Killer TB

The guardian reports today on the growing and deadly problem of TB (not Tony Blair) that is resistant to treatment. In the past tuberculosis was complacently dismissed as being on the way out ( it was quite prevalent in the UK in the early 1900s and probably before, but decreased steadily in modern times), however recent trends indicate a world-wide resurgence. The WHO declared TB as a global emergency back in 1993. Reports show that in the UK, those over 65 are most affected amongst the male population but there does not appear to be the same kind of age dependence in the female population. The culprits are Mycobacterium tuberculosis, spore-like bacteria. These bacilli (rod-like bacteria) have a waxy coat, grow slowly and can survive in the body for years in a dormant state (actually bacterial persistence is currently an interest of mine, but I will explore that some other day). Infected people may show no signs of TB disease. However, when the bacillus is awake and dividing, it can be infectious. The bacteria can spread on tiny droplets expelled upon sneezing and coughing. Hence, you will see nurses and visitors wearing masks when interacting with patients.

The outbreak of drug-resistant forms is extremely worrying particularly given the HIV situation in the whole of Africa. As usual, whatever is being done is too little and too late for the current African crisis. Contrast this with the world’s massive investment in new ways to kill people. I doubt whether the public-private partnerships that have been set up to develop new drugs, will produce anything sufficiently quickly to prevent millions more from dying in the next decade. I recommend De Cock for a more intimate examination of the issue.

The new tuberculosis. De Cock K. Afr Health 1994 Mar;16(3):8-10

Tuberculosis and human immunodeficiency virus infection in developing countries. Harries AD. Lancet 1990 Feb 17;335(8686):387-90.