The Resurgence of Tuberculosis


The Resurgence of Tuberculosis

Step Perspective, Volume 5, Number 1; A Publication Of The Seattle Treatment Education Project - February 1993
Stephen R. Tabet, MD

From 1953 through 1984, the number of cases of TB infection was on the decline. In 1985, in conjunction with a rise in the number of AIDS cases, we witnessed a striking reversal of that trend. Areas with the highest rates of HIV infected people (e.g. New York, New Jersey, Florida and California) showed the largest number of new TB cases. Unlike HIV, TB is rather efficiently transmitted through coughed droplets. It was traditionally spread among family members and other close contact5s. Because immunologic resistance to TB is related to cellular immunity, which is decreased in persons with HIV, persons with HIV are at particular risk of becoming infected with tuberculosis in less traditional settings. In fact, some researchers have estimated that persons with HIV have as much as 500 times the risk of acquiring TB infection that persons without HIV. Because TB is a potentially serious disease that can be prevented and cured, it is especially important for HIV infected people to be knowledgeable about TB. Recently, the media has focused on a particularly deadly (but rare) form of TB called multidrug-resistant tuberculosis (MDRTB). However, this article will focus on the more classic tuberculosis.

The literal definition of tuberculosis is "a condition of little knots or swellings." There are several tubercle (knot)-producing organisms that can produce classic tuberculosis: Mycobacterium tuberculosis, Mycobacterium bovis, and Mycobacterium africanum. These are not to be confused with the "atypical" forms of tuberculosis, Mycobacterium avium complex and Mycobacterium avium intracellulare (MAC and MAI), which are the cause of a different disease that commonly infects people with HIV. The weakened strain of Mycobacterium bovis, called BCG (Bacillus Camletter- Guerin) is used for vaccines against TB in other countries, but its efficacy is debatable. in developed countries, TB is caused by Mycobacterium tuberculosis, while in underdeveloped countries, particularly those where milk is not pasteurized, the other strains account for a high number of cases.

Symptoms of active tuberculosis infection are numerous and varied. They include cough, chest pain, fever, chills and weight loss. of course, these same symptoms are also caused by many6 other diseases that affect people with HIV. All people with HIV who feel they might have tuberculosis (whether experiencing symptoms or not) need prompt medical evaluation.

As in many other infectious diseases, some people who are exposed to TB do not develop active infection, and thus do not have symptoms. People with HIV are at a much higher risk of developing active TB infection than non-HIV infected persons. Note, however, that TB can be easily prevented in most people. Those who have been exposed to tuberculosis but do not have active infection, are placed on a single drug called isoniazid (NH) to prevent active TB. People who develop active TB require several drugs for effective treatment. If the medications are taken sporadically, or if one or more of the medications is omitted, drug-resistant organisms can then emerge, thus making the TB infection more difficult to treat.

Before HIV disease, tuberculosis was the single infectious disease written most about in the medical literature. Volumes and volumes can be found on the subject of tuberculosis, yet much about the disease is still controversial or unknown. specific questions regarding TB should be addressed to your health care provider or local public health department.
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Always watch for outdated information. This article first appeard in 1993. This material is designed to support, not replace, the relationship that exists between you and your doctor.

Copyright © 1993 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102.    Email: step100@aol.com  STEP web page

This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1993. AEGIS.