, sputum, pus, or tissue biopsy). However, a difficult culture process for this slow-growing organism can take two to six weeks for blood cultures or phlegm. Thus, treatment often begins before culture is confirmed.
The nucleic acid amplification test and adenosine deaminase test may allow rapid TB diagnosis. However, these tests are not routinely recommended, as they rarely change how a person is treated. Blood tests to detect antibodies are neither specific nor sensitive, so they are not recommended.
Latent tuberculosis
Mantoux tuberculin skin tests are often used to screen people at high risk for TB. Those who had previously been immunized with the Bacille Calmette-Guerin vaccine may have false-positive test results. This test may be negatively wrong in those with sarcoidosis, Hodgkin's lymphoma, malnutrition, and most notably, active tuberculosis. The interferon gamma release test, on blood samples, is recommended in those with a positive Mantoux test. These are not affected by immunization or most environmental mycobacteria, so they produce fewer false-positive results. However, they are influenced by M. Szulgai, M. Marinum, and M. kansasii. IGRA can improve sensitivity when used in addition to skin tests, but may be less sensitive than skin tests when used alone.
Prevention
Efforts to prevent and control tuberculosis depend on infant vaccination and appropriate detection and treatment for active cases. The World Health Organization has achieved some success with improved treatment regimens, and a slight decrease in the number of cases. The US Preventive Services Task Force (USPSTF) recommends screening people at high risk for latent TB with tuberculin skin test or interferon-gamma release test.
Vaccines
The only vaccine available in 2011 was Bacillus Calmette-GuÃÆ'Â © rin (BCG). In children it reduces the risk of infection by 20% and the risk of infection turns into an active disease of almost 60%.
It is the most widely used vaccine worldwide, with over 90% of all children vaccinated. The immunity induces a decline after about ten years. Because tuberculosis is uncommon in most Canadian, British, and US, BCG is administered only to people at high risk. Part of the reason against the use of vaccines is that the false tuberculin skin test is positive, reducing the utility of the test as a screening tool. A number of new vaccines are under development.
Public health
The World Health Organization declared TB a "global health emergency" in 1993, and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis aimed at saving 14 million lives between its launch and 2015. The number of targets they set was not achieved by 2015, largely due to increases in HIV-related TB and the emergence of some drug-resistant TB. The tuberculosis classification system developed by the American Thoracic Society is used primarily in public health programs.
Management
TB treatment uses antibiotics to kill bacteria. Effective TB treatment is difficult because of the unusual structure and chemical composition of the mycobacterial cell wall, which inhibits the entry of drugs and makes many antibiotics ineffective. The two most commonly used antibiotics are isoniazid and rifampicin, and treatments can be prolonged, taking several months. Latent TB treatment usually uses a single antibiotic, while active TB disease is best treated with a combination of several antibiotics to reduce the risk of bacteria developing antibiotic resistance. People with latent infection are also treated to prevent them from developing into active TB disease later in life. Directly observed therapies, that is, have health care providers take care of the person taking their medication, recommended by WHO in an effort to reduce the number of people who do not take antibiotics appropriately. The evidence to support this practice for people who only use their drugs independently has poor quality. There is no strong evidence to suggest that the observed therapy directly increases the number of people who recover or the number of people who completed their medication. Moderate quality evidence suggests that there is no difference if people are observed at home rather than in the clinic, or by family members versus health care workers. Methods to remind people of the importance of care and promise can result in minor but important improvements.
New onset
The recommended treatment for new pulmonary tuberculosis, in 2010, was six months from a combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and ethambutol during the first two months, and only rifampicin and isoniazid for the last four months. Where resistance to isoniazid is high, ethambutol may be added for the last four months as an alternative.
Recurrent illness
If tuberculosis recurs, testing to determine which antibiotics are sensitive is important before determining the treatment. If some drug-resistant TB (MDR-TB) is detected, treatment with at least four effective antibiotics for 18 to 24 months is recommended.
Drug resistance
Primary resistance occurs when a person becomes infected with a resistant strain of TB. Someone with highly susceptible MTBs may develop secondary resistance (acquired) during therapy because of inadequate treatment, not taking a properly prescribed regimen (lack of adherence), or using low-quality drugs. Drug-resistant TB is a serious public health problem in many developing countries, because it is longer and requires more expensive drugs. MDR-TB is defined as the most effective resistance to two first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six second-line drug classes. Drug-resistant TB is resistant to all drugs currently in use. It was first observed in 2003 in Italy, but is not widely reported until 2012, and has also been found in Iran and India. Bedaquiline is tentatively supported for use in some drug-resistant TB.
XDR-TB is a term sometimes used to define highly resistant TB, and is one of ten cases of MDR-TB. XDR TB cases have been identified in more than 90% of countries.
Prognosis
The progression of TB infection into a real TB disease occurs when bacilli overcomes the immune system's defenses and begins to multiply. In primary TB disease (about 1-5% of cases), this occurs immediately after the initial infection. However, in most cases, latent infection occurs without obvious symptoms. These dormant bacillas produce active tuberculosis in 5-10% of these latent cases, often years after infection.
The risk of reactivation increases with immunosuppression, as is caused by HIV infection. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increased to 10% per year. Studies using DNA fingerprinting of M. tuberculosis have shown that reinfection contributes more to recurrent TB than previously thought, with estimates that it may include more than 50% of reactivated cases in the area TB is common. The chance of death from tuberculosis cases was about 4% in 2008, down from 8% in 1995.
Epidemiology
About a third of the world's population has been infected with M. tuberculosis, with new infections occurring in about 1% of the population each year. However, most infections with M. tuberculosis do not cause TB disease, and 90-95% of infections remain asymptomatic. In 2012, an estimated 8.6 million chronic cases are active. In 2010, 8.8 million new TB cases were diagnosed, and 1.20 to 1.45 million deaths occurred, mostly in developing countries. Of these 1.45 million deaths, about 0.35 million occur in those who are also infected with HIV.
Tuberculosis is the second most common cause of death from infectious diseases (after HIV/AIDS disease). The total number of cases of tuberculosis has declined since 2005, while new cases have declined since 2002. China has achieved dramatic progress, with about 80% reduction in TB death rates between 1990 and 2010. The number of new cases has declined. by 17% between 2004 and 2014. Tuberculosis is more common in developing countries; about 80% of the population in many Asian and African countries tests positive in tuberculin test, while only 5-10% of the US population is positive. Expectations for overall disease control have been dramatically mitigated due to a number of factors, including the difficulty of developing an effective vaccine, costly and time-consuming diagnostic process, month-long treatment, and increased HIV-related tuberculosis. , and the emergence of drug-resistant cases in the 1980s.
In 2007, the country with the highest incidence rate of TB was Swaziland, with 1,200 cases per 100,000 people. India has the largest total incidents, with an estimated 2.0 million new cases. In developed countries, tuberculosis is less common and is found mainly in urban areas. Rates per 100,000 people in various regions of the world are: global 178, Africa 332, America 36, ​​Mediterranean East 173, Europe 63, Southeast Asia 278 and Western Pacific 139 in 2010. In Canada and Australia, tuberculosis many times -times more common among Aboriginal people, especially in remote areas. In the United States, Native Americans have five times greater deaths than TB, and racial and ethnic minorities account for 84% of all reported TB cases.
TB levels vary with age. In Africa, it mainly affects teenagers and young adults. However, in countries where incidence rates have declined dramatically (such as the United States), TB is primarily a parent and immunocompromised disease (risk factors listed above). Around the world, states or states "high load" 22% have 80% of cases and 83% of deaths.
Regular use of rifabutin rather than rifampicin in HIV positive people with tuberculosis is an unclear benefit in 2007.
History
Tuberculosis has been present in humans since antiquity. The most obvious sudden detection of M. tuberculosis involved evidence of disease in remains of bison in Wyoming dated some 17,000 years ago. However, whether tuberculosis is derived from bovines, then transferred to humans, or whether it deviates from the same ancestor, is currently unclear. Comparison of gene from M. tuberculosis complex (MTBC) in humans for MTBC in animals shows that humans did not obtain MTBC from animals during animal domestication, as previously believed. Both strains of tuberculosis bacteria share a common ancestor, which could infect humans even before the Neolithic Revolution. The skeletal remains indicate prehistoric humans (4000 BC) had TB, and researchers have found tuberculous rotation in Egypt's mummy spines dating from 3000-2400 BC. Genetic studies show TB is present in America from about 100 AD.
Before the Industrial Revolution, folklore often connected tuberculosis with vampires. When one family member dies, the other infected members will lose their health slowly. These believers are caused by indigenous people with TBs draining life from other family members.
Although the lung form associated with tubercles was established as a pathology by Richard Morton in 1689, due to various symptoms, TB was not identified as a single disease until the 1820s. It was not named "tuberculosis" until 1839, by J. L. SchÃÆ'¶nlein. During 1838-1845, Dr. John Croghan, owner of the Mammoth Cave, brought a number of people with tuberculosis into the cave in the hope of curing diseases with constant temperature and purity of cave air; they die within a year. Hermann Brehmer opened the first TB tube in 1859 in GÃÆ'¶rbersdorf (now Soko? Owsko), Silesia.
Basil causes tuberculosis, M. tuberculosis , identified and described on March 24, 1882 by Robert Koch. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. Koch does not believe that cow disease (cow) and human tuberculosis are similar, which delay the recognition of infected milk as a source of infection. Then, the risk of transmission from this source is dramatically reduced by the discovery of the pasteurization process. Koch announced a glycerine extract from tubercle bacilli as a "cure" for tuberculosis in 1890, calling it "tuberculin". Although not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic TB. World Tuberculosis Day is marked on 24 March every year, Koch's original scientific anniversary warning.
Albert Calmette and Camille Guà ©  © rin achieved the first genuine success in immunization against tuberculosis in 1906, using underserved bovine-strain tuberculosis. It's called bacille Calmette-GuÃÆ'  © rin (BCG). The BCG vaccine was first used in humans in 1921 in France, but was widely accepted in the United States, Britain and Germany after World War II.
Tuberculosis caused widespread public concerns in the late 20th and early 20th centuries as the disease became common among urban poor. In 1815, one in four deaths in Britain was caused by "consumption". In 1918, one in six deaths in France was still caused by TB. After TB was determined to be contagious, in the 1880s, it was put on a list of illnesses reported in the UK; the campaign begins to stop people spitting in public places, and the infected poor are "encouraged" to enter a prison-like sanatorium (sanatorium for the middle and upper classes offering excellent care and constant medical attention). Whatever the benefits of "fresh air" and energy in the sanatorium, even under the best conditions, 50% of those who enter die within five years (c.1916). When the Medical Research Council was formed in England in 1913, the initial focus was on tuberculosis research.
In Europe, tuberculosis rates began to increase in the early 1600s to peak levels in the 1800s, when it accounted for nearly 25% of all deaths. In the 1950s, the mortality rate in Europe has fallen by about 90%. Improvements in sanitation, vaccination, and other public health measures began to significantly reduce tuberculosis levels even before the arrival of streptomycin and other antibiotics, although the disease remains a significant threat. In 1946, the development of streptomycin antibiotics made the effective treatment and cure of TB a reality. Prior to the introduction of this drug, the only treatment was surgical intervention, including "pneumothorax technique", which involved infected lung collapse to "rest" and allowing tuberculosis lesions to heal.
Because of the emergence of MDR-TB, surgery has been reintroduced for certain TB infection cases. This involves the removal of infected chest cavities ("bulls") in the lungs to reduce the number of bacteria and increase the exposure of the remaining bacteria to antibiotics in the bloodstream. The hope of fully eliminating TB ended with the emergence of drug-resistant strains in the 1980s. The subsequent revival of tuberculosis resulted in a global health emergency declaration by the World Health Organization in 1993.
Society and culture
Name
Tuberculosis is well known by many names from the technical to the familiar. Phthisis (??????) is the Greek word for consumption, the old term for pulmonary tuberculosis; about 460 BC, Hippocrates described phthisis as a droughts disease. The abbreviation "TB" is short for tubercle bacillus . "Consumption" is the most common nineteenth-century English word for this disease. The Latin root "con" meaning "fully" is related to "sumere" meaning "to take from below." In Mr. Badman's Life and Death by John Bunyan, the author mentions the consumption of "the captain of all these dead." The "big white plague" has also been used.
Art and literature
Tuberculosis for centuries is associated with poetic and artistic qualities among those infected, and also known as "romantic illness". Major artistic figures such as poet John Keats, Percy Bysshe Shelley, and Edgar Allan Poe, composer FrÃÆ' Â © ric Chopin, playwright Anton Chekhov, novelist Franz Kafka, Katherine Mansfield, Charlotte BrontÃÆ' Â «, Fyodor Dostoyevsky, Thomas Mann, W. Somerset Maugham, and Robert Louis Stevenson, and the artists, Alice Neel, Jean-Antoine Watteau, Elizabeth Siddal, Marie Bashkirtseff, Edvard Munch, Aubrey Beardsley, and Amedeo Modigliani have the disease or are surrounded by people who do. The widespread belief is that artistic talent is aided by tuberculosis. The physical mechanism is proposed to this effect, including mild fever and toxemia that causes, allegedly helped them to see life more clearly and act decisively.
Tuberculosis forms a theme that is often reused in literature, as in Thomas Mann's The Magic Mountain , which is set in a sanatorium; in music, as in Van Morrison's song "T.B. Sheets"; in opera, as in Puccini La bohÃÆ'¨me and Verdi La Traviata ; in art, as in Monet's painting of his first wife Camille on his deathbed; and in movies, such as 1945 The Bells of St. Mary's starring Ingrid Bergman as a nun with tuberculosis. Community health efforts
The World Health Organization, the Bill and Melinda Gates Foundation, and the US government subsidize rapid-acting diagnostic tuberculosis tests for use in low- and middle-income countries. In addition to rapid action, these tests may determine whether there is resistance to rifampicin antibiotics that may indicate drug-resistant TB and are accurate in those who are also HIV-infected. Many resource-poor places in 2011 have access to only sputum microscopy.
India has the highest number of TB cases in the world by 2010, in part due to poor disease management in the private and public health care sector. Programs such as the revised National Tuberculosis Control Program are working to reduce TB levels among people receiving public health care.
A 2014 EIU-health report is necessary to overcome apathy and urges to increase funding. The report cites, among others, Lucica Ditui "[TB] like orphans, has been neglected even in high-burden countries and is often forgotten by donors and those who invest in health interventions."
Slow progress has led to frustration, expressed by the executive director of the Global Fund for Fighting AIDS, Tuberculosis and Malaria - Mark Dybul: "we have the means to end TB as a threat of pandemic and public health on this planet, but we do not do it. Some international organizations are encouraging more transparency in medicine, and more countries are implementing mandatory reporting of cases to governments, although compliance is often vague. Commercial care providers can sometimes prescribe second-line drugs as well as additional treatments, promoting demands for further regulation. The Brazilian government provides universal TB treatment, which reduces this problem. Conversely, a decrease in TB infection rates may not be related to the number of programs directed at reducing infection rates but may be related to increased levels of education, income, and population health. The cost of illness, calculated by the World Bank in 2009 could exceed 150 billion USD per year in "high load" countries. The lack of progress in eradicating the disease may also be due to a lack of follow-up of patients - such as among 250 million rural migrants in China.
Stigma
Slow progress in preventing disease may be partly due to the stigma associated with TB. Stigma may be caused by fear of transmission from affected individuals. This stigma can also arise because of the relationship between TB and poverty, and in Africa, AIDS. Such stigmatization may be real and perceived; for example, in Ghana people with TB are barred from attending public meetings.
Stigma against TB may result in delay in seeking treatment, lower medication adherence, and family members keeping the cause of death - allowing the disease to spread further. The opposite is Russia, where stigma is associated with increased medical adherence. TB stigma also affects socially marginalized individuals to a greater extent and varies across regions.
One way to reduce stigma is possible through the promotion of "TB club", where those who are infected can share experiences and offer support, or through counseling. Several studies have shown that TB education programs are effective in reducing stigma, and thus can be effective in improving medication adherence. However, studies of the relationship between reduced stigma and mortality have been lacking since 2010, and similar efforts to reduce stigma surrounding AIDS have been minimally effective. Some people claim stigma is worse than disease, and healthcare providers may inadvertently reinforce stigma, as those with TB are often perceived as difficult or undesirable. A greater understanding of the social and cultural dimensions of tuberculosis can also help reduce stigma.
Research
The BCG vaccine has limitations, and research to develop a new TB vaccine is ongoing. A number of potential candidates are currently in Phase I and II clinical trials. Two main approaches are used to try to increase the effectiveness of available vaccines. One approach involves adding subunit vaccines to BCG, while other strategies try to create new and better vaccines. MVA85A, an example of a subunit vaccine, currently in trials in South Africa, is based on genetically modified vaccinia virus. Vaccines are expected to play an important role in the treatment of latent and active disease.
To encourage further discovery, researchers and policy makers promote new economic models of vaccine development, including rewards, tax incentives, and advanced market commitments. A number of groups, including the Stop TB Partnership, the South African Tuberculosis Vaccine Initiative, and the National Aeras Tuberculosis Vaccine Foundation, were included in the study. Among them, the TB TB Global TB Vaccine Foundation receives more than $ 280 million (US) from the Bill and Melinda Gates Foundation to develop and license enhanced vaccines against tuberculosis for use in high-burden countries.
A number of drugs are being studied for multidrug-resistant tuberculosis, including bedaquiline and delamanid. Bedaquiline received the approval of the US Food and Drug Administration (FDA) by the end of 2012. The safety and effectiveness of these new agents remains uncertain, as they are based on relatively small research results. However, existing data suggest that patients taking bedaquiline in addition to standard TB therapy are five times more likely to die than those who do not have new drugs, which has resulted in medical journal articles raising health policy questions about why the FDA approves the drug and whether financial relationships the company that makes the differencequiline affects physician support for its use.
Other animals
Mycobacteria infects many different animals, including birds, rodents, and reptiles. Subspecies Mycobacterium tuberculosis , though, is rarely present in wild animals. Attempts to combat cow tuberculosis caused by Mycobacterium bovis from New Zealand cattle and herds have been relatively successful. Efforts in Great Britain are less successful.
By 2015, tuberculosis appears to be widespread among breeding elephants in the US. It is believed that animals initially acquired the disease from humans, a process called reverse zoonosis. Because the disease can spread through the air to infect humans and other animals, it is a public health problem that affects circuses and zoos.
References
External links
- Tuberculosis in Curlie (based on DMOZ)
- "Tuberculosis (TB)". Centers for Disease Control.
- "Tuberculosis (TB)". UK Health Protection Agency. Archived from the original on July 5, 2007.
Source of the article : Wikipedia
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