Vampires “consumption” Draining of blood making victim pale and

weak Masturbation

Leaving patient drained of energy Sin

Creativity Patients got burst of energy- made women

more beautiful and men more creative

Origin of Word - Tuberculosis – TB: Tubercle bacillus

Has often been referred to as ‘white plague’ and ‘consumption’

Eastern Mediterranean – 9250 to 8160 years ago TB lesions from a woman and infant buried

together PCR to examine bone samples

Mycobacterium tuberculosis Slow growing Acid fast bacillus Has waxy layer which prevents

drying

Less common causes: Mycobacterium bovis Mycobacterium africanum Mycobacterium canetti Mycobacterium microti

www.genomeindia.org/mycobacterium/

In healthy individuals or when only small amounts of bacteria are ingested, active macrophages will kill bacteria

The immune system will form a wall around the bacteria called a granuloma or tubercule, which can stay dormant for many years before reappearing (latent TB)

In some individuals a full blown infection will occur which often leads to death (miliary TB)

Taken from figure 19-1 in Salyers and Whitt, 2002

Miliary TB- TB infection in the lung that results in the bacteria getting into the pulmonary vein and going systemic

If untreated it is 100% fatal

In 25% of the cases, it will cross blood-brain barrier and cause tuberculous meningitis

M. tuberculosis is able to survive and grow within unactivated macrophages

Prevent fusion with lysosome (oxidative burst) due to waxy coated capsule

Inhibits IL-12 production which will prevent TH1 response

Important defenses: the T helper cells (CD4+) producing IFN-γ which

will stimulate macrophage activation the cytotoxic (CD8+) T cells killing infected

phagosomes that have been unable to destroy the bacteria

http://www.brown.edu/Courses/Bio_160/Projects1999/tb/tbbody.html

Respiratory droplets from coughing, sneezing, talking, or spitting

Aerosol droplets 0.5 to 5µm in diameter A single sneeze can release up to 40, 000

droplets

Infectious dose of tuberculosis is very low Inhalation of just a single bacterium can cause

a new infection. Dormant, which can later cause disease if

weakened Mechanism of transmission:

People who inject drugs using unsanitary needles Residents and employees of high-risk congregate settings Medically under-served and low-income populations Children exposed to adults in high-risk categories Patients immunocompromised (i.e. HIV/AIDS) Immunosuppressant drugs Health care workers serving high-risk patients

Transmission can only occur from people with active — not latent — TB

Factors influencing effective transmission: Number of infectious droplets expelled by a carrier The effectiveness of ventilation The duration of exposure The virulence of the M. tuberculosis strain

Chronic cough Blood in sputum Fever Night sweats Weight loss If it travels to other organs than the

lungs, then a wider range of symptoms may occur

1) Tuberculin Skin Test

2) Chest Radiograph

3) Bacteriological Smears & Cultures

4) Clinical Observations

Tuberculin injected intradermally Sensitivity of this extract that the

bacteria produces will appear as red circle

Those immunized or have previously had the infection will show the same result as those that now have the disease

Patient Status Positive Result

HIV + >5mm

Healthy individuals with exposure history or risk factors

>10mm

Healthy individuals with no exposure history

>15mm

The white arrows show bilateral pulmonary infiltrate, black arrows show caving formation

Sputum smear is tested for the presence of Acid-Fast-Bacilli Negative result will

rule out TB infection. Most definitive

diagnosis will come from culture of lung secretions Positive Acid-

Fast stain of TB

M. Tuberculosis culture

Clinical signs of active infection: Fatigue, fever, unexplained weight loss, night

sweats.

Symptoms of pulmonary TB include: Productive cough >3 weeks, coughing up

blood, and chest pain.

Extra-pulmonary TB will have a range of signs and symptoms depending on the site of primary infection.

Sanatoriums for both the rich and poor citizens

First sanatorium in Canada was at Muskoka lake in 1897 Patients received rest, fresh air, good nutrition

to support healing and isolation to prevent spread

Closed down mid 1900s after antibiotics were found to be better at treating patients

http://urbexbarrie.blogspot.com/2006/06/muskoka-regional-centre.html

First-line drugs taken for 6-8 months Isoniazid- inhibit mycolic acid synthesis Rifampin- inhibits bacterial RNA polymerase Ethambutol- inhibit mycolic acid synthesis Pyrazidamide- nicotinamide analog

Second-line drugs Streptomycin, capreomycin, clofazamine,

amikacin, ethionamide, ofloxacin, ribabutin, kanamycin, fluoroquinolones

Taken from http://www3.niaid.nih.gov/topics/tuberculosis/Understanding/WhatIsTB/ScientificIllustrations/firstLineIllustration.htm

Directly Observed Treatment (DOT) Used to deal with the high number of

noncompliant patients who do not take the drugs every day for the full length of time

Important since not taking the drugs as prescribed is a main cause of drug resistance

Proof of its effectiveness: 1986- prior to DOT 26% of patients acquired drug

resistance After 1990- thanks to DOT, drug resistance is 7%

MDR-TB -> multi-drug resistant (1980s)-resistance to 2 of the first line drugs (often

isoniazid and rifampicin) XDR-TB -> extremely drug resistant

-first reported outbreak was in 2006

-resistance to 2 of the first line drugs, atleast 1 quinolone and atleast 1 of the second line anti-TB injection drugs

-can take 6-16 weeks to diagnose CDR-TB -> completely drug resistant

-resistance to all known drugs

Screening Programs Testing those in high risk groups

Vaccine: BCG (Bacillus Calmette-Guerin)

Developed in the 1920’s Live, attenuated M. Bovis strains Only lasts ~15 years Given to children to prevent TB meningitis or

miliary TB Effectiveness ranging from 0%-80% Use was previously widespread in Canada

www.phac-aspc.gc.ca/tbpc-latb/fa-fi/bcg-eng.php

Who qualifies for a BCG vaccine?

Children of families with a strong history of TB Groups of people that display an uncommonly

high rate of infection. Health care workers who are working with the

bacteria or patients Newborn infants whose mother has infectious TB

at the time of delivery Individuals travelling to TB-laden areas for an

extended period of time (i.e. six months or more).

http://www.lung.ca/tb/tbtoday/prevention/bcg.html

Variable efficiency. Reasons may include: Interference with non-tuberculous mycobacteria Genetic variation in BCG strains Genetic variation in the population

Severe local inflammation and scarring occurring in patients

Tuberculin skin test must be performed first and if positive then they can’t vaccinate

Immunocompromised individuals often will get a miliary TB infection

Annually, 8 million people become ill with tuberculosis 2 million people will die from the disease,

worldwide

Growing problem In 2004: 14.6 million people active TB disease 9 million new cases

In Canada, still an endemic Northwest Territories

Country # (per 100, 000)

Africa 356

North & South America 41

Switzerland (2005) 1262

London 40

Portugal 31.3

China 113

Brazil 64

United States 4.9

↑ HIV infections

Neglect of TB control programs

Drug-resistant strains

↑ migration, international travel, and tourism

↑ incidence of AIDS

Co-infection with HIV Smoking (>20

cigarettes/day) ↑ risk by 2x-4x

Diabetes mellitus

Hodgkin lymphoma, End-stage renal

disease Chronic lung disease Malnutrition Alcoholism

QUESTIONS?