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Tuberculosis Is Back, And It’s Not Playing Around

Tuberculosis Is Back, And It’s Not Playing Around

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.

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Photo credit: Esparta Palma.

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10:01AM PDT on Jul 22, 2014

Try to help another country that is more disease ridden than your own and you are bound to bring something back. Thank you Desert Storm.

1:20PM PDT on Apr 28, 2014

(Continued)
The main factor in the Taino population reduction directly results from Spanish obsession for gold and the establishment of the Encomienda and the Repartimiento, which destroyed the rhythm of their lives, and their social structure. The Taino family structure was broken up as the men were sent to work on gold mines all over the island. They suddenly faced the obligation to spend most of their day working for a master whose cruelty and punishments were swift and justified by greed. Malnutrition quickly developed and the Taino suffered from protein deficiency and overwork. Another factor was the deliberate cruelty the Spaniards displayed towards the Indians. In their inexorable march for conquest in the island, the Spanish destroyed and burned entire villages."
Taino Conquest - Latin American Studies
www.latinamericanstudies.org/taino/taino-conquest.htm‎
Thanks to those who understood my use of "global south" as a metaphor.
To those who want to delve into this piece of history, our Puerto Rican historian, Ricardo Alegria is widely cited as an authority. Among other sources, the Smithsonian mag also quotes from his work.
"La Boheme" is fine but I feel the best work from the western culture on the anguish caused by TB is really from literature, Thomas Mann's, "The Magic Mountain".


1:12PM PDT on Apr 28, 2014

"A lot of reasons have been advanced explaining the disappearance of the original Haitians. Many scholars explain the annihilation of the Taino by pointing to the introduction of European diseases in the Americas. Indeed, the introduction of small pox, measles, whooping cough, bubonic plague, typhoid, influenza, Malaria, and yellow fever wiped out an important section of the Taino population whose immune system was not accustomed to those diseases. For example, the outbreak of the small pox epidemic in Espanola in Dec 1518 extinguished about one third of the native population in a few weeks. What must however be understood is that the decline of the population also occurred in years when there was no epidemic.

4:55AM PDT on Apr 27, 2014

Eventually the bugs are going to win. They can mutate faster than we can come up with ways to treat them and the diseases they cause.

4:02AM PDT on Apr 27, 2014

Big Ag is only partly to blame. People in the U.S. take antibiotics, often even prescribed by doctors over the phone, when it's not even known if they have a bacterial infection or a virus. Every time someone takes antibiotics when it isn't necessary or doesn't treat the illness, they become just a little more resistant to their help in the future, when they really ARE warranted. The disaster fear-mongers are always telling people to have at least a 3-month supply of them along with aspirin and other items in a disaster medical kit, just in case... And then what happens? The person with that supply reaches for antibiotics at the first cough or sneeze... instead of going to the doctor for a proper diagnosis. So it's Big Ag & us who are bringing these superbugs into our lives by improper self-diagnosis when there's no disaster. We can have all the disaster supplies we want. The point is, save them FOR a disaster. A trip to the doctor's office or a clinic will be much healthier for us in the long-run.

9:37PM PDT on Apr 26, 2014

Bad news!

2:09PM PDT on Apr 26, 2014

Blame the doctors and ag companies for the drug resistance.

1:00PM PDT on Apr 26, 2014

ty

10:05AM PDT on Apr 26, 2014

bad news!!!

7:11AM PDT on Apr 26, 2014

John S..... what has TB making a comeback have to do with "being gay and immigration?"..... Just another place for you to be a bigot?

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