1. Tuberculosis
Theresa Herstad
Anatomy & Physiology
Everest College
July 27, 2009

2. There are many types of infections infecting the lungs of people every day. People
of all ages contract various types of colds and influenza on a regular basis. Other diseases
can and do affect the lungs more severely, such as emphysema, pneumonia, and asthma.
We have the development of many of these diseases under control through antibiotics,
lifestyle practices, and sanitation. People all over the world are developing these diseases
on a daily basis. Like any condition or disease these diseases see no boundaries between
race, age, gender or location.
There is one disease infecting the respiratory system that affects millions of
people in the world so severely that it is considered a worldwide epidemic. More effort
and money is and has been spent on the treatment and cure of Tuberculosis than any other
single condition in the world. Commonly referred to as TB, tuberculosis is an infection of
the lungs caused by the bacterium Mycobacterium tuberculosis.
It is contracted by the exposure of the bacteria
through the air. Even though TB affects millions of people
on an epidemic scale, the contraction isn’t that easy. An
uninfected person has to be exposed to an infected person
who has to breathe, cough or sneeze into the air. The TB
droplets hang in the air and enter the respiratory system of the “new victim.” Even though
this may seem like an “easy” infection process, the spread of TB from person to person
happens through continuous exposure over a somewhat extended period of time.
From the time of infection, a person may or even may not show symptoms. In
some cases, a person’s own immune system may prevent symptoms from showing at all.
This type of case is considered Latent TB. This person is not contagious because the TB

3. germs are being fought by the immune system. Most cases of Latent TB may not even be
diagnosed because of the lack of prevalent symptoms.
The known infections of tuberculosis are the cases in which a patient shows
symptoms. This is known a s Active TB. A person may have Latent TB for years before
displaying Active TB. Once symptoms show in the patient, that person is now considered
contagious.
At the time tuberculosis becomes active, a patient will show several symptoms.
Sings of TB include:
 Persistent cough
 Constant fatigue
 Weight loss
 Loss of appetite
 Fever
 Coughing up blood
 Night sweats
If symptoms are left untreated, tuberculosis can spread to other parts of the human body.
These include the following systems:
 Central Nervous System
 Lymphatic
 Circulatory
 Urinary, especially the kidney itself
 Skeletal

4. Because of the ability TB has of spreading throughout the body several other
complication illnesses came develop. A patient may come down with severe lung
damage, joint destruction, or meningitis. A more severe form of TB, known as Miliary
TB can develop, when the TB has spread throughout the entire body.
For the most part, every disease knows no form of discrimination. Although
anyone can contract tuberculosis, there are many “groups” of people that have a higher
risk of development.
People with a lowered or compromised immune
system are at a higher risk of contracting and developing
active TB than people in regular good health. These
people don’t have the immune system to fight the
bacterial infection like most others. There are many
factors that can have a negative impact on the immune
system. Patients with HIV/AIDS are at extremely high
risk of developing TB if exposed. Others at high risk
from weakened immunity include patients with drug habits, diabetes, end-stage renal
failure, or cancer also fall into this category.
Those who come in close contact with an infected TB patient are at risk of
developing the disease. Infection through contact usually takes repeated contact between
a person and one infected with TB.
In some cases, people are at higher risk of infection from TB based upon where
those people live. I know it sounds discriminatory, but a person’s country of origin can
affect the potential of infection. This is because there are countries and regions of the

5. world with very high TB infection rates already. Most of these are “undeveloped” and
very low-income regions of the world, including Africa, India, China and the Western
Pacific. Those people living in refugee camps, even within other low-risk nations are at
higher risk of TB infection. Most of the tuberculosis infection of these parts of the world
occurs because of a lacking presence of health care, nutrition and sanitation.
One group considered of high risk, even in North America, involves health care
work. Tuberculosis loves to breed in crowded places with generally bad ventilation.
Residents and employees of health care long-term residential facilities are at a high risk
of infection. Age also plays a factor. As a person ages with time, the immune system
becomes weakened, allowing infections to enter the human body. Elderly people infected
with TB are less likely the recover from TB than younger people. Even with antibiotics,

6. elderly people may not recover at all.
Simply put, if not treated early and completely, tuberculosis is deadly. The World
Health Organization reported over 1.6 million deaths from TB in 2005 alone. Infection
rates of TB are almost as high. The highest single region accounting for TB related deaths
came from South-East Asia. That part of the world alone, accounts for thirty-four percent
of all known new cases. Almost thirty percent of the global total came from Africa while

7. only four percent came from all of the Americas.
In the Unites States, 2008 reports show only 13,000 new cases in the entire
country. Fortunately, this is a near four percent drop from new reported infections in

8. 2007. Canada is in a similar situation. The rate of TB infection has declined over the past
several years. Much of the low infection rate of TB can be accounted to national efforts
to stop and eradicate the disease. Much of the efforts to stop TB in North America and
Europe come from national health organizations. In the United States, the Center for
Disease Control makes very strong efforts to promote research, testing and education at
levels affordable to everyone. The CDC of the United States works closely with State and
local health departments to ensure quality reporting and treatment of all communicable
diseases. Curing a disease in higher status economic groups does no good if less fortunate
people are still at high risk of infection.
Around the rest of the world, tuberculosis treatment information comes from the
World Health Organization. In cooperation with non-profit groups, TB treatments are

9. reaching the populations most in need. Just a few of the organizations working on this
include:
 The Bill and Melinda Gates Foundation
 USAID from the American People
 The Global Alliance for TB Drug Development
 TB Alliance
 The American Lung Association
 Stop TB Partnership
 The International Union Against Tuberculosis and Lung Disease
These organizations are going into under-privileged communities with treatments. They
are also investing time, cash, and people in the
development of new technology in fighting and
eliminating TB, as well as many other diseases.
At one time, tuberculosis was very
prevalent all over the world, even in North
America and Europe. This is one disease that has been able to evolve with the entire
human race over time since probably the beginning of time. Ancient Egyptian remains
show the effects of TB infection. The Bible makes several references to the symptoms of
tuberculosis, calling it a “wasting disease.” The Hebrew word used at the time was
“Schachepheth”; the now modern Hebrew word for TB. For many centuries, it was
misunderstood, and treatments were based very much on undeveloped science and
dogma. The Greek people believed in cutting off cool air to cause a burning up of the
tissue. Roman people believed diet would cure it. Some other “method” include: mother’s

10. milk, seaweed under the pillow, warm sea air and cool baths and deep breathing. OK,
some of those may have been close, but nothing really worked. By the year 1650,
“consumption,” as TB was referred to, was considered the top killing disease.
Shakespeare even made references to TB in Much Ado About Nothing and Macbeth.
The first major turning point in the study of tuberculosis came about in 1882. A
German doctor, Robert Koch (pronounced “Cook”) discovered the bacteria responsible
for the spread of TB. At this point, the name “tuberculosis” was given to the disease. In
1905, Dr. Koch was given the Nobel Prize in medicine for his work with tuberculosis.
Even before TB was “discovered” people were receiving treatments through a
type of organization known as a sanatorium. The first of these
was built by Hermann Brehmer in 1854. Sanatoriums provided
a place of recovery by administering a diet of whole foods and
fresh air. Organizations, primarily the American Lung
Association formed with its initial primary mission to educate
the public and eliminate tuberculosis.
This type of treatment lasted over 100 years. The sanatorium was replaced by a new
breakthrough discovery in treating TB: the vaccination and antibiotic.
The Bacille Calmette Guerin vaccination was introduced in the early twentieth
century. In the United States and Canada, it is no longer used as a primary prevention of
TB. In other parts of the world, it is considered an important player in stopping TB from
developing. This vaccine is derived from an atypical mycobacterium. It doesn’t
completely stop TB from developing, but does offer some protection, especially in infants

11. and children. As research continues, new and better vaccines are on their way into the
active health care community.
Even if a TB vaccination fails to prevent the development of active TB, there are
three main tests used for diagnosis. These include the Quantiferon TB Gold Test, the
AFB Smear and Culture, and the Mantoux test.
The Quantiferon test is a whole-blood test for use as an aid in diagnosing
Mycobacterium tuberculosis infection, including latent tuberculosis. In this test, Blood
samples are mixed with antigens (substances that can produce an immune response) and
controls. For QFT-G, the antigens include mixtures of synthetic peptides representing
two M. tuberculosis proteins, ESAT-6 and CFP-10. After incubation of the blood with
antigens for 16 to 24 hours, the amount of interferon-gamma (IFN-gamma) is measured.
This test has advantages that promote its use. It only requires one blood draw. Results are
ready in twenty-four hours, and it is not affected by the BCG vaccine.
AFB smears and cultures are used to determine whether you have an active
Mycobacterium tuberculosis infection, an infection due to another member of the
Mycobacterium family, or TB-like symptoms due to another cause. They are used to help
determine whether the TB is confined to the lungs or has spread to organs outside the
lungs. The AFB test is usually ordered when a patient has proven a positive TB skin test,
or shows symptoms of TB.
The most common, and preferred test

12. is the Mantoux test, also known as the TB skin test. In this test, a small amount of testing
material is placed just below the top layers of skin. In two to three days, a health care
professional measures the presence and size of a bump in the testing location. Once a TB
test proves positive, a patient enters a treatment regimen.
Antibiotics were introduced and perfected between 1940 and 1960. As a result,
sanatoriums were closing. Patients were able to be treated in their own homes. At one
point, surgical procedures were done. These were proven pretty much pointless and are
now considered outdated. Today, a patient is given a combination of medications. The
regimen followed must be strictly adhered to by the patient for six to nine months. A
prescribed TB regimen may include isoniazid, rifampin, pyrazinamide, and ethambutol.
Dosing strength, method and regimen will vary according to the individual patient needs.
Isoniazid is considered an antitubercular drug. It comes with a very nice black box
warning, and requires constant monitoring. It can cause side effects such as peripheral
neuropathy, nausea and vomiting, heartburn, dizziness and optic neuritis.
Rifampin is also considered an antitubercular drug. This drug does not have the
need for a black box warning, but does come with a very long list of interaction with
other drugs. Side effects of this drug include nausea and vomiting, dizziness, diarrhea,
headache and anorexia.
The next line of treatment, pyrazinamide, is also considered an antitubercular
drug. Patients started on this should have baseline serum uric acid and liver function
determinations. Side effects can include nausea and vomiting, fever, and anorexia.

13. Finally, a patient may also be given another drug called ethambutol. This is given
in conjunction with isoniazid, but not the other two drugs mentioned. Ethambutol is given
to patients when the TB becomes resistant to other combinations of therapy. Patients my
experience side effects regarding visual acuity, including irreversible blindness, which
appear to be due to optic neuritis.
If a patient stops treatment prematurely, the TB can develop further and become
resistant to medication. Patient education and monitoring are considered crucial to
complete cure of TB. Even after a patient does recover, annual testing is done to make
sure the tuberculosis stays away.
In North America, a patient has several resources to turn to. The American Lung
Association has a department solely dedicated to
education and assistance for TB patients. The Mayo
Clinic of Minnesota provides resources and
education both on and off the internet. Patients and
physicians should always counsel with their local
health department.
Eventually, this can and will be cured. I find it shameful that there are countries
out there with leaders who don’t care more about this stuff. Non-profit organizations
should not have to carry the burden of curing this illness around the word to the extent
that they do. I don’t think we, as the United Stated should be financially supporting
governments in nations where we are sending aid to impoverished and uneducated
people. I think we have way too many distractions even here in the US alone.

14. I think we need to be paying much more attention to helping kids read, write, and
live healthy than whether or not Adam can get married to Steve. I think we need to spend
more time in America making sure we can be quality citizens than paying attention to
even cool stuff like the cars we drive and houses we live in. There is way too much greed
and corruption all around the world. People suffer from this instead of receiving basic
needs such as shelter, clothing, water and health care.
I have no problem with the fact that Bill Gates has more cash from computer
development than he needs. He earned ever penny of it and I wish whiny brats would
leave him alone. If he developed it first, he should be entitled to exclusive rights and all
the cash he has. I do deeply respect what he does with his cash for the improvement of
health care and education all around the world. So if he decided to build a multi-billion
dollar business to turn around and help the rest of the world become a better place, I don’t
think anybody should have the right to sue him for doing something before somebody
else did. Shut up and compete with him!
There is so much corrupted government all over the world that we have left taking
care of those less fortunate. Tuberculosis should be gone by now. We, as a human race,
have ourselves so miserably distracted with other nonsense that we haven’t done it yet.

15. Bibliography
http://en.wikipedia.org/wiki/Tuberculosis
http://www.who.int/mediacentre/factsheets/fs104/en/print.html
http://www.medicinenet.com/tuberculosis/article.htm

16. http://www.lungusa.org/site/apps/nlnet/content3.aspx?
c=dvLUK9O0E&b=2060731&content_id={50031760-2D7C-4FFF-AD75-
4C49BDD1CD7D}&notoc=1&printmode=1
http://www.labtestsonline.org/understanding/analytes/afb_culture/test.html
http://www.nlm.nih.gov/medlineplus/news/fullstory_85162.html
http://www.cdc.gov/tb/publications/factsheets/testing/QFT.htm
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a2.htm?s_cid=mm5810a2_e
http://micklebring.com/oakwood/ch18.html
http://www.finddiagnostics.org/programs