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Lecture 4

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Health Studies
Caroline Barakat

Tuberculosis-The White Plague History  TB has been present in the human population since antiquity (agents present in animals as well)  Egyptian mummies from 2400 BC show definite pathological signs of tubercular decay  The term ‘phthisis’ or ‘consumption’ appears first in Greek literature – Homer 800BC  460 BC - Hippocrates identified ‘phthisis’ (pulmonary TB) as the most widespread and fatal disease. He warned his fellow colleagues to avoid visiting cases in the late stages of the disease  TB was documented in Egypt, India, and China as early as 5,000, 3,300, and 2,300 years ago respectively (Daniel 2006)  Typical skeletal abnormalities, including Pott's deformities, were found in Egyptian and Andean mummies  Suggestion that tuberculosis was limited to animals in prehistoric times until domestication of cattle and other animals (change in lifestyle, crowding, etc.)  TB epidemics throughout the world likely from changes in the host population and the environment rather from the introduction of foreign pathogens  People became more susceptible to TB  (1546) Fracastorius describes Modern Theory of Contagion; believes phthisis is caused by invisible germs in the lungs  (1629) Consumption - leading cause of death in London – approximately 20% of all deaths  Due to change in living, crowding  choice to get TB  (1679) Franciscus Delaboe Sylvius discovers the lung nodules, which he terms "tubercles“  First time identifying something to do with consumption  1720 - Benjamin Marten - suggests a version of the "germ theory" of TB, and speculates that it may be communicable from one individual to another  Theory of contagion was accepted  (1839) term "tuberculosis" first used  (1854) Dr. Hermann Brehmer - Doctoral Dissertation- “Tuberculosis is a Curable Disease”- institution in Gorbersdorf –introduction of the sanatorium in Silesia, Germany  Thought to help cure them:  Rest, fresh air, good nutrition and isolation  Treatment -specializing in diagnosis and recovery of patients - Luxury sanatoriums were provided for patients suffering from tuberculosis o Davos, Switzerland: Became widespread around the world o Sanatorio Pineta del Carso, Trieste, Italy - 1854 - Jean-Antoine Villemin -postulated a specific microorganism as the cause of the disease - 1882 – Dr. Robert Koch - Koch-German physician and scientist - discovery of Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB) - 1895 - Wilhelm Konrad von Rontgen –use of radiation to assess progression of disease.  1920 – 1950  Mass screening programs/campagnes implemented based on: - Tuberculin (thought to be cure, BUT killed a lot of people): screened exposure to TB, method of diagnosis - X-rays - Looking for where it’s going and progression Etiology  Agent - tubercle bacillus germ, Mycobacterium tuberculosis, an acid-fast bacillus: (after being treated with certain dyes is not decolorized on subsequent treatment with a mineral acid)  3 main types of the human bacillus - Type 1 – found in India; least virulent - Type A – Africa, China, Japan, Europe, N America - Type B – Exclusively in Europe and North America Forms of Tuberculosis  Chronic disease and manifest  Several animal forms of the bacillus  Only the bovine types can infect humans (infants) – ingested through digestive tract via milk and milk products - May lead to pulmonary TB (most common form) - Pulmonary TBaffects only lungs - Miliary tuberculosis – acute form that forms grain-like tubercles in almost every organ of the body - Commonly affects infants and young children - Fatal within few weeks or days - The tubercle bacillus germ is contracted and starts to affect the lungs but can then spread to other parts of the body, often including the central nervous system, bones and joints - Spread through the air by coughs or sneezes - Maybe dry contact, (bacilli can live on dry environment for a period of time) - Each droplet nuclei (airborne particles) can contain between one and three bacilli - Each sneeze contains 100,000 droplets What happens when TB enters the body? In human body, tubercle bacilli can remain viable throughout the host’s lifetime (arial transmission inhalation, viable through hosts’s lifetime) - Infection can remain dormant until resistance fails (immunity stops working) - Can cause active disease  Indefinite and variable incubation period  People with TB infection do not look or feel sick, cannot spread the germ to others, have a 10% risk of developing TB disease in their lifetime  Only people who are sick with TB in their lungs are infectious (sneeze, coughing, singing, talking, etc)  Dormant won’t affect anyone  Left untreated, each person with active TB will infect 10-15 people every year  TB in other parts of the body such as the kidneys or spine, cannot be easily spread to other people  No acquired resistance to tubercle bacillus if exposed to TB Mode of Transmission - A person may crontract pulmonary tuberculosis from inhaling droplets from a cough or sneeze by another infected person - Granulomas develop from Mycobacterium tuberculosis
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