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“Medical education does not exist to provide students with a way of making a living but to ensure the health of the community” Rudolf Virchow Mid 1800s. Tuberculosis has been killing millions for centuries. Symptoms of untreated active TB. Persistent cough and Low grade-fever.

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slide1

“Medical education does not exist

to provide students with a way of

making a living but to ensure

the health of the community”

Rudolf Virchow Mid 1800s

slide2

Tuberculosis has

been killing millions

for centuries

slide3

Symptoms of untreated active TB

Persistent cough and

Low grade-fever

Difficultyin breathing

Night sweats

Blood in sputum

Cambodian TB patient

Severe weight loss

Picture: World Lung Foundation

slide4

TB is an ancient human disease!

Recent evidence supports a diagnosis of TB

in this 500,000 year old

young male Homo erectus

Bone lesions indicative of TB

Credit: Marsha Miller, the University of Texas at Austin

slide5

TB is an ancient human disease!

TB spinal lesions have also been found in

Egyptian mummies

slide6

It is estimated that from 1700-1900,

TB killed 1 billion people.

The annual death rate in the late 1800s

was 7 million.

TB Ward, Ellis Island

Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926

"Forgotten Ellis Island,”

photographer Stephen Wilkes

slide7

After urbanization as many as one-quarter

of all European deaths in the 1800’s

may have resulted from TB

TB Ward, Ellis Island

http://www.birdchildsandgoldsmith.com/acatalog/slums.gif

slide8

The famous and the infamous died of TB

Anton Chekhov

John Keats

Frederic Chopin

Emily Bronte

Simon Bolivar

Henry Thoreau

slide9

The famous and the infamous died of TB

along with countless millions

known only to their families

George Orwell

Eleanor Roosevelt

DH Lawrence

Franz Kafka

Eugene O’Neill

slide10

In 1900

TB was still

the second

leading cause

of death

in the US

CDC

slide11

Now infectious diseases are

much less prominent as causes of death

and TB has dropped off the list

CDC

slide12

In the early to mid 1900s TB remained a

major public health challenge in the US

"Prevent Disease: Careless Spitting, Coughing, Sneezing, Spread Influenza and Tuberculosis."

Rensselaer County Tuberculosis Association (Troy, N.Y.), [ca. 1925]

"'Stamp' Out Tuberculosis: Buy Christmas Seals." National Tuberculosis Association, 1924.

American Red Cross. "The Next to Go: Fight Tuberculosis." [American Red Cross], 1919.

slide13

In the US TB is now an almost

forgotten disease

US TB deaths in 2004:

657

CDC

slide14

In the US TB is now an almost

forgotten disease

US TB deaths in 2004:

657

US Influenza deaths in 2004:

1100

US deaths due to asthma

in 2004: 3816

CDC

slide15

But not in the developing world!

Stats from WHO; slide from TBAlliance

slide16

TB is present world-wide but

Incidence rates differ dramatically

CDC

slide17

For this Peruvian family mourning a child dead to TB

the disease is certainly not forgotten

Partners in Health and Harvard Medical School

Dept. of Social Medicine Program in Infectious Disease and Social Change

http://www.hms.harvard.edu/news/releases/family_cemetery.html

slide18

Two billion people

--one third of the world’s population--

are infected with the bacteria that causes TB

World Lung Foundation (2008)

slide19

Worldwide TB causes:

5% of all deaths

~10% of all adult deaths

Morocco

India

China

South Africa

Stats:NIAID/NIH Pix: World Lung Foundation

slide20

Left untreated, a person with active TB

will infect 10-15 other people per year

World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html

slide21

Left untreated, a person with active TB

will infect 10-15 other people per year

new infections occur at a rate of one per second!

World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html

slide22

In most cases TB starts as an

infection of the lungs = pulmonary TB

http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html

slide23

X-rays used to be

the primary means of diagnosis

http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html

slide24

Now TB exposure is

diagnosed by a skin test

slide25

A positive test result simply means you

have been exposed to TB* at some point

and have developed antibodies to it

*=Active case

Previously “cured”

Inactive case

Vaccinated with BCG

slide27

The next frontier: DNA testing to identify

different strains of TB

and assess drug resistance

Dbtechno.com

slide28

The next frontier: DNA testing to identify

different strains of TB

and assess drug resistance

July 2008: WHO unveils

$26 million program

to create labs in poor nations

that can do DNA tests

Cost: $5 per test

Time frame: 24 hours

Rather than weeks to months!

slide29

However, the TB bacterium can also

Infect many other organs,

causing distinct “diseases

http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html

slide30

However, the TB bacterium can also

Infect many other organs,

causing distinct “diseases

Renal TB

www.vetmed.wsu.edu

slide31

However, the TB bacterium can also

Infect many other organs,

causing distinct “diseases

Lupus vulgaris

Renal TB

http://www.ecureme.com/atlas/data/Tuberculosis_of_Skin550_ab.htm

slide32

TB infecting the spine

Pott’s disease = tuberculous spondylitis

Credit: Dr Laughlin Dawes

www3.shropshire-cc.gov.uk/. ../med/med_i03.htm

slide33

“Miliary TB” is disseminated throughout the body

Here it is presenting in the eye

www.aippg.net/forum/ viewtopic.php?t=11673

slide34

Scrofula: TB of the lymph nodes of neck

King Henry IV of France touching

sufferers of scrofula. André de Laurens, 1609

slide35

As late as the 1800s, causes and

cures of TB remained mysterious

www.nlm.nih.gov

slide37

This may seem like ancient history to you

Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926

housed over 400 patients, from infants to adults.

Waverly Hills closed in 1961

library.louisville.edu

slide38

But they remained in operation until

after your professor was born

Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926

housed over 400 patients, from infants to adults.

Waverly Hills closed in 1961

library.louisville.edu

slide39

Gravely Building on the other side

of the hospital, torn down in 2010,

was a TB sanitorium

www.med.unc.edu