The topic of tuberculosis is one that is overlooked by many in the United States today. This disease dates back to ancient times, and has taken the lives of many throughout the years. While technology has been developing for years to prevent tuberculosis from spreading, it would appear today to be somewhat of a losing battle. Knowledge of the history, transmission, treatment, and prevention of tuberculosis would help many all over the world to help to prevent such a disease to run rampant in the future.

A bacterial microorganism known as Tubercle bacillus is the cause of tuberculosis. This microorganism is also known as Mycobacterium tuberculosis (Cramer, 1999). The problem with such a microorganism is that it is known to be airborne, and mixes with the air that people all over the world breathe (Harding, 2000). While tuberculosis can affect almost any part of the body, it is most often found in the lungs. The infected lung of an individual produces what is known as sputum. The individual can cough up this sputum, and release microscopic droplets into the air that are very contagious. These droplets can dry out, and remain suspended in the air until they are inhaled by somebody merely passing by (Cramer, 1999). However, sputum can be harvested and cultured in laboratories for testing (Cramer).

There are two general stages of tuberculosis. The first stage is known as tuberculosis infection, or latent tuberculosis. In this stage, one may have the infection but the infection may not be active. Therefore, somebody with latent tuberculosis would not be contagious to others. The second stage of tuberculosis is known as active tuberculosis. This occurs when the infection is active, and contagious particles can be expelled from the body ("U.S.", 1993).

Although a variety of forms exist in which tuberculosis occurs, the most grave are known as miliary and meningital tuberculosis. Meningitis can lead to brain damage, and has been known to occur in both children and adults of all ages. Miliary tuberculosis occurs when the bacteria spreads to all parts of the body. Unless treated quickly, many lesions will form all over the body, and will often times kill a human being unless he or she is treated immediately (Cramer, 1999).

Since Tubercle bacillus has been found in Egyptian mummies, scientists know that tuberculosis has plagued mankind since prehistoric times. However, autopsy studies done in the 1700s and 1800s show that scientists have been aware of the disease since around the turn of the eighteenth century. In 1865, Jean-Antoine Villemin established that the disease was infectious. He did this through an experiment with rabbits. In his experiment, he injected rabbits with material from human tubercular lesions, and observed the rabbits to see if they eventually became sick. When the rabbits became ill, Villemin concluded that the disease of tuberculosis was infectious (Harding, 2000).

Since the disease was so common during the nineteenth century, it often times struck young people, where victims of the disease were often considered to be attractive. Symptoms of flushed cheeks, pale skin, and gradual weight loss were considered to be romantic. This probably led to the transmission of the bacteria to many throughout the world (Harding, 2000).

In 1882, a man by the name of Robert Koch isolated the Tubercle bacillus. From then on, the Tubercle bacillus could be studied, and progress toward a cure was somewhat in sight (p.202). At approximately the same time, the only control of the infection was to isolate the patients from society, since one of every seven deaths was caused by tuberculosis. Patients were isolated in what became known at the time as sanatoriums, or sanitariums (Cramer, 1999).

Since drugs for treatment were not available at the time, people went to sanitariums that were high in the mountains. It was believed that the high altitude, fresh air, rest, and food could be effective treatments in the fight against tuberculosis. Edward Livingston Trudeau, who was infected with tuberculosis himself, founded the first tuberculosis spa in 1884. This spa would be found on Saranac Lake in New York’s Adirondack Mountains. The treatment of placing people in sanitariums was very helpful for people with less advanced tuberculosis, often times halting the process of the infection. However, these sanitariums were not of much help to those with advanced stages of tuberculosis. Although it may not be useful to all with tuberculosis, the practice of isolating people with the infection is still used in different parts of the world today (Harding, 2000).

Among the factors for the transmission of tuberculosis, some trends in transmission have stood out to many scientists throughout the world. A process known as genetic fingerprinting was used to discover the transmission of tuberculosis from a corpse to an embalmer. During the process of embalming, preservatives and disinfectants are used to preserve a corpse. However, it was discovered that while the chemicals ran through the body, the preservatives bubbled out of the nose or mouth of the body. This in turn caused the tuberculosis bacteria from the dead body to be let out into the air, and inhaled by the embalmer. Other cases similar to this one have been reported, and therefore even the dead need to be watched closely when dealing with tuberculosis (Bovsun, 2000).

Patients that have the AIDS virus must pay special attention to what they do since the risk of them coming into contact with tuberculosis is very high. Since the AIDS virus weakens the immune system, not only are individuals with AIDS more likely to get sick from the bacteria, but they are more likely to die from it as well. In people of ages 20 to 49, more than half the deaths from tuberculosis have been seen in people who also have AIDS ("U.S.", 1993).

Being born outside of the United States is included in the tuberculosis risk. This is because immigrants that come to the United States may have a form of antibiotic- resistant tuberculosis, and therefore causing others with who the immigrant comes into contact with to get sick (Cramer, 1999, p.2933). "Of course, if we do not do as much as possible to eradicate tuberculosis and many other infectious diseases with high prevalence in other countries, we run a greater risk of being infected by innocent visitors than by terrorists (Shapiro, 2001, p.1)".

Tuberculosis is more commonly found in African Americans, Hispanics, Asians, and those from the Pacific Islands. Two-thirds of all tuberculosis cases in the United States occur in the black community. One-fourth of the cases can affect people born outside of the United States; this risk factor is expected to increase in years to come for both groups (Cramer, 1999).

Among the cases reported in the United States, the elderly appear to be at a high risk. Only 23,000 of these cases were reported in 1995, but many more cases probably went unreported. Around one-fourth developed in people that were above the age of 65 (Cramer).

Hospital facilities have been known to help the increase in transmission of tuberculosis. Since patients can come and go at any time, a bacteria can be expelled into a room, and remain in the room for several days before being inhaled by a family member or nurse. Because of this, tuberculosis has become more resistant as well, since it can be exposed to so many people that may have drug-resistant forms of tuberculosis. Somebody could come to the hospital for a certain illness, leave with tuberculosis, and not even know about it (Cramer).

Tuberculosis in prisons has had a massive impact on tuberculosis being transmitted. This can be related to the close living quarters, and poor ventilation that one may experience while staying in a prison. Prisoners with active tuberculosis can place the staff of the prison, fellow family members, and close contacts at risk for catching the bacteria. Prison populations themselves are made up of people who are at risk for tuberculosis. These include HIV-infected people, homeless people, and drug users. For these reasons, tuberculosis may be as much as six to 11 times more prevalent among prisoners than in the normal population ("U.S.", 1993).

The odds of a recovery from tuberculosis are very good, as long as the disease is found early, and long-term treatment is provided (Cramer, 1999). In order to find out if one has the disease or not, different tests can be done. The Mantoux test, or PPD test, is a common check for tuberculosis. In this test, a small amount of Tubercle bacilli is injected into the skin. This is used to find out if whether a person currently has the disease, or if they have ever had the disease (Cramer). X-rays were also common in examining for tuberculosis, and still are to this day (Harding, 2000).

Pneumothorax is a treatment used in attempting to heal tuberculosis in the lungs. Through this treatment, air is injected into the lungs. The air that is injected would partly collapse the lung with tuberculosis. While the lung is collapsed, it could rest, and hopefully halt the tuberculosis. This practice is still even being used in some areas today (Bates, 1992).

Another treatment used in an attempt to heal tuberculosis is known as thoracoplasty. In this procedure, a surgeon removes some ribs so that the chest wall sinks in on the lung, or lungs. This decreases the space of the lung, and can close a cavity that might possibly be exposed due the tuberculosis (Cramer, 1999).

Vaccines could be the most effective treatment when dealing with tuberculosis. The most common vaccine is called Bacillus Calmette-Guérin, or BCG. This is made from a weakened mycobacterium. While this vaccine strengthens the immune system of first-time tuberculosis patients, it will not prevent infection. Complications that are of a serious nature will not likely develop as a result. This vaccine is used more often in the developing countries, rather than in the United States currently (Cramer).

The treatment of chemotherapy has been found to be both good and bad in certain cases. A chemotherapy regimen may persist of taking antibiotics over a long period of time. When taken correctly, the tuberculosis can be cured. However, when taken incorrectly, the tuberculosis can develop a resistance to the drugs, and therefore leaving the individual sick. Since many people find that certain drugs have bad side effects, they may stop taking their medication, or may even simply forget every now and then. However, this can only favor the tuberculosis ("U.S.", 1993). In New York City, a program was developed in which health workers were hired to watch individuals take medicine. These workers were sent to make sure that those they watched took all of their medicine at the right times. The program was also financed by the city of New York (Steinhauer, 1999).

Just when things are seemingly under control, some problems can arise in years to come. Many people are infected with the first stage of tuberculosis, in which they are not contagious. However, some of these dormant infections can turn into active ones. While many people all over the world have tuberculosis, only one in 20 really become ill from it (Harding, 2000). More than 1.7 billion people can have inactive tuberculosis infections (Hill, 1996).

Resistant bacteria have evolved under natural selection to survive in the presence of an antibiotic or other treatment (Cramer, 1999). Resistant tuberculosis strains are found in more than ten percent of tuberculosis patients in the world (Tech Talk, 2000). These are resistant to the two most powerful tuberculosis medicines created thus far. In order to combat this problem, much research has gone into the development of new drugs that the tuberculosis will not recognize (Harding, 2000).

The resistance found in tuberculosis could have arisen in a number of ways. Many of the drugs that were available at certain times in the past may have been very easy to get and overuse, or not use enough (Tech Talk, 2000). Areas with poor tuberculosis control programs could have contributed to resistance, by having it spread to many areas, and having people with the resistant types spreading it to others. Improper use of antibiotics may have helped as well. When people feel better, they stop taking their medication, which will not kill all of the bacteria. This will only help the bacteria to build up a defense to it (Shapiro, 2001).

Although the outlook might not seem good, there are ways to fight tuberculosis today, and new ways to fight are being developed. Surgeons are resorting to older methods in order to fight the bacteria. Older techniques being brought back include the removal of organs that will not respond to drug treatments (Harding, 2000). Combination chemotherapy is being used to treat resistant bacteria by hitting it with multiple drugs ("U.S.", 1993). Vaccinations are still given to many all over the world, and are important factors for children in prevention of tuberculosis. Hospital emergency rooms use ultraviolet light in some locations. This light has an antibacterial effect, and can kill off many tuberculosis bacteria that may not have been killed using other methods (Cramer, 1999).

Concerns in the future include more efforts throughout the world. Most need is in the underdeveloped countries that cannot afford proper treatment centers and drugs ("U.S.", 1993). The cost of drugs is predicted to go up drastically, since they have been going up for years ("U.S", 1993). Eight million new cases of active tuberculosis are predicted to be diagnosed each year by the World Health Organization (Hill, 1996). Of the eight million, three million are predicted to die each year (Cramer, 1999). In response to these predictions, the World Health Organization estimates a 10 to 14 percent increase annually for tuberculosis testing, having almost one billion tests (Hill, 1996).

Although it may not seem like it now, the problem of tuberculosis could go from a problem in certain countries to a huge problem all over the world. Preventative measures must be taken before the problem becomes too big to fix. Countries that have a good financial status need to help out other countries in need if this problem is ever to be fixed as well. Even though it may not seem like it, somebody standing next to somebody else could have tuberculosis, and neither of them would know it. Just how safe is everybody from tuberculosis is a question that should be taken seriously throughout the world.

Bates, B. (1992). Bargaining For Life. Philadelphia: University of Pennsylvania Press.

Bovson, M. (2000, February 7). DNA Fingerprinting Traces TB Bug’s Path From Dead Man to Embalmer. Biotechnology Newswatch.

Cramer, D. (1999). The Gale Encyclopedia of Medicine (Vol. 5). Detroit: Gale.

Harding, A. (2000). Milestones in Health and Medicine. Phoenix, Arizona: Oryx Press.

Hill, G. (1996, November 26). Cortecs, Inflazyme to Develop Tuberculosis Tests. Medical Industry Today.

Shapiro, H. (2001, October 1). States of Readiness: Do New Threats Loom? The New York Times.

Steinhauer, J. (1999, October 16). Battles Over Turf in Health Arena; Response To a Viral Outbreak Highlights City-State Tensions. The New York Times.
(2000, August 26). Tech Talk: Technology in Medicine. Global News Wire.

U.S. Congress, Office of Technology Assessment. (1993). The Continuing Challenge of
Tuberculosis. Washington D.C.: U.S. Government Printing Office.