Tuberculosis

Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption,<ref name="Chambers_1998">Template:Cite book</ref> is a contagious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria.<ref name="CDC_2025">Template:Cite web</ref> Tuberculosis generally affects the lungs, but it can also affect other parts of the body.<ref name="WHO_Factsheet_2025">Template:Cite web</ref> Most infections show no symptoms, in which case it is known as inactive or latent tuberculosis.<ref name="CDC_2025" /> A small proportion of latent infections progress to active disease that, if left untreated, can be fatal.<ref name="WHO_Factsheet_2025" /> Typical symptoms of active TB are chronic cough with blood-containing mucus, fever, night sweats, and weight loss.<ref name="WHO_Factsheet_2025"/> Infection of other organs can cause a wide range of symptoms.<ref name="Adkinson-2010">Template:Cite book</ref>

Tuberculosis is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak, or sneeze.<ref name="WHO_Factsheet_2025"/><ref name="CDC_2025" /> People with latent TB do not spread the disease.<ref name="WHO_Factsheet_2025"/> A latent infection is more likely to become active in those with weakened immune systems.<ref name="WHO_Factsheet_2025"/> There are two principal tests for TB: interferon-gamma release assay (IGRA) of a blood sample, and the tuberculin skin test.<ref name="WHO_Factsheet_2025" /><ref>Template:Cite web</ref>

Prevention of TB involves screening those at high risk, early detection and treatment of cases, and vaccination with the bacillus Calmette-Guérin (BCG) vaccine.<ref>Template:Cite journal</ref><ref name="WHO_Strategy_2008">Template:Cite book</ref><ref>Template:Cite book</ref> Those at high risk include household, workplace, and social contacts of people with active TB.<ref name="WHO_Strategy_2008"/> Treatment requires the use of multiple antibiotics over a long period of time.<ref name="WHO_Factsheet_2025"/>

Tuberculosis has been present in humans since ancient times.<ref name="Lawn-2011">Template:Cite journal</ref> In the 1800s, when it was known as consumption, it was responsible for an estimated quarter of all deaths in Europe.<ref name="Bloom_1994" /> The incidence of TB decreased during the 20th century with improvement in sanitation and the introduction of drug treatments including antibiotics.<ref>Template:Cite book</ref> However, since the 1980s, antibiotic resistance has become a growing problem, with increasing rates of drug-resistant tuberculosis.<ref name="WHO_Factsheet_2025" /><ref>Template:Cite web</ref> It is estimated that one quarter of the world's population have latent TB.<ref>Template:Cite web</ref> In 2023, TB is estimated to have newly infected 10.8 million people and caused 1.25 million deaths, making it the leading cause of death from an infectious disease.<ref name="WHO_Factsheet_2025" /><ref name="Who_Global_2024" />

File:En.Wikipedia-VideoWiki-Tuberculosis.webm

Video summary (script)

History

File:Mummy at British Museum.jpg

An Egyptian mummy in the British Museum – tubercular decay has been found in the spine.

Tuberculosis has existed since antiquity.<ref name="Lawn-2011"/> The oldest unambiguously detected M. tuberculosis gives evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago.<ref>Template:Cite journal</ref> However, whether tuberculosis originated in bovines, then transferred to humans, or whether both bovine and human tuberculosis diverged from a common ancestor, remains unclear.<ref>Template:Cite journal</ref> A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as researchers previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans even before the Neolithic Revolution.<ref>Template:Cite journal</ref> Skeletal remains show some prehistoric humans (4000 BC) had TB, and researchers have found tubercular decay in the spines of Egyptian mummies dating from 3000 to 2400 BC.<ref>Template:Cite journal</ref> Genetic studies suggest the presence of TB in the Americas from about AD 100.<ref>Template:Cite journal</ref>

Identification

Although Richard Morton established the pulmonary form associated with tubercles as a pathology in 1689,<ref>Template:WhoNamedIt</ref><ref>Template:Cite journal</ref> due to the variety of its symptoms, TB was not identified as a single disease until the 1820s. Benjamin Marten conjectured in 1720 that consumptions were caused by microbes which were spread by people living close to each other.<ref>Template:Cite book P. 51: "The Original and Essential Cause ... may possibly be some certain Species of Animalcula or wonderfully minute living Creatures, ... " P. 79: "It may be therefore very likely, that by an habitual lying in the same Bed with a Consumptive Patient, constantly Eating and Drinking with him, or by very frequently conversing so nearly, as to draw in part of the Breath he emits from his Lungs, a Consumption may be caught by a sound Person; ... "</ref> In 1819, René Laennec claimed that tubercles were the cause of pulmonary tuberculosis.<ref>Template:Cite book From p. 20: "L'existence des tubercules dans le poumon est la cause et constitue le charactère anatomique propre de la phthisie pulmonaire (a). (a) ... l'effet dont cette maladie tire son nom, c'est-à-dire, la consumption." (The existence of tubercles in the lung is the cause and constitutes the unique anatomical characteristic of pulmonary tuberculosis (a). (a) ... the effect from which this malady [pulmonary tuberculosis] takes its name, that is, consumption.)</ref> J. L. Schönlein first published the name "tuberculosis" (German: Tuberkulose) in 1832.<ref>Template:Cite book</ref><ref>The word "tuberculosis" first appeared in Schönlein's clinical notes in 1829. See: Template:Cite journal See especially Appendix, p. iii.</ref>

Between 1838 and 1845, John Croghan, the owner of Mammoth Cave in Kentucky from 1839 onwards, brought a number of people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year.<ref>Template:Cite web</ref> Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf (now Sokołowsko) in Silesia.<ref name="McCarthy-2001">Template:Cite journal</ref> In 1865, Jean Antoine Villemin demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals.<ref>Template:Cite journal

• See also: Template:Cite book</ref> (Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson.<ref>Burdon-Sanderson, John Scott. (1870) "Introductory Report on the Intimate Pathology of Contagion." Appendix to: Twelfth Report to the Lords of Her Majesty's Most Honourable Privy Council of the Medical Officer of the Privy Council [for the year 1869], Parliamentary Papers (1870), vol. 38, 229–256.</ref>)

File:RobertKoch.jpg

Robert Koch discovered the tuberculosis bacillus.

Robert Koch identified and described the bacillus causing tuberculosis, M. tuberculosis, on 24 March 1882.<ref>Template:Cite book</ref><ref>Template:Cite web</ref> In 1905, he was awarded the Nobel Prize in Physiology or Medicine for this discovery.<ref>Template:Cite web</ref>

Development of treatments

In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths.<ref name="Bloom_1994">Template:Cite book</ref> In the 18th and 19th century, tuberculosis had become epidemic in Europe, showing a seasonal pattern.<ref>Template:Cite web</ref><ref name="Zürcher_2016">Template:Cite journal</ref> Tuberculosis caused widespread public concern in the 19th and early 20th centuries as the disease became common among the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, TB still caused one in six deaths in France.Template:Citation needed

After TB was determined to be contagious, in the 1880s, it was put on a notifiable-disease list in Britain. Campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons. The sanatoria for the middle and upper classes offered excellent care and constant medical attention.<ref name="McCarthy-2001"/> What later became known as the Alexandra Hospital for Children with Hip Disease (tuberculous arthritis) was opened in London in 1867.<ref>Template:Cite web</ref> Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years (Template:Circa 1916).<ref name="McCarthy-2001"/>

Robert Koch did not believe the cattle and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". Although it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis.<ref>Template:Cite journal</ref> World Tuberculosis Day is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the Medical Research Council formed in Britain in 1913, it initially focused on tuberculosis research.<ref>Template:Cite book</ref>

Albert Calmette and Camille Guérin achieved the first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called bacille Calmette–Guérin (BCG). The BCG vaccine was first used on humans in 1921 in France,<ref>Template:Cite journal</ref> but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II.<ref>Template:Cite journal</ref>

In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Prior to the introduction of this medication, the only treatment was surgical intervention, including the "pneumothorax technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal.<ref>Template:Cite book</ref>

By the 1950s mortality in Europe had decreased about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat.Template:Cn

Drug resistant tuberculosis

However, a few years after the first antibiotic treatment for TB in 1943, some strains of the TB bacteria developed resistance to the standard drugs (streptomycin, para-aminosalicylic acid, and isoniazid).<ref name="Keshavjee-2012">Template:Cite journal</ref> Between 1970 and 1990, there were numerous outbreaks of drug-resistant tuberculosis involving strains resistant to two or more drugs; these strains are called multi-drug resistant TB (MDR-TB).<ref name="Keshavjee-2012" /> The resurgence of tuberculosis, caused in part by drug resistance and in part by the HIV pandemic, resulted in the declaration of a global health emergency by the World Health Organization (WHO) in 1993.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Treatment of MDR-TB requires treatment with second-line drugs, which in general are less effective, more toxic and more expensive than first-line drugs.<ref>Template:Cite journal</ref> Treatment regimes can run for two years, compared to the six months of first-line drug treatment.<ref>Kaplan, Jeffrey. 2017. "Tuberculosis" American University. Lecture.</ref><ref name="accessmedicine.mhmedical.com">Template:Cite book</ref>

Signs and symptoms

File:Tuberculosis symptoms.svg

The main symptoms of variants and stages of tuberculosis are given,<ref>Template:Cite web</ref> with many symptoms overlapping with other variants, while others are more, but not entirely, specific for certain variants. Multiple variants may be present simultaneously.

File:Tuberculosis lip (1).jpg

Tuberculosis of the lip, secondary to open pulmonary TB

There is a popular misconception that tuberculosis is purely a disease of the lungs that manifests as coughing.<ref>Template:Cite book</ref> Tuberculosis may infect many organs, even though it most commonly occurs in the lungs (known as pulmonary tuberculosis).<ref name="Adkinson-2010"/> Extrapulmonary TB occurs when tuberculosis develops outside of the lungs, although extrapulmonary TB may coexist with pulmonary TB.<ref name="Adkinson-2010"/>

General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue.<ref name="Adkinson-2010"/> In severe cases, nail clubbing may also occur.<ref name="Gibson_BMJ_2005">Template:Cite book</ref>

Latent tuberculosis

The majority of individuals with TB infection show no symptoms, a state known as inactive or latent tuberculosis.<ref name="CDC_2025" /> This condition is not contagious, and can be detected by the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA); other tests should be conducted to eliminate the possibility of active TB.<ref name="Price_2024">Template:Citation</ref> Without treatment, an estimated 5% to 15% of cases will progress into active TB during the person's lifetime.<ref name="Price_2024" />

Pulmonary

If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases).<ref name="Lawn-2011"/><ref>Template:Cite book</ref> Symptoms may include chest pain, a prolonged cough producing sputum which may be bloody, tiredness, temperature, loss of appetite, wasting and general malaise.<ref name="Lawn-2011"/><ref>Template:Cite web</ref> In very rare cases, the infection may erode into the pulmonary artery or a Rasmussen aneurysm, resulting in massive bleeding.<ref name="Adkinson-2010"/><ref>Template:Cite journal</ref>

Tuberculosis may cause extensive scarring of the lungs, which persists after successful treatment of the disease. Survivors continue to experience chronic respiratory symptoms such as cough, sputum production, and shortness of breath.<ref>Template:Cite journal</ref><ref>Template:Cite web</ref>

Extrapulmonary

Template:Main In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB.<ref>Template:Cite book</ref> These are collectively denoted as extrapulmonary tuberculosis.<ref name="Golden-2005">Template:Cite journal</ref> Extrapulmonary TB occurs more commonly in people with a weakened immune system and young children. In those with HIV, this occurs in more than 50% of cases.<ref name="Golden-2005"/> Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis), and the bones and joints (in Pott disease of the spine), among others. A potentially more serious, widespread form of TB is called "disseminated tuberculosis"; it is also known as miliary tuberculosis.<ref name="Adkinson-2010"/> Miliary TB currently makes up about 10% of extrapulmonary cases.<ref name="Habermann-2008"/>

Symptoms of extrapulmonary TB usually include the general signs and symptoms as above, with additional symptoms related to the part of the body which is affected.<ref>Template:Cite web</ref> Urogenital tuberculosis, however, typically presents differently, as this manifestation most commonly appears decades after the resolution of pulmonary symptoms. Most patients with chronic urogenital TB do not have pulmonary symptoms at the time of diagnosis. Urogenital tuberculosis most commonly presents with urinary 'storage symptoms' such as increased frequency and/or urgency of urination, flank pain, hematuria, and nonspecific symptoms such as fever and malaise.<ref name="Figueiredo-2017">Template:Cite journal</ref>

Causes

Mycobacteria

File:Mycobacterium tuberculosis.jpg

Scanning electron micrograph of M. tuberculosis

The main cause of TB is Mycobacterium tuberculosis (MTB), a small, aerobic, nonmotile bacillus.<ref name="Adkinson-2010"/> It divides every 16 to 20 hours, which is slow compared with other bacteria, which usually divide in less than an hour.<ref>Template:Cite book</ref> Mycobacteria have a complex, lipid-rich cell envelope, with the high lipid content of the outer membrane acting as a robust barrier contributing to their drug resistance.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref> If a Gram stain is performed, MTB either stains very weakly "Gram-positive" or does not retain dye as a result of the high lipid and mycolic acid content of its cell wall.<ref name=Madison_2001>Template:Cite journal</ref> MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the laboratory.<ref>Template:Cite journal</ref>

The term M. tuberculosis complex describes a genetically related group of Mycobacterium species that can cause tuberculosis in humans or other animals. It includes four other TB-causing mycobacteria: M. bovis, M. africanum, M. canettii, and M. microti.<ref>Template:Cite journal</ref> M. bovis causes bovine TB and was once a common cause of human TB, but the introduction of pasteurized milk has almost eliminated this as a public health problem in developed countries.<ref name="Kumar-2007">Template:Cite book</ref><ref>Template:Cite journal</ref> M. africanum is not widespread, but it is a significant cause of human TB in parts of Africa.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> M. canettii is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants.<ref>Template:Cite book</ref><ref>Template:Cite journal</ref> M. microti appears to have a natural reservoir in small rodents such as mice and voles, but can infect larger mammals. It is rare in humans and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

There are other known mycobacteria which cause lung disease resembling TB. M. avium complex is an environmental microorganism found in soil and water sources worldwide, which tends to present as an opportunistic infection in immunocompromised people.<ref>Template:Cite web</ref><ref>Template:Cite journal</ref> The natural reservoir of M. kansasii is unknown, but it has been found in tap water; it is most likely to infect humans with lung disease or who smoke.<ref>Template:Cite journal</ref> These two species are classified as "nontuberculous mycobacteria".<ref>Template:Cite journal</ref>

File:TB poster.jpg

Public health campaigns in the 1920s tried to halt the spread of TB.

Transmission

Tuberculosis spreads through the air when people with active pulmonary TB cough, sneeze, speak, or sing, releasing tiny airborne droplets containing the bacteria. Anyone nearby can breathe in these droplets and become infected. The droplets can remain airborne and infective for several hours, and are more likely to persist in poorly ventilated areas.<ref>Template:Cite web</ref>

Risk factors

Template:Main Risk factors for TB include exposure to droplets from people with active TB and environmental-related and health-condition related factors that decrease a person's immune system response such as HIV or taking immunosuppressant medications.<ref name="PHA_Canada_2024" />

Close contact

Prolonged, frequent, or close contact with people who have active TB is a high high risk factor for becoming infected; this group includes health care workers and children where a family member is infected.<ref>Template:Cite web</ref><ref name="Ahmed_2011">Template:Cite journal</ref> Transmission is most likely to occur from only people with active TB – those with latent infection are not thought to be contagious.<ref name="Kumar-2007" /> Environmental risk factors which put a person at closer contact with infective droplets from a person infected with TB are overcrowding, poor ventilation, or close proximity to a potentially infective person.<ref name="Schmidt-2008">Template:Cite journal</ref><ref name="Narasimhan_2013">Template:Cite journal</ref>

Immunodeficiencies

The most important risk factor globally for developing active TB is concurrent human immunodeficiency virus (HIV) infection; in 2023, 6.1% of those becoming infected with TB were also infected with HIV.<ref name="Who_Global_2024" /> Sub-Saharan Africa has a particularly high burden of HIV-associated TB.<ref name="WHO_Factsheet_2025" /> Of those without HIV infection who are infected with tuberculosis, about 5–15% develop active disease during their lifetimes;<ref name="Price_2024" /> in contrast, 30% of those co-infected with HIV develop the active disease.<ref name="Gibson_BMJ_2005" /> People living with HIV are estimated 16 times more likely to fall ill with TB than people without HIV; TB is the leading cause of death among people with HIV.<ref name="WHO_Factsheet_2025" />

Another important risk factor is use of medications which suppress the immune system; these include, chemotherapy, medication for lupus or rheumatoid arthritis, and medication after an organ transplant.<ref name="PHA_Canada_2024">Template:Cite web</ref> Other risk factors include: alcoholism, diabetes mellitus, silicosis, tobacco smoking, recreational drug use, severe kidney disease, head and neck cancer, low body weight.<ref name="PHA_Canada_2024" /><ref name="CDC_Risk_2016">Template:Cite web</ref> Children, especially those under age five, have undeveloped immune systems and are at higher risk.<ref name="CDC_Risk_2016" />

Environmental factors which weaken the body's protective mechanisms and may put a person at additional risk of contracting TB include air pollution, exposure to smoke (including tobacco smoke), and exposure (often occupational) to dust or particulates.<ref name="Schmidt-2008" />

Pathogenesis

File:Miliary TB of the spleen.jpg

The spleen in a patient with miliary tuberculosis showing granulomas (tubercles)

TB infection begins when a M. tuberculosis bacterium, inhaled from the air, penetrates the lungs and reaches the alveoli. Here it encounters an alveolar macrophage, a cell which is part of the body's immune system, which attempts to destroy it.<ref name="Ahmad-2022">Template:Cite journal</ref> However, M. tuberculosis is able to neutralise and colonise the macrophage, leading to persistent infection.<ref name="Ahmad-2022" />

The defence mechanism of the macrophage begins when a foreign body, such as a bacterial cell, binds to receptors on the surface of the macrophage. The macrophage then stretches itself around the bacterium and engulfs it. <ref>Template:Cite journal</ref> Once inside this macrophage, the bacterium is trapped in a compartment called a phagosome; the phagosome subsequently merges with a lysosome to form a phagolysosome.<ref name="Rohde-2007">Template:Cite journal</ref> The lysosome is an organelle which contains digestive enzymes; these are released into the phagolysosome and kill the invader.<ref>Template:Cite book</ref>

The M. tuberculosis bacterium is able to subvert the normal process by inhibiting the development of the phagosome and preventing it from fusing with the lysosome.<ref name="Rohde-2007" /> The bacterium is able to survive and replicate within the phagosome; it will eventually destroy its host macrophage, releasing progeny bacteria which spread the infection.<ref name="Ahmad-2022" />

In the next stage of infection, macrophages, epithelioid cells, lymphocytes and fibroblasts aggregate to form a granuloma, which surrounds and isolates the infected macrophages.<ref name="Ahmad-2022" /> This does not destroy the tuberculosis bacilli, but contains them, preventing spread of the infection to other parts of the body. They are nevertheless able to survive within the granuloma.<ref name="Ahmad-2022" /><ref name="Silva-Miranda-2012">Template:Cite journal</ref> In tuberculosis, the granuloma contains necrotic tissue at its centre, and appears as a small white nodule, also known as a tubercle, from which the disease derives its name.<ref name="Alzayer-2025">Template:Citation</ref>

Granulomas are most common in the lung, but they can appear anywhere in the body. As long as the infection is contained within granulomas, there are no outward symptoms and the infection is latent.<ref name="Alzayer-2025" /> However, if the immune system is unable to control the infection, the disease can progress to active TB, which can cause significant damage to the lungs and other organs.<ref name="Silva-Miranda-2012" />

If TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues.<ref>Template:Cite book</ref> This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis.<ref>Template:Cite book</ref> People with this disseminated TB have a high fatality rate even with treatment (about 30%).<ref name="Habermann-2008">Template:Cite book</ref><ref>Template:Cite journal</ref>

In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis.<ref name="Grosset-2003">Template:Cite journal</ref> Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages (bronchi) and this material can be coughed up. It contains living bacteria and thus can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.<ref name="Grosset-2003" />

Diagnosis

File:TB in sputum.png

M. tuberculosis (stained red) in sputum

Diagnosis of tuberculosis is often difficult. Symptoms manifest slowly, and are generally non-specific, e.g. cough, fatigue, fever which could be caused by a number of other factors.<ref>Template:Citation</ref> The conclusive test for pulmonary TB is a bacterial culture taken from a sample of sputum, but this is slow to give a result, and does not detect latent TB. Extra-pulmonary TB infection can affect the kidneys, spine, brain, lymph nodes, or bones - a sample cannot easily be obtained for culture.<ref>Template:Cite web</ref> Tests based on the immune response are sensitive but are likely to give false negatives in those with weak immune systems such as very young patients and those coinfected with HIV. Another issue affecting diagnosis in many parts of the world is that TB infection is most common in resource-poor settings where sophisticated laboratories are rarely available.<ref>Template:Cite journal</ref><ref>Template:Cite web</ref>

A diagnosis of TB should be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks.<ref name="Escalante-2009">Template:Cite journal</ref> Diagnosis of TB, whether latent or active, starts with medical history and physical examination. Subsequently a number of tests can be performed to refine the diagnosis:<ref>Template:Cite web</ref> A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation.<ref name="Escalante-2009" />

Mantoux test

File:Mantoux tuberculin skin test.jpg

The Mantoux skin test consists of an injection of a small quantity of PPD tuberculin just below the skin on the forearm.

The Mantoux tuberculin skin test is often used to screen people at high risk for TB such as health workers or close contacts of TB patients, who may not display symptoms of infection.<ref name="Escalante-2009" /> In the Mantoux test, a small quantity of tuberculin antigen is injected intradermally on the forearm.<ref>Template:Cite web</ref><ref>Template:Cite web</ref> The result of the test is read after 48 to 72 hours. A person who has been exposed to the bacteria would be expected to mount an immune response; the reaction is read by measuring the diameter of the raised area.<ref>Template:Cite web</ref> Vaccination with Bacille Calmette-Guerin (BCG) may result in a false-positive result. Several factors may lead to false negatives; these include HIV infection, some viral illnesses, and overwhelming TB disease.<ref>Template:Cite web</ref><ref>Template:Cite journal</ref>

Interferon-Gamma Release Assay

The Interferon-Gamma Release Assay (IGRA) is recommended in those who are positive to the Mantoux test.<ref>Template:NICE</ref> This test mixes a blood sample with antigenic material derived from the TB bacterium. If the patient has developed an immune response to a TB infection, white blood cells in the sample will release interferon-gamma (IFN-γ), which can be measured.<ref name="CDC_Testing_2024">Template:Cite web</ref> This test is more reliable than the Mantoux test, and does not give a false positive after BCG vaccination; <ref name="CDC_Testing_2024" /> however it may give a positive result in case of infection by the related bacteria M. szulgai, M. marinum, and M. kansasii.<ref>Template:Cite book</ref>

Chest radiograph

In active pulmonary TB, infiltrates (opaque areas) or scarring are visible in the lungs on a chest X-ray. Infiltrates are suggestive but not necessarily diagnostic of TB. Other lung diseases can mimic the appearance of TB; and this test will not detect extrapulmonary infection or a recent infection.<ref>Template:Cite web</ref>

Microbiological studies

File:TB Culture.jpg

A close-up of Mycobacterium tuberculosis in a culture medium

A definitive diagnosis of tuberculosis can be made by detecting Mycobacterium tuberculosis organisms in a specimen taken from the patient (most often sputum, but may also be pus, cerebrospinal fluid, biopsied tissue, etc.).<ref>Template:Citation</ref> The specimen is examined by fluorescence microscopy.<ref>Template:Cite journal</ref> The bacterium is slow growing so a cell culture may take several weeks to yield a result.<ref>Template:Cite web</ref>

Other tests

Nucleic acid amplification tests (NAAT) and adenosine deaminase testing may allow rapid diagnosis of TB.<ref>Template:Cite journal</ref><ref name="CDC_Xpert_2024" /> In December 2010, the World Health Organization endorsed the Xpert MTB/RIF system (a NAAT) for diagnosis of tuberculosis in endemic countries.<ref>"WHO endorses new rapid tuberculosis test" 8 December 2010. Retrieved on 12 June 2012</ref>

Blood tests to detect antibodies are not specific or sensitive, so they are not recommended.<ref>Template:Cite journal</ref>

PCR testing for Mycobacterium tuberculosis is often required for the diagnosis of urogenital tuberculosis and may also be used to diagnose tuberculosis in other tissues. It is highly sensitive and specific with good turnaround time.<ref name="Figueiredo-2017" />

Prevention

The main strategies to prevent infection with TB are treatment of both active and latent TB, as well as vaccination of children who are at risk.<ref name="Lawn-2011" />

Although latent TB is not infective, it should be treated in order to prevent its development into active pulmonary TB, which is infective.<ref>Template:Cite web</ref> The cascade of person-to-person spread can be circumvented by segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others; however it is important to complete the full course of treatment which is usually six months.<ref>Template:Cite web</ref><ref name="Ahmed_2011" />

Vaccines

Template:Main The only available vaccine Template:As of is bacillus Calmette-Guérin (BCG).<ref>Template:Cite journal</ref><ref>Template:Cite web</ref> In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated.<ref name="WHO_BCG_2018">Template:Cite journal</ref> In countries where tuberculosis is common, one dose is recommended in healthy babies as soon after birth as possible.<ref name="WHO_BCG_2018" /> A single dose is given by intradermal injection. Administered to children under 5, it decreases the risk of getting the infection by 20% and the risk of infection turning into active disease by nearly 60%.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> It is not effective if administered to adults.<ref>Template:Cite journal</ref>

Public health

File:Notice Do not spit - National Association for the Prevention of Tuberculosis Dublin Branch.jpg

A tuberculosis public health campaign in Ireland, 1905

The first International Congress on Tuberculosis was held at Berlin in 1899. It was known by this time that tuberculosis was caused by a bacillus, thought to be passed by phlegm coughed up by a sick person, dried into dust and then inhaled by a healthy person.Template:Sfn Milk was known to be an important means of infection.Template:Sfn Means of prevention included free ventilation of houses and wholesome and abundant food. Milk should be boiled, and meat should be carefully inspected, or else the cattle tested for infection. Cures for the disease included abundant food, particularly of a fatty nature, and life in the open air.Template:Sfn

TB was made a notifiable disease in Britain; there were campaigns to stop spitting in public places, and the infected poor were pressured to enter sanatoria that resembled prisons.<ref>McCarthy 2001:413-7</ref> In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into spittoons.  

Worldwide campaigns

File:Tuberculosis screening, 1940, Royal Navy Barracks, Chatham (IWM A 2008).jpg

Royal Navy sailors being screened for tuberculosis (1940)

The World Health Organization (WHO) declared TB a "global health emergency" in 1993,<ref name="Lawn-2011" /> and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aimed to save 14 million lives between its launch and 2015.<ref>Template:Cite web</ref> A number of targets they set were not achieved by 2015, mostly due to the increase in HIV-associated tuberculosis and the emergence of multi-drug resistant tuberculosis.<ref name="Lawn-2011" />

In 2014, the WHO adopted the "End TB" strategy which aims to reduce TB incidence by 80% and TB deaths by 90% by 2030.<ref>Template:Cite web</ref> The strategy contains a milestone to reduce TB incidence by 20% and TB deaths by 35% by 2020.<ref name="WHO_Global_2020">Template:Cite book</ref> However, by 2020 only a 9% reduction in incidence per population was achieved globally, with the European region achieving 19% and the African region achieving 16% reductions.<ref name="WHO_Global_2020" /> Similarly, the number of deaths only fell by 14%, missing the 2020 milestone of a 35% reduction, with some regions making better progress (31% reduction in Europe and 19% in Africa).<ref name="WHO_Global_2020" /> Correspondingly, also treatment, prevention and funding milestones were missed in 2020, for example only 6.3 million people were started on TB prevention short of the target of 30 million.<ref name="WHO_Global_2020" />

The goal of tuberculosis elimination is being hampered by the lack of rapid testing, short and effective treatment courses, and completely effective vaccines.<ref>Template:Cite journal</ref>

Management

File:Tubi - 1234,0186.jpg

Tuberculosis phototherapy treatment in Kuopio, Finland, 1934

Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective.<ref>Template:Cite journal</ref>

Active TB is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance.<ref name="Lawn-2011" />

Latent TB

Latent TB is treated with either isoniazid or rifampin alone, or a combination of isoniazid with either rifampicin or rifapentine.<ref name="WHO_Latent_2018">Template:Cite book</ref><ref>Template:Cite journal</ref><ref name="Sterling-2020">Template:Cite journal</ref>

The treatment takes three to nine months depending on the medications used.<ref>Template:Cite web</ref><ref name="WHO_Latent_2018" /><ref>Template:Cite journal</ref><ref name="Sterling-2020" /> People with latent infections are treated to prevent them from progressing to active TB disease later in life.<ref>Template:Cite journal</ref>

Education or counselling may improve the latent tuberculosis treatment completion rates.<ref>Template:Cite journal</ref>

New onset

The recommended treatment of new-onset pulmonary tuberculosis, Template:As of, is six months of a combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and ethambutol for the first two months, and only rifampicin and isoniazid for the last four months.<ref name="Lawn-2011" /> Where resistance to isoniazid is high, ethambutol may be added for the last four months as an alternative.<ref name="Lawn-2011" /> Treatment with anti-TB drugs for at least 6 months results in higher success rates when compared with treatment less than 6 months, even though the difference is small. Shorter treatment regimen may be recommended for those with compliance issues.<ref name="Gelband_1999">Template:Cite journal</ref> There is also no evidence to support shorter anti-tuberculosis treatment regimens when compared to a 6-month treatment regimen.<ref>Template:Cite journal</ref> However, results presented in 2020 from an international, randomized, controlled clinical trial indicate that a four-month daily treatment regimen containing high-dose, or "optimized", rifapentine with moxifloxacin (2PHZM/2PHM) is as safe and effective as the existing standard six-month daily regimen at curing drug-susceptible tuberculosis (TB) disease.<ref>Template:Cite web</ref>

Recurrent disease

If tuberculosis recurs, testing to determine which antibiotics it is sensitive to is important before determining treatment.<ref name="Lawn-2011" /> If multi-drug resistant TB (MDR-TB) is detected, treatment with at least four effective antibiotics for 18 to 24 months is recommended.<ref name="Lawn-2011" />

Medication administration

Directly observed therapy, i.e., having a health care provider watch the person take their medications, is recommended by the World Health Organization (WHO) in an effort to reduce the number of people not appropriately taking antibiotics.<ref>Template:Cite book</ref> The evidence to support this practice over people simply taking their medications independently is of poor quality.<ref name="Karumbi2015" /> There is no strong evidence indicating that directly observed therapy improves the number of people who were cured or the number of people who complete their medicine.<ref name="Karumbi2015">Template:Cite journal</ref> Moderate quality evidence suggests that there is also no difference if people are observed at home versus at a clinic, or by a family member versus a health care worker.<ref name="Karumbi2015" />

Methods to remind people of the importance of treatment and appointments may result in a small but important improvement.<ref>Template:Cite journal</ref> There is also not enough evidence to support intermittent rifampicin-containing therapy given two to three times a week has equal effectiveness as daily dose regimen on improving cure rates and reducing relapsing rates.<ref>Template:Cite journal</ref> There is also not enough evidence on effectiveness of giving intermittent twice or thrice weekly short course regimen compared to daily dosing regimen in treating children with tuberculosis.<ref>Template:Cite journal</ref>

Medication resistance

Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible MTB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication.<ref>Template:Cite journal</ref> Drug-resistant TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs.<ref>Template:Cite journal</ref> Totally drug-resistant TB is resistant to all currently used drugs.<ref name="McKenna-2012">Template:Cite magazine</ref> It was first observed in 2003 in Italy,<ref>Template:Cite journal</ref> but not widely reported until 2012,<ref name="McKenna-2012" /><ref>Template:Cite web</ref> and has also been found in Iran and India.<ref name="Kielstra-2014">Template:Cite news</ref> There is some efficacy for linezolid to treat those with XDR-TB but side effects and discontinuation of medications were common.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Bedaquiline is tentatively supported for use in multi-drug resistant TB.<ref>Template:Cite web</ref>

XDR-TB is a term sometimes used to define extensively resistant TB, and constitutes one in ten cases of MDR-TB. Cases of XDR TB have been identified in more than 90% of countries.<ref name="Kielstra-2014" />

For those with known rifampicin or MDR-TB, molecular tests such as the Genotype MTBDRsl Assay (performed on culture isolates or smear positive specimens) may be useful to detect second-line anti-tubercular drug resistance.<ref>Template:Cite journal</ref><ref>Template:Cite web</ref>

Xpert MTB/XDR can be used to detect resistance of isoniazid, fluoroquinolones, and amikacin and can be helpful in selection of optimal medication.<ref>Template:Cite journal</ref>

Prognosis

File:Tuberculosis world map - DALY - WHO2004.svg

Age-standardized disability-adjusted life years caused by tuberculosis per 100,000 inhabitants, 2004:<ref>Template:Cite web</ref> Template:Col-begin Template:Col-break Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Col-break Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Legend Template:Col-end

Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune system defenses and begin to multiply. In primary TB disease (some 1–5% of cases), this occurs soon after the initial infection.<ref name="Kumar-2007" /> However, in the majority of cases, a latent infection occurs with no obvious symptoms.<ref name="Kumar-2007" /> These dormant bacilli produce active tuberculosis in 5–10% of these latent cases, often many years after infection.<ref name="Gibson_BMJ_2005" />

The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year.<ref name="Kumar-2007" /> Studies using DNA fingerprinting of M. tuberculosis strains have shown reinfection contributes more substantially to recurrent TB than previously thought,<ref>Template:Cite journal</ref> with estimates that it might account for more than 50% of reactivated cases in areas where TB is common.<ref>Template:Cite journal</ref> The chance of death from a case of tuberculosis is about 4% Template:As of, down from 8% in 1995.<ref name="Lawn-2011" />

In people with smear-positive pulmonary TB (without HIV co-infection), after 5 years without treatment, 50–60% die while 20–25% achieve spontaneous resolution (cure). TB is almost always fatal in those with untreated HIV co-infection and death rates are increased even with antiretroviral treatment of HIV.<ref>Template:Cite web</ref>

Epidemiology

Roughly one-quarter of the world's population has been infected with M. tuberculosis,<ref name="WHO_Factsheet_2018a">Template:Cite web</ref> with new infections occurring in about 1% of the population each year.<ref>Template:Cite web</ref> However, most infections with M. tuberculosis do not cause disease,<ref>Template:Cite web</ref> and 90–95% of infections remain asymptomatic.<ref>Template:Cite book</ref> In 2012, an estimated 8.6 million chronic cases were active.<ref>Template:Cite web</ref> In 2010, 8.8 million new cases of tuberculosis were diagnosed, and 1.20–1.45 million deaths occurred (most of these occurring in developing countries).<ref name="WHO_Global_2011">Template:Cite web</ref><ref>Template:Cite journal</ref> Of these, about 0.35 million occur in those also infected with HIV.<ref name="WHO_Control_2011">Template:Cite web</ref> In 2018, tuberculosis was the leading cause of death worldwide from a single infectious agent.<ref name="WHO_Factsheet_2025" /> The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002.<ref name="WHO_Global_2011" />

TuberculosisTemplate:Clarify incidence is seasonal, with peaks occurring every spring and summer.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name="Korthals2012">Template:Cite journal</ref> The reasons for this are unclear, but may be related to vitamin D deficiency during the winter.<ref name="Korthals2012" /><ref>Template:Cite journal</ref> There are also studies linking tuberculosis to different weather conditions like low temperature, low humidity and low rainfall. It has been suggested that tuberculosis incidence rates may be connected to climate change.<ref>Template:Cite journal</ref>

• Number of new cases of tuberculosis per 100,000 people in 2016.
  Number of new cases of tuberculosis per 100,000 people, 2016<ref>Template:Cite web</ref>
• Tuberculosis deaths per million persons, 2012
  Tuberculosis deaths per million persons, 2012
• Tuberculosis deaths by region, 1990 to 2017<ref>Template:Cite web</ref>
  Tuberculosis deaths by region, 1990 to 2017<ref>Template:Cite web</ref>
• Deaths from tuberculosis, by age, World<ref>Template:Cite web</ref>
  Deaths from tuberculosis, by age, World<ref>Template:Cite web</ref>

At-risk groups

Tuberculosis is closely linked to both overcrowding and malnutrition, making it one of the principal diseases of poverty.<ref name="Lawn-2011" /> Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients.<ref name="Griffith_1996">Template:Cite journal</ref>

The rate of tuberculosis varies with age. In Africa, it primarily affects adolescents and young adults.<ref>Template:Cite web</ref> However, in countries where incidence rates have declined dramatically (such as the United States), tuberculosis is mainly a disease of the elderly and immunocompromised (risk factors are listed above).<ref name="Kumar-2007" /><ref>Template:Cite web</ref> Worldwide, 22 "high-burden" states or countries together experience 80% of cases as well as 83% of deaths.<ref name="Kielstra-2014" />

In Canada and Australia, tuberculosis is many times more common among the Indigenous peoples, especially in remote areas.<ref>Template:Cite journal</ref><ref>Template:Cite book</ref> Factors contributing to this include higher prevalence of predisposing health conditions and behaviours, and overcrowding and poverty. In some Canadian Indigenous groups, genetic susceptibility may play a role.<ref name="Narasimhan_2013" />

Socioeconomic status (SES) strongly affects TB risk. People of low SES are both more likely to contract TB and to be more severely affected by the disease. Those with low SES are more likely to be affected by risk factors for developing TB (e.g., malnutrition, indoor air pollution, HIV co-infection, etc.), and are additionally more likely to be exposed to crowded and poorly ventilated spaces. Inadequate healthcare also means that people with active disease who facilitate spread are not diagnosed and treated promptly; sick people thus remain in the infectious state and (continue to) spread the infection.<ref name="Narasimhan_2013" />

Geographical epidemiology

The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many African, Caribbean, South Asian, and eastern European countries test positive in tuberculin tests, while only 5–10% of the U.S. population test positive.<ref name="Kumar-2007" /> Hopes of totally controlling the disease have been dramatically dampened because of many factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.<ref name="Lawn-2011" />

In developed countries, tuberculosis is less common and is found mainly in urban areas. In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research.<ref>Template:Cite web</ref>

In 2010, rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139.<ref name="WHO_Control_2011" />

In 2023, tuberculosis overtook COVID-19 as the leading cause of infectious disease-related deaths globally, according to a World Health Organization.<ref name="Who_Global_2024">Template:Cite book</ref> Around 8.2 million people were newly diagnosed with TB last year, allowing them access to treatment—a record high since WHO's tracking began in 1995 and an increase from 7.5 million cases in 2022.<ref>Template:Cite web</ref> The report highlights ongoing obstacles in combating TB, including severe funding shortages that hinder efforts toward eradication. Although TB-related deaths decreased slightly to 1.25 million in 2023 from 1.32 million in 2022, the overall number of new cases rose marginally to an estimated 10.8 million.

Russia

Russia has achieved particularly dramatic progress with a decline in its TB mortality rate—from 61.9 per 100,000 in 1965 to 2.7 per 100,000 in 1993;<ref>Template:Cite book</ref><ref name="WHO_Control_2011a">Template:Cite web</ref> however, mortality rate increased to 24 per 100,000 in 2005 and then recoiled to 11 per 100,000 by 2015.<ref>Template:Cite web</ref>

China

China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010.<ref name="WHO_Control_2011" /> The number of new cases has declined by 17% between 2004 and 2014.<ref name="Kielstra-2014" />

Africa

In 2007, the country with the highest estimated incidence rate of TB was Eswatini, with 1,200 cases per 100,000 people. In 2017, the country with the highest estimated incidence rate as a % of the population was Lesotho, with 665 cases per 100,000 people.<ref name="WHO_Global_2018">Template:Cite web</ref>

In South Africa, 54,200 people died in 2022 from TB. The incidence rate was 468 per 100,000 people; in 2015, this was 988 per 100,000. The total incidence was 280,000 in 2022; in 2015, this was 552,000.<ref>Template:Cite web</ref>

India

As of 2017, India had the largest total incidence, with an estimated 2,740,000 cases.<ref name="WHO_Global_2018" /> According to the World Health Organization (WHO), in 2000–2015, India's estimated mortality rate dropped from 55 to 36 per 100,000 population per year with estimated 480 thousand people died of TB in 2015.<ref>Template:Cite web</ref><ref>Template:Cite web</ref> In India a major proportion of tuberculosis patients are being treated by private partners and private hospitals. Evidence indicates that the tuberculosis national survey does not represent the number of cases that are diagnosed and recorded by private clinics and hospitals in India.<ref>Template:Cite journal</ref>

North America

In Canada, tuberculosis was endemic in some rural areas as of 1998.<ref>Template:Cite journal</ref> The tuberculosis case rate in Canada in 2021 was 4.8 per 100,000 persons. The rates were highest among Inuit (135.1 per 100,000), First Nations (16.1 per 100,000) and people born outside of Canada (12.3 per 100,000).<ref>Template:Cite web</ref>

In the United States, Native Americans have a fivefold greater mortality from TB,<ref>Template:Cite book</ref> and racial and ethnic minorities accounted for 88% of all reported TB cases.<ref name="Williams-2024">Template:Cite journal</ref> The overall tuberculosis case rate in the United States was 2.9 per 100,000 persons in 2023, representing a 16% increase in cases compared to 2022.<ref name="Williams-2024" />

In 2024, Long Beach, California authorized a public health emergency in response to a local outbreak of TB.<ref>Template:Cite news</ref>

Western Europe

In 2017, in the United Kingdom, the national average was 9 per 100,000 and the highest incidence rates in Western Europe were 20 per 100,000 in Portugal.

India

India had the highest total number of TB cases worldwide in 2010, in part due to poor disease management within the private and public health care sector.<ref>Template:Cite journal</ref> Programs such as the Revised National Tuberculosis Control Program are working to reduce TB levels among people receiving public health care.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Society and culture

Names

Tuberculosis has been known by many names from the technical to the familiar.<ref name="Lawlor" /> Template:Lang (Template:Lang) in ancient Greek translates to decay or wasting disease, presumed to refer to pulmonary tuberculosis;<ref>Template:Citation</ref> around 460 BCE, Hippocrates described phthisis as a disease of dry seasons.<ref>Template:Cite web</ref> The abbreviation TB is short for tubercle bacillus. Consumption was the most common nineteenth century English word for the disease, and was also in use well into the twentieth century.<ref name="Chambers_1998" /> The Latin root Template:Lang meaning 'completely' is linked to Template:Lang meaning 'to take up from under'.<ref>Template:Cite book</ref> In The Life and Death of Mr Badman by John Bunyan, the author calls consumption "the captain of all these men of death."<ref>Template:Cite book</ref> "Great white plague" has also been used.<ref name="Lawlor" />

Art and literature

File:Munch Det Syke Barn 1885-86.jpg

Painting The Sick Child by Edvard Munch, 1885–1886, depicts the illness of his sister Sophie, who died of tuberculosis when Edvard was 14; his mother also died of the disease.

Tuberculosis was for centuries associated with poetic and artistic qualities among those infected, and was also known as "the romantic disease".<ref name="Lawlor">Template:Cite web</ref><ref>Template:Cite book</ref> Major artistic figures such as the poets John Keats, Percy Bysshe Shelley, and Edgar Allan Poe, the composer Frédéric Chopin,<ref>Template:Cite web</ref> the playwright Anton Chekhov, the novelists Franz Kafka, Katherine Mansfield,<ref>Template:Cite journal</ref> Charlotte Brontë, Fyodor Dostoevsky, Thomas Mann, W. Somerset Maugham,<ref>Template:Cite book</ref> George Orwell,<ref>Template:Cite web</ref> and Robert Louis Stevenson, and the artists Alice Neel,<ref>Template:Cite journal</ref> Jean-Antoine Watteau, Elizabeth Siddal, Marie Bashkirtseff, Edvard Munch, Aubrey Beardsley and Amedeo Modigliani either had the disease or were surrounded by people who did. A widespread belief was that tuberculosis assisted artistic talent. Physical mechanisms proposed for this effect included the slight fever and toxaemia that it caused, allegedly helping them to see life more clearly and to act decisively.<ref>Template:Cite journal</ref><ref>Template:Cite thesis</ref><ref name="Morens2002">Template:Cite journal</ref>

Tuberculosis formed an often-reused theme in literature, as in Thomas Mann's The Magic Mountain, set in a sanatorium;<ref>Template:Cite web</ref> in music, as in Van Morrison's song "T.B. Sheets";<ref>Template:Cite news</ref> in opera, as in Puccini's La bohème and Verdi's La Traviata;<ref name="Morens2002" /> in art, as in Munch's painting of his ill sister;<ref>Template:Cite web</ref> and in film, such as the 1945 The Bells of St. Mary's starring Ingrid Bergman as a nun with tuberculosis.<ref>Template:Cite magazine</ref>

Folklore

In 19th century New England, tuberculosis deaths were associated with vampires. When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members.<ref>Template:Cite journal</ref>

Law

Some countriesTemplate:Which have legislation to involuntarily detain or examine those suspected to have tuberculosis, or involuntarily treat them if infected.<ref>Template:Cite journal</ref>

Public health efforts

In 2012, The World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the U.S. government subsided a fast-acting diagnostic tuberculosis test, Xpert MTB/RIF, for use in low- and middle-income countries.<ref>Template:Cite web</ref><ref>Template:Cite journal</ref><ref>Template:Cite news</ref> This is a rapid molecular test used to diagnose TB and simultaneously detect rifampicin resistance. It provides results in about two hours, which is much faster than traditional TB culture methods. The test is designed for use with the GeneXpert System.<ref name="CDC_Xpert_2024">Template:Cite web</ref>

A 2014 EIU-healthcare report finds there is a need to address apathy and urges for increased funding. The report cites among others Lucica Ditui "[TB] is like an orphan. It has been neglected even in countries with a high burden and often forgotten by donors and those investing in health interventions."<ref name="Kielstra-2014"/>

Slow progress has led to frustration, expressed by the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it."<ref name="Kielstra-2014"/> Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government as of 2014, although adherence is often variable. Commercial treatment providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations.<ref name="Kielstra-2014"/>

The government of Brazil provides universal TB care, which reduces this problem.<ref name="Kielstra-2014"/> Conversely, falling rates of TB infection may not relate to the number of programs directed at reducing infection rates but may be tied to an increased level of education, income, and health of the population.<ref name="Kielstra-2014"/> Costs of the disease, as calculated by the World Bank in 2009 may exceed US$150 billion per year in "high burden" countries.<ref name="Kielstra-2014"/> Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250 million rural migrants in China.<ref name="Kielstra-2014"/>

There is insufficient data to show that active contact tracing helps to improve case detection rates for tuberculosis.<ref>Template:Cite journal</ref> Interventions such as house-to-house visits, educational leaflets, mass media strategies, educational sessions may increase tuberculosis detection rates in short-term.<ref>Template:Cite journal</ref> There is no study that compares new methods of contact tracing such as social network analysis with existing contact tracing methods.<ref>Template:Cite journal</ref>

Stigma

Slow progress in preventing the disease may in part be due to stigma associated with TB.<ref name="Kielstra-2014"/> Stigma may be due to the fear of transmission from affected individuals. This stigma may additionally arise due to links between TB and poverty, and in Africa, AIDS.<ref name="Kielstra-2014"/> Such stigmatization may be both real and perceived; for example, in Ghana, individuals with TB are banned from attending public gatherings.<ref name="Courtwright-2010">Template:Cite journal</ref>

Stigma towards TB may result in delays in seeking treatment,<ref name="Kielstra-2014"/> lower treatment compliance, and family members keeping cause of death secret<ref name="Courtwright-2010"/> – allowing the disease to spread further.<ref name="Kielstra-2014"/> In contrast, in Russia stigma was associated with increased treatment compliance.<ref name="Courtwright-2010"/> TB stigma also affects socially marginalized individuals to a greater degree and varies between regions.<ref name="Courtwright-2010"/>

One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling.<ref name="Courtwright-2010"/> Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence.<ref name="Courtwright-2010"/> Despite this, studies on the relationship between reduced stigma and mortality are lacking Template:As of, and similar efforts to decrease stigma surrounding AIDS have been minimally effective.<ref name="Courtwright-2010"/> Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable.<ref name="Kielstra-2014"/> A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.<ref>Template:Cite journal</ref>

Research

Template:See also The BCG vaccine has limitations and research to develop new TB vaccines is ongoing.<ref name="Martín Montañés-2011">Template:Cite journal</ref> A number of potential candidates are currently in phase I and II clinical trials.<ref name="Martín Montañés-2011"/><ref>Template:Cite journal</ref> Two main approaches are used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines.<ref name="Martín Montañés-2011"/> MVA85A, an example of a subunit vaccine, is in trials in South Africa as of 2006, is based on a genetically modified vaccinia virus.<ref name=Ibanga_2006>Template:Cite journal</ref> Vaccines are hoped to play a significant role in treatment of both latent and active disease.<ref>Template:Cite journal</ref>

To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development as of 2006, including prizes, tax incentives, and advance market commitments.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> A number of groups, including the Stop TB Partnership,<ref>Template:Cite book</ref> the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research.<ref>Template:Cite book</ref> Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280 million (US) from the Bill and Melinda Gates Foundation to develop and license an improved vaccine against tuberculosis for use in high burden countries.<ref>Template:Cite web</ref><ref>Template:Cite web</ref>

In 2012 a new medication regimen was approved in the US for multidrug-resistant tuberculosis, using bedaquiline as well as existing drugs. There were initial concerns about the safety of this drug,<ref name="Zumla2012">Template:Cite journal</ref><ref>Template:Cite news</ref><ref>Template:Cite journal</ref><ref>Template:Cite web</ref><ref>Template:Cite journal</ref> but later research on larger groups found that this regimen improved health outcomes.<ref>Template:Cite journal</ref> By 2017 the drug was used in at least 89 countries.<ref name="Khoshnood-2021">Template:Cite journal</ref> Another new drug is delamanid, which was first approved by the European Medicines Agency in 2013 to be used in multidrug-resistant tuberculosis patients,<ref>Template:Cite web</ref> and by 2017 was used in at least 54 countries.<ref name="Khoshnood-2021"/>

Steroids add-on therapy has not shown any benefits for active pulmonary tuberculosis infection.<ref>Template:Cite journal</ref>

Other animals

Mycobacteria infect many different animals, including birds,<ref>Template:Cite journal</ref> fish, rodents,<ref>Template:Cite journal</ref> and reptiles.<ref>Template:Cite journal</ref> The subspecies Mycobacterium tuberculosis, though, is rarely present in wild animals.<ref>Template:Cite book</ref> An effort to eradicate bovine tuberculosis caused by Mycobacterium bovis from the cattle and deer herds of New Zealand has been relatively successful.<ref>Template:Cite journal</ref> Efforts in Great Britain have been less successful.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>

Template:As of, tuberculosis appears to be widespread among captive elephants in the US. It is believed that the animals originally acquired the disease from humans, a process called reverse zoonosis. Because the disease can spread through the air to infect both humans and other animals, it is a public health concern affecting circuses and zoos.<ref>Template:Cite web</ref><ref>Template:Cite web</ref>

See also

• Post-tuberculosis lung disease
• List of deaths due to tuberculosis
• Bibliography of tuberculosis

Sources

• Template:Citation

External links

• Template:Cite web
• Template:Cite web
• WHO global 2016 TB report (infographic)
• WHO tuberculosis country profiles
• "Tuberculosis Among African Americans", 1990-11-01, In Black America; KUT Radio, American Archive of Public Broadcasting (WGBH and the Library of Congress)
• Working Group on New TB drugs, tracking clinical trials and drug candidates