Think tuberculosis is a disease of the past, for wilting ladies on fainting couches with delicate handkerchiefs? Think again: tuberculosis is back, and it’s ugly. The spread of drug-resistant forms of tuberculosis across the Global South and into the West is a rising health concern in an era where some diseases are mutating too quickly for medical science to address them, which is bad news for patients. If you watched Frontline’s “TB Silent Killer,” you got a glimpse into this fatal and pernicious disease, but how much do you know about this pernicious disease?
Tuberculosis is one of the oldest known human diseases, with evidence of TB present in the bodies of Egyptian mummies and other ancient human remains. Prehistoric humans had the disease, and it’s difficult to determine where exactly it came from, but it’s safe to say that it’s been living with us for a very long time. In fact, approximately 1/3 of the population carries the bacterium responsible for the infection at any given time, but most humans have immune systems capable of fighting off the infection.
For those who don’t, however, tuberculosis infection can be brutal. The disease settles in the lungs, causing coughing, bloody sputum, chest discomfort and difficulty breathing. Patients sweat at night, and with every cough, they expel infectious organisms, ready to land on bystanders and spread the disease. Especially in close quarters, outbreaks can spread like wildfire, even with protective masks and garments to shield people.
Consumption, as it used to be known, used to be an ominous diagnosis. Fortunate patients would recover when sent to sanitariums for rest and fresh air, while others would fight a long and unpleasant battle with the disease — and it didn’t end nearly as prettily as Mimi’s did in La Boheme. In the 20th century, with the development of antibiotics, that changed, with a fleet of powerful drugs to tackle not just TB but also staph and other potentially dangerous infections.
Now, bacteria are outsmarting us again, evolving to resist medication and exchanging the genetic material that allows them to do so. This means that some bacteria are developing multi-drug resistance, which is very, very bad news for patients and doctors. In the United States, much of the focus on drug-resistant infections has been on methicillin-resistant Staphylococcus aureus (MRSA), which is raging through US hospitals.
Tuberculosis, however, is a growing cause for concern in the Global South, and it’s starting to creep into the West as well. This infectious disease is notorious for gaining a foothold in HIV/AIDS-afflicted communities, taking advantage of compromised immune systems to grow and spread. And in those communities, the first lines of defense are breaking down. Multi-drug resistant tuberculosis, known as MDR TB, now requires treatment with a cocktail of grueling medications that may need to be taken for up to two years, which is especially challenging for children.
While in treatment for MDR TB, people typically live in isolation to avoid spreading the disease. Designated tuberculosis hospitals are hard for friends and family to reach, and visitors are discouraged. 1/3 of patients die from the extreme toxicity of the treatment, or the expense that makes it impossible to complete a round of drug therapy. Living in isolation, some patients become so desperate that they take their own lives — and the situation is even worse for patients with extensively drug resistant TB, known as XDR TB. This form of the infection is effectively untreatable for some patients.
How has this happened? It’s the result of complex foreign policy decisions which have led to unstable supplies of medicine and medical aid in the Global South. This makes it difficult for patients to get the care they need when they need it. NGOs active in the region work to develop treatment plans for patients, negotiate low-cost or free drugs, and provide comprehensive health services, but they can’t meet the volume of need — and it’s not helpful when patients are forced to move for work, or stop coming to clinics because the drugs aren’t working or they’re tired of the side effects.
Partially-completed treatments lead to more drug resistance, and create even bigger problems for care providers. And as MDR and XDR TB become more and more aggressive, they’re preparing to make the leap into the West. While many Westerners are healthier and better-equipped to handle infections, some are defenseless thanks to immune problems, and they’re sitting ducks for infections that won’t respond to even the most aggressive of antibiotics.
The evolution of MDR and XDR TB is a striking illustration of the consequences of not prioritizing international public health in foreign policy. While health surveillance in the United States reveals a relatively low rate of MDR and XDR TB infections, the American Lung Association is noticing an upward trend, and that is cause for concern. Aggressive typing and treatment of tuberculosis infections is critical to ensure that people get the treatment they need in the most timely fashion — and to cut down on the risk that drug-resistant forms of TB will spread.
Photo credit: Esparta Palma.