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Tuberculosis is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. In , one quarter of the world’s population was thought to have a latent infection of TB. Tuberculosis may infect any part of the body, but most commonly occurs in the lungs known as pulmonary tuberculosis.
General signs and symptoms include fever, chills , night sweats, loss of appetite , weight loss, and fatigue. The upper lung lobes are more frequently affected by tuberculosis than the lower ones. A potentially more serious, widespread form of TB is called “disseminated tuberculosis”, it is also known as miliary tuberculosis. In nature, the bacterium can grow only within the cells of a host organism, but M.
Using histological stains on expectorated samples from phlegm also called sputum , scientists can identify MTB under a microscope. Since MTB retains certain stains even after being treated with acidic solution, it is classified as an acid-fast bacillus. The M. Other known pathogenic mycobacteria include M. The latter two species are classified as ” nontuberculous mycobacteria ” NTM or atypical mycobacteria.
When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0. A single sneeze can release up to 40, droplets. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others. Other risk factors include: alcoholism ,  diabetes mellitus 3-fold increased risk ,  silicosis fold increased risk ,  tobacco smoking 2-fold increased risk ,  indoor air pollution , malnutrition, young age,  recently acquired TB infection, recreational drug use, severe kidney disease, low body weight, organ transplant, head and neck cancer,  and genetic susceptibility  the overall importance of genetic risk factors remains undefined .
Tobacco smoking increases the risk of infections in addition to increasing the risk of active disease and death. Additional factors increasing infection susceptibility include young age.
TB infection begins when the mycobacteria reach the alveolar air sacs of the lungs, where they invade and replicate within endosomes of alveolar macrophages. During this process, the bacterium is enveloped by the macrophage and stored temporarily in a membrane-bound vesicle called a phagosome. The phagosome then combines with a lysosome to create a phagolysosome. In the phagolysosome, the cell attempts to use reactive oxygen species and acid to kill the bacterium.
However, M. The primary site of infection in the lungs, known as the Ghon focus , is generally located in either the upper part of the lower lobe, or the lower part of the upper lobe. This is known as a Simon focus and is typically found in the top of the lung. Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages , epithelioid cells , T lymphocytes , B lymphocytes , and fibroblasts aggregate to form granulomas, with lymphocytes surrounding the infected macrophages.
When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system.
Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Another feature of the granulomas is the development of abnormal cell death necrosis in the center of tubercles. To the naked eye, this has the texture of soft, white cheese and is termed caseous necrosis. If TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues.
In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis. During active disease, some of these cavities are joined to the air passages bronchi and this material can be coughed up. It contains living bacteria and thus can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue. Diagnosing active tuberculosis based only on signs and symptoms is difficult,  as is diagnosing the disease in those who have a weakened immune system.
A definitive diagnosis of TB is made by identifying M. However, the difficult culture process for this slow-growing organism can take two to six weeks for blood or sputum culture. Nucleic acid amplification tests and adenosine deaminase testing may allow rapid diagnosis of TB.
The Mantoux tuberculin skin test is often used to screen people at high risk for TB. Tuberculosis prevention and control efforts rely primarily on the vaccination of infants and the detection and appropriate treatment of active cases.
Public health campaigns which have focused on overcrowding, public spitting and regular sanitation including hand washing during the s helped to either interrupt or slow spread which when combined with contact tracing, isolation and treatment helped to dramatically curb the transmission of both tuberculosis and other airborne diseases which led to the elimination of tuberculosis as a major public health issue in most developed economies.
The goal of tuberculosis elimination is hampered by the lack of rapid testing, of short and effective treatment courses, and of completely effective vaccines.
Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective.
Active TB is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance. Latent TB is treated with either isoniazid or rifampin alone, or a combination of isoniazid with either rifampicin or rifapentine.
The treatment takes three to nine months depending on the medications used. Education or counselling may improve the latent tuberculosis treatment completion rates.
The recommended treatment of new-onset pulmonary tuberculosis, as of [update] , is six months of a combination of antibiotics containing rifampicin, isoniazid, pyrazinamide , and ethambutol for the first two months, and only rifampicin and isoniazid for the last four months.
Shorter treatment regimen may be recommended for those with compliance issues. If tuberculosis recurs, testing to determine which antibiotics it is sensitive to is important before determining treatment. Directly observed therapy , i. Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible MTB may develop secondary acquired resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately lack of compliance , or using low-quality medication.
Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs. Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune system defenses and begin to multiply. The risk of reactivation increases with immunosuppression , such as that caused by infection with HIV.
In people coinfected with M. TB is almost always fatal in those with untreated HIV co-infection and death rates are increased even with antiretroviral treatment of HIV. Roughly one-quarter of the world’s population has been infected with M. Tuberculosis incidence is seasonal, with peaks occurring every spring and summer. It has been suggested that tuberculosis incidence rates may be connected to climate change.
Tuberculosis is closely linked to both overcrowding and malnutrition , making it one of the principal diseases of poverty. The rate of tuberculosis varies with age. In Africa, it primarily affects adolescents and young adults. In Canada and Australia, tuberculosis is many times more common among the aboriginal peoples , especially in remote areas.
In some Canadian aboriginal groups, genetic susceptibility may play a role. People of low SES are both more likely to contract TB and to be more severely affected by the disease. Inadequate healthcare also means that people with active disease who facilitate spread are not diagnosed and treated promptly; sick people thus remain in the infectious state and continue to spread the infection.
In developed countries, tuberculosis is less common and is found mainly in urban areas. In Europe, deaths from TB fell from out of , in to 50 out of , by Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in its initial focus was tuberculosis research.
In , rates per , people in different areas of the world were: globally , Africa , the Americas 36, Eastern Mediterranean , Europe 63, Southeast Asia , and Western Pacific Russia has achieved particularly dramatic progress with a decline in its TB mortality rate—from In , the country with the highest estimated incidence rate of TB was Eswatini , with 1, cases per , people.
As of , India had the largest total incidence, with an estimated 2,, cases. Evidence indicates that the tuberculosis national survey does not represent the number of cases that are diagnosed and recorded by private clinics and hospitals in India.
In the United States, the overall tuberculosis case rate was 3 per , persons in In , in the United Kingdom, the national average was 9 per , and the highest incidence rates in Western Europe were 20 per , in Portugal. Number of new cases of tuberculosis per , people in Tuberculosis deaths by region, to Tuberculosis has existed since antiquity.
Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans even before the Neolithic Revolution. Before the Industrial Revolution , folklore often associated tuberculosis with vampires. When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members.
Although Richard Morton established the pulmonary form associated with tubercles as a pathology in ,   due to the variety of its symptoms, TB was not identified as a single disease until the s.
Benjamin Marten conjectured in that consumptions were caused by microbes which were spread by people living in close proximity to each other. Robert Koch identified and described the bacillus causing tuberculosis, M. During the first half of the s the risk of transmission from this source was dramatically reduced after the application of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a “remedy” for tuberculosis in , calling it “tuberculin”.
Although it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. Tuberculosis caused widespread public concern in the 19th and early 20th centuries as the disease became common among the urban poor. In one in four deaths in England was due to “consumption”.