TB or not TB?

Tuberculosis has been killing people for thousands of years. Hippocrates in 430 B.C. noted that was one of the more widespread diseases found in patients. In his memoirs, Alexandre Dumas, author of The Three Muskeeters, observed that "it was all the fashion to suffer from chest complaint; everybody was consumptive, poets especially." Indeed, in the 19th and early 20th century consumption was widely viewed as an illness peculiar to passionate and sensitive souls. This theme was played out in many literary and artistic works, including Puccini's opera La Boheme, and Thomas Mann's novel The Magic Mountain.

Today, tuberculosis is the number one infectious disease killer. Globally more than one-third of the world's population is infected by the tuberculosis bacterium and between 2 and 3 million people die each year from the disease. "More people are dying of tuberculosis today than ever before in history," says Dr. Lee Reichman the executive director of the New Jersey Medical School National Tuberculosis Center.

TB began to come under control in the developed world with the pasteurization of milk and the creation of sanitoria which isolated from the public patients with active cases of TB. The introduction of effective chemotherapies in the 1940s and 1950s drove TB rates down ever further. TB rates fell in the United States until the late 1980s when they began to rise again as a consequence of the immunosuppression caused by the AIDS epidemic and increased immigration from regions of the world in which TB infections are more common. TB rates began to fall again in the United States in the early 1990s.

Unfortunately, new multi-drug resistant strains of TB are being incubated in other regions of the world in which public health measures are failing, particularly in Russia. The chief problem is that many of those infected with TB do not undergo the full treatment regimen--a failing that allows TB bacteria to mutate and resist drug treatments. Recently, the World Health Organization has launched a global campaign to control TB. The most effective way to treat and prevent the spread of TB would be a vaccine (there is a vaccine currently available, but it's not consistently effective). Because most cases of TB occur in poverty-stricken areas, pharmaceutical companies have been reluctant to invest in research that would lead to more effective TB vaccines. However, the Bill and Melinda Gates Foundation is now bankrolling the Sequella Global Tuberculosis Foundation effort to interest companies in vaccine development. This private effort may well lead to the defeat of one of humanity's greatest enemies.