TUBERCULOSIS-ITS JOURNEY IN THE LIVES
OF MANKIND
The ancient Greek literature mentions of a disease called “Phthisis”.
Hippocrates described the disease as the most common illness of his time,
typically affecting young adults and nearly always fatal. While Hippocrates
thought Phthisis to be hereditary in nature, Aristotle believed it was
contagious.
Some authors
described tuberculosis as the first disease known to mankind. It appears likely
that Akhenaten, the Pharaoh of the Eight Dynasty of Egypt and his wife
Nefertiti both died of tuberculosis. Evidence indicates that hospitals for
tuberculosis existed in ancient Egypt as early as 1500 B.C.
The Old Testament mentions of a consumptive illness that would affect the
Jewish people if they stray from God. It is listed in the section of curses
given before they enter the land of Cannan.
The oldest of the Vedas, Rigveda called it Yaksma. The Atharvaveda called it
Balasa.
Fransicus Sylvius, Dutch physician recognized that skin ulcers caused by
scrofula resembled tubercles seen in phthisis and in his book ‘Opera Medica’
described phthisis as the ‘scrofula of the lungs’.
In the 17th
century, the tuberculosis epidemic hit Europe for 2 decades and it was known as
the “Great White Plague”. It was seen as a romantic disease. Suffering from the
disease was believed to bestow upon the sufferer heightened sensitivity.
British poet Lord Byron wrote “I should like to die of consumption.” helping to
popularize the disease as the disease of artists. George Sand described her
lover Fredrick Chopin’s illness as “Chopin coughs with infinite grace.”
Shakespeare also mentioned of a disease called “Consumption” in his play “Much
Ado about nothing” and another called “Scrofula” in “Macbeth”.
Rene Laennec who invented stethoscope died of tuberculosis. He used the stethoscope
to corroborate his auscultatory findings and respiratory symptoms with the
autopsy findings of lung lesions of patients who died of TB.
Robert Koch demonstrated that the disease was
caused by an infectious agent, Mycobacterium Tuberculosis. He made this public
at the Physiological Society of Berlin on 24 March 1882 in a famous letter
entitled “Uber Tuberculose”. March 24 has ever since been known as the World
Tuberculosis Day.
On April 20, 1882, Robert Koch demonstrated that Mycobacterium was the single
cause of tuberculosis in all its forms. In 1890, Koch developed tuberculin, a
purified protein derivative of the bacteria. In 1908, Charles Mantoux
demonstrated it to be an effective intradermic test for diagnosing
tuberculosis.
In 1895, Wilhelm Konrad Von Roentgen discovered X-ray which made doctors
possible to observe the presence and the progress of the disease.
In 1902, the international conference on tuberculosis in Berlin proposed the
‘Cross of Lorraine’ to be the international symbol of the fight against
tuberculosis. The Lorraine Cross was carried to the Crusades by the original
Knight’s Templar, granted to them for their use by the Patriarch of Jerusalem.
In the Catholic Church, an equal armed Lorraine Cross denotes the office of
archbishop.
Albert Calmette and Camille Geurin discovered the BCG vaccine from attenuated
bovine strains of tuberculosis. The vaccine was first used on humans in France
in 1921.
Streptomycin discovered in 1944 became the first antibiotic effective against
Mycobacterium Tuberculosis and its discovery marked the modern era of tuberculosis
treatment. Soon after in 1952, Isoniazid was developed to become the first oral
drug effective against Mycobacterium tuberculosis. Rifampicin followed in the
70s.
The possibility of the disease getting completely eliminated became visible on
the horizon. However, the emergence of HIV, the development of resistance to
drugs particularly Rifampicin and Isoniazid coupled with inadequate control programs
let to resurgence of the disease.
60% of HIV
+ve patients contract tuberculosis during their lifetime. Management requires
therapy with both anti-tubercular as well as anti-retroviral drugs.
Multi-drug resistant TB (MDR-TB) and its more severe form extremely drug
resistant TB (XDR-TB) is rocking the planet. Statistics on the quantum of drug
resistance is still patchy but the trend is hard to refute. There are drugs
that cure MDR-TB but it does not cure everybody. It takes a minimum of two
years under the available regimen though trials are on, for shorter courses of
treatment.
In a recent study published in the Lancet Respiratory Medicine journal,
researchers said that more than half of 30 drug resistant TB patients treated
with transfusion with their own bone-marrow stem cells were cured of drug
resistant TB after 6 months. This may be another new ray of hope.
After a gap
of 40 years, a new drug for treatment of tuberculosis was discovered.
Bedaquiline, was approved under the accelerated approval programme of the FDA.
The drug demonstrated the potential to fill an unmet medical need, has the
potential to provide effective treatment where no satisfactory alternative
therapy exist particularly in some cases of MDR and XDR tuberculosis. However,
the drug also carries a “Black-box warning” of possible fatal cardiac
arrhythmias.
Today, we are at the cross-road of elimination of this age-old disease during
our life-time and million more TB deaths. The concept of “Universal Access”
calls for all health-care professionals to deliver his maximum towards
tuberculosis control.
The cost of inaction can be high, failure to roll out the tools that we have, can
be disastrous.
