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Tuberculosis
Category: Illness or disabilities
Type
Involuntary
Introduction and description

Tuberculosis, (short for tubercle bacillus) is a common and in many cases lethal infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis.
Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air when people who have an active MTB infection cough, sneeze, or otherwise transmit their saliva through the air.
Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of those infected.
One third of the world's population is thought to be infected with M. tuberculosis, and new infections occur at a rate of about one per second. The proportion of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still increasing.
In 2007 there were an estimated 13.7 million chronic active cases, 9.3 million new cases, and 1.8 million deaths, mostly in developing countries.
Tuberculosis is the world's greatest infectious killer of women of reproductive age. In 1815, one in four deaths in England was of TB - consumption.
People at special risk of developing TB include people with, or who have undergone:
- Silicosis have an approximately 30-fold greater risk for developing TB. Some possible indoor sources of silica include paint, concrete, and Portland cement. Crystalline silica is found in concrete, masonry, sandstone, rock, paint, and other abrasives
- Chronic renal failure and also on hemodialysis have an increased risk.
- Diabetes mellitus have a risk for developing active TB that is two to four times greater than persons without diabetes mellitus
- Major transplant or bypass surgery
- Cancer for example carcinoma of the head or neck, and other neoplasms e.g., lung cancer, lymphoma, and leukemia
- Low body weight – anorexics etc
- Compromised immune systems – for example those on prolonged corticosteroid therapy and immunosuppressive drugs, or a compromised immune system due to disease (30–40% of people with AIDS worldwide also have TB)
- Malnutrition - among immigrants in London from the Indian subcontinent, vegetarian Hindu Asians were found to have an 8.5 fold increased risk of tuberculosis, compared to Muslims who ate meat and fish daily. Although a causal link is not proved by this data, this increased risk could be caused by micronutrient deficiencies: possibly iron, vitamin B12 or vitamin D.
- Smokers - people who smoke more than 20 cigarettes a day increase the risk of TB by two to four times.
- HIV - Tuberculosis is the world's leading cause of death among people with HIV/AIDS
- Alcoholics
Tuberculosis patients from St. Thomas' Hospital rest in their beds in the open air
Symptoms

In olden days the word Phthisis was used to specifically refer to the symptoms of pulmonary tuberculosis. The classic symptoms of pulmonary tuberculosis are:
- a chronic cough with blood-tinged sputum - when tuberculosis becomes active, 75% of cases involve infection in the lungs (pulmonary TB). Symptoms include chest pain and a productive, prolonged cough for more than three weeks
- fever as well as chills
- night sweats
- pallor and fatigue
- appetite and weight loss (the last giving rise to the formerly prevalent colloquial term "consumption").
In 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis. This occurs more commonly in immunosuppressed or immunocompromised persons and young children. Extrapulmonary infection sites include
- the pleura in tuberculous pleurisy,
- the central nervous system in meningitis,
- the lymphatic system in scrofula of the neck,
- the genitourinary system in urogenital tuberculosis, and
- the bones and joints in Pott's disease of the spine.
When spread to the bones it is also known as "osseous tuberculosis", a form of Osteomyelitis (as a complication of tuberculosis). An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Extrapulmonary TB may co-exist with pulmonary TB.
Cause
The main cause of TB, Mycobacterium tuberculosis (MTB), is a small aerobic non-motile bacillus. Bacteria. It divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour. Since MTB has a cell wall but lacks an outer membrane, it is classified as a ‘Gram-positive’ bacterium.

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 vitro.
The M. tuberculosis complex includes four other TB-causing mycobacteria: M. bovis, M. africanum, M. canetti, and M. microti
- M. africanum is not widespread, but in parts of Africa it is a significant cause of tuberculosis.
- M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has largely eliminated this as a public health problem in developed countries.
- M. canetti is rare and seems to be limited to Africa
- M. microti is mostly seen in immunodeficient people, although it is possible that the prevalence of this pathogen has been underestimated.
People suffering from active pulmonary TB cough expel infectious aerosol droplets 0.5 to 5 µm in diameter. A single sneeze can release up to 40,000 droplets. Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low and inhaling fewer than ten bacteria may cause an infection. A person with active but untreated tuberculosis can infect 10–15 other people per year. Transmission can only occur from people with active—not latent—TB.
Treatment
Antibiotics
It was not until 1946 with the development of the antibiotic streptomycin that effective treatment and cure became possible. Prior to the introduction of this drug, the only treatment besides sanatoria were surgical interventions, including the pneumothorax technique—collapsing an infected lung to "rest" it and allow lesions to heal—a technique that was of little benefit and was largely discontinued by the 1950s.
But, hopes that the disease could be completely eliminated have been dashed since the rise of drug-resistant strains in the 1980s. The resurgence of tuberculosis resulted in the declaration of a global health emergency by the World Health Organization in 1993.
Boosting the immune system
There has been the rather unfortunate tendency in the past 60 or 70 years to dismiss the medicine of the past. But the medicine of the past did not use drugs and was remarkably effective. Its main aim was to boost the immune system by:
- removing any stress,
- encouraging sleep,
- providing fresh air free from pollutants and pathogens - which is why most sanatoriums were by the sea,
- and improving nutrition with fresh fruit and vegetables with plenty of vitamin C [tomatoes, oranges, lemons etc]

Another extremely interesting part of the remedy was the use of cold. Patients were wrapped up warm with plenty of blankets and layers of clothes but were taken out to breathe bitingly cold air.
For those with the constitution to take it the other part of the 'cure', and cure it often was, was a plunge in the sea or a cold water bath - quick, but in summer and winter. For someone with a bacterial infection this may seem madness, but the proof that this worked [and works] goes back to the 1850s.

Cold water therapy was described by the German priest Sebastian Kneipp in 1849. That winter, Kneipp was successfully battling tuberculosis using cold water therapy, which actually involved him plunging into the frigid Danube River several times each week. Kneipp’s 1886 book, My Water Cure, became an international bestseller.
Modern science and numerous case histories support cold water therapy’s benefits and we have provided some observations supporting this claim. The reason it works is that it can boost the immune function, decrease inflammation and pain, and increase blood flow and metabolism. But the cold must be followed by warmth for it to work.
Illustrations Of The Influence Of The Mind Upon The Body In Health And Disease, Designed To Elucidate The Action Of The Imagination - Daniel Hack Tuke, M.D., M.R.C.P.,
Dr. Rush refers to the cases related by Van Swieten and Smollett of consumptive patients recovering their health from falling into cold water, … — observing that this is only one of many proofs which might be brought forward, of partial or unequal action being suddenly changed into general and equal excitement throughout the system. (Medical Inquiries and Observations. By Benjamin Rush, M D., Professor of the Institutes and Practice of Medicine, and of Clinical Practice, in the University of Pennsylvania. 4 vols, in two. 4th Edit. Philadelphia, 1815, II, p. 83).
Avoiding stress, seeking relaxation

all likely to affect the immune system negatively
As we saw above, one third of the world's population is thought to be infected with M. tuberculosis, and of those infected, about one in ten latent cases may progress to active disease. So why is it that two thirds of the world's population never catch it, even though it is highly contagious and of those infected, most infections in humans result in an asymptomatic, latent infection?
The reasons appear to be that they are not nutritionally deprived, their immune system is working well and constantly, they are not ill with other disease and thus 'run down' and last but not least they are not stressed, anxious, frightened or suffering from other severe negative states and emotions.
War was a notorious breeding ground for TB and it was not just the insanitary conditions in which the soldiers lived but the terror it provoked:
The passions excited by war are regarded …. as explaining some of the cases of phthisis which are said to have occurred in camp life (Medical Inquiries and Observations. By Benjamin Rush, M D., Professor of the Institutes and Practice of Medicine, and of Clinical Practice, in the University of Pennsylvania. 4 vols, in two. 4th Edit. Philadelphia, 1815, II, p. 83).
In contrast, a sudden boost to the emotions, a happy event, a change of fortune can make all the difference. The same writer noted that even in war, when the soldiers thought they were winning, the rate of illness subsided; and we have the following example
Tissot records the following: A man of letters reached an advanced stage of phthisis, when he consulted a physician. At this period he happened to obtain fresh literary distinction, and was fortunate in other ways; the consequence being that he was greatly delighted. The physical effect was that his pulmonary affection was suspended and remained stationary for a long time (Annales Medico-Psychologiques. Edited by Baillarger, Cerise, et Longet, Sept., 1867, p. 167).
How it works
Why do people get hallucinations with tuberculosis?

but its principal cause was unrequited love
Physically - The destruction of the lung by tuberculosis induces hypoxia, thus the primary cause is hypoxia, but tuberculosis also produces a fever and fever itself can cause experiences.
The body dilates the blood vessels in an attempt to dissipate the heat, and this in turn produces low blood pressure. This can lead to fainting or dizziness, as the supply of oxygen to the brain is reduced.
Heart rate and respiration rate increase as blood pressure drops and the heart attempts to supply enough oxygen to the body, but this will be ineffective as the lung is damaged and can provide no more oxygen. It is at this point that spiritual experience may occur ranging from hallucinations to full out of body experiences. If the fever and lung damage is very severe, the person may get a near death experience.
Logically - the illness defeats the will, depresses the ego and removes desires. Furthermore the memory no longer chatters, so the composer can take over; then inspiration may strike and wisdom.
see also Bacterial infectionRelated observations
Healing observations
- Antimycobacterial crude plant extracts from South, Central, and North America 019929
- Antitubercular activity of Arctium lappa and Tussilago farfara extracts and constituents 017003
- Auranofin exerts broad-spectrum bactericidal activities by targeting thiol-redox homeostasis 017781
- Chemical composition of hexane extract of Citrus aurantifolia and anti-Mycobacterium tuberculosis activity of some of its constituents 021223
- Clinical Results and Physiological Effects of Immobilizing Lung Chamber Therapy in Chronic Pulmonary Tuberculosis 016525
- Cod liver oil, tomato juice, orange juice and TB 012324
- Culpepper's Complete Herbal on Burdock 017009
- Culpepper's Complete Herbal on White Willow 020521
- Dr Duke's activity for Malic acid 017755
- Dr Duke's list of Plants with Antitubercular activity 018399
- Dr Duke’s list of Antibacterial Activities in: Ailanthus altissima -- Stinktree, Tree Of Heaven 018310
- Dr. Liébeault - Hypnotic suggestion to induce or cure blisters 028752
- Drug resistant tuberculosis and homeopathic medicine 012150
- Durville, Hector- Psychic Actions at a distance – 02 The remarkable remote healing of Mrs. Marie Durieu, diagnosed with heart failure and tuberculosis 028057
- Farrelly, Frances - Diagnosing TB in the ear 004213
- Fighting off bugs by sweating 010331
- Gerson, Dr Max - Healing history 011332
- Hack Tuke, Daniel – Healing - Tuberculosis cured by powerful emotions of fear 026190
- Kum-Hwa Kim – Healing a patient with TB 027207
- Lomatium - Properties of Lomatium 017478
- Miracle cures in Lourdes 006676
- Mrs Grieve on Abscess Root 020487
- Mrs Grieve on Alehoof or Ground Ivy 018068
- Mrs Grieve on Common bugle 021240
- Mrs Grieve on Elecampane 019928
- Mrs Grieve on Fenugreek 016791
- Mrs Grieve on Liquorice 005547
- Mrs Grieve on Nettles 016790
- Mrs Grieve on Slippery Elm 017215
- Sai Baba - Howard Murphet – Curing rheumatoid arthritis, tuberculosis, dysentry and cancer 015900
- Scrofula, TB and spa and sea water 006683
- Summary of Antipathogenic Activities in: Phellodendron amurense -- Amur Cork Tree, Huang Bai, Huang Po, Po Mu 018332
- Sunshine as a cure for illness 026789
- The Healing effects of Cold Water Therapy 026191
- The healing effects of Vitamin D and sunlight 012466
- The Healing Power of Sleep 026790
- Vitamin D, sunlight and TB 007166
Hallucination
- Addison's disease and TB 007003
- County Limerick - The wailing banshee of Lough Gur 013973
- Ethambutol hydrochloride 018971
- Ethambutol-induced psychosis: a case report 023849
- Isoniazid-induced visual hallucinosis in Lymph node tuberculosis 016648
- Lamprene 019250
- Louis XVII of France hears celestial music as he dies 027857
- Mrs Shagren sees Mr. Hendrickson in her bedroom, Mr. Hendrickson sees Mrs Shagren in a dream 028017
- Myambutol 019557
- Mycobutin 019559
- Snell, Joy – Ministry of Angels – She died of consumption and without sufferings 027297
Wisdom, Inspiration, Divine love & Bliss
- Böcklin, Arnold - Die Heimkehr (The Homecoming or The Return) 1887 024387
- Bronte, Anne - Au revoir but not farewell 002983
- Bronte, Emily - Anticipation - How beautiful the earth is still 000005
- Bronte, Emily - If love for love can reach you 004687
- Bronte, Emily - No coward soul is mine 000016
- Bronte, Emily - No later light has lightened up my heaven 004592
- Bronte, Emily - The Old Stoic 000022
- Bronte, Emily - Waiting 004589
- Bronte, Emily - Yes, as I mused, the naked room The flickering firelight died away 002831
- Chopin - Barcarolle in F sharp major, Op. 60 025519
- Chopin - Etudes Op. 10 025518
- Chopin - Etudes Op. 25 025517
- Chopin - Fantaisie Impromptu, Op. 66 025505
- Chopin - Introduction and Polonaise brillante in C major, Op. 3 025510
- Chopin - Mazurkas Op. 63 Nos. 1-3 025524
- Chopin - Nocturne Op. 20 in C-sharp minor 025511
- Chopin - Nocturne Op. 27 No. 1 in C sharp 025501
- Chopin - Nocturne Op. 27 No. 2 025504
- Chopin - Nocturne Op. 48 No. 1 025513
- Chopin - Nocturne Op. 72 No. 1 025502
- Chopin - Piano Concerto No. 1 (in E minor) - Larghetto 025509
- Chopin - Piano Concerto No. 2 in F Minor 025506
- Chopin - Polonaise Op. 40 No. 2 025514
- Chopin - Polonaise Op. 53 'Heroic' 025515
- Chopin - Prelude No. 15 in D flat major 'Raindrop' op. 28 025512
- Chopin - Rondo Op.1 025508
- Chopin - Scherzo No. 1 in B minor, Op. 20 025521
- Chopin - Scherzo No. 2 in B-flat minor, Op. 31 025520
- Chopin - Scherzo No. 3 in C-sharp minor, Op. 39 025522
- Chopin - Scherzo No. 4 in E major, Op. 54 025523
- Chopin - Sonata in B minor Op. 58 025516
- Chopin - Waltz Op. 64 No. 2 025503
- Daniélou, Alain – The Way to the Labyrinth – Is our destiny foreseen 021182
- Daniélou, Alain – The Way to the Labyrinth – Our destiny justifies the unique gifts we have been blessed with 021183
- Daniélou, Alain – The Way to the Labyrinth – Time is an illusion 021181
- Daumal, René - Mount Analogue 006655
- Davidson, Lucretia Maria - A Dream 026119
- Davidson, Lucretia Maria - An Address To My Muse 026112
- Davidson, Lucretia Maria - Death 026113
- Davidson, Lucretia Maria - Love, Joy, And Pleasure 026114
- Davidson, Lucretia Maria - On Solitude 026115
- Davidson, Lucretia Maria - Prophecy 026116
- Davidson, Lucretia Maria - The Fear Of Madness 026117
- Herbert, George - Heaven 022780
- Herbert, George - Judgement 022781
- Herbert, George - Love [1] 022784
- Herbert, George - Love [2] 022787
- Herbert, George - Peace 022782
- Herbert, George - The Elixir 022783
- Herbert, George - The Flower 022790
- Iyengar, Srinivasa Ramanujan 000467
- Jeans, Sir James - The Mysterious Universe - Conservation of matter, spirit and energy 004061
- Jeans, Sir James - The Mysterious Universe - Cosmic radiation 002978
- Jeans, Sir James - The Mysterious Universe - Energy 002969
- Jeans, Sir James - The Mysterious Universe - Matter and energy 002968
- Jeans, Sir James - The Mysterious Universe - Reality 002963
- Jeans, Sir James - The Mysterious Universe - Spirit 002971
- Jeans, Sir James - The Mysterious Universe - Spirit and the expanding universe 002965
- Jeans, Sir James - The Mysterious Universe - The Bell Rope 002964
- Jeans, Sir James - The Mysterious Universe - The carbon atom 002962
- Jeans, Sir James - The Mysterious Universe - The Creator 002976
- Jeans, Sir James - The Mysterious Universe - The Loom 004436
- Jeans, Sir James - The Mysterious Universe - The stage of life, why are we here? 002977
- Jeans, Sir James - The Mysterious Universe - Threads and the loom 002979
- Jefferies, Richard - The Story of my Heart - Begin wholly afresh 004464
- Jefferies, Richard - The Story of my Heart - Prayer 015439
- Jefferies, Richard - The Story of my Heart - The ocean 001192
- Keats, John - Lamia 011827
- Keats, John - The Tapestry of Life 002337
- Laubscher, B J F – Mrs. Greyling’s Near Death Experience 023307
- Lawrence, D H - from The Ship of Death 001099
- Lawrence, D H - Promises 1929 013234
- Lawrence, D H - The Bride 001100
- Modigliani, Amedeo Clemente - Portrait of Madame Kisling 000020
- Modigliani, Amedeo Clemente - Beatrice Hastings 007748
- Modigliani, Amedeo Clemente - Female nude 007749
- Modigliani, Amedeo Clemente - Le grand nu 007752
- Modigliani, Amedeo Clemente - Marie daughter of the people 007757
- Modigliani, Amedeo Clemente - Nude on sofa 007750
- Modigliani, Amedeo Clemente - Oscar Miestchaninoff 007753
- Modigliani, Amedeo Clemente - Reclining nude 007754
- Modigliani, Amedeo Clemente - Reclining nude 007751
- Modigliani, Amedeo Clemente - Recumbent nude 007756
- Modigliani, Amedeo Clemente - Standing nude 007755
- Modigliani, Amedeo Clemente - Standing nude with garden background 007747
- Novalis - Hymns to the Night 2 012615
- Novalis - Hymns to the Night 4 012617
- Novalis - Hymns to the Night 5 012618
- Paganini - Caprice No. 24 003632
- Paganini - Caprices 01, 05 and 24 for solo violin 003633
- Paganini - Caprices 4 & 13 012076
- Paganini - Moto perpetuo 003646
- Paganini - Violin Concerto No 2 003634
- Riemann, Bernhard - On Inspiration and inner speech 014983
- Riemann, Bernhard - On Riemann geometry 000021
- Ritsos, Yiannis - 1950 Letter to Joliot-Curie 029400
- Ritsos, Yiannis – Selected Poems - About Colours 029410
- Ritsos, Yiannis – Selected Poems - Almost a Conjurer 029403
- Ritsos, Yiannis – Selected Poems - Another Time 029405
- Ritsos, Yiannis – Selected Poems - Emergence 029406
- Ritsos, Yiannis – Selected Poems - Evening 029409
- Ritsos, Yiannis – Selected Poems - In Foreign Parts 029407
- Ritsos, Yiannis – Selected Poems - One Night 029402
- Ritsos, Yiannis – Selected Poems - Piraeus Detainees' Transport Section 029418
- Ritsos, Yiannis – Selected Poems - Search 029416
- Ritsos, Yiannis – Selected Poems - Submission 029408
- Ritsos, Yiannis – Selected Poems - Unconfirmed 029404
- Schiller - Die Bürgschaft (The Hostage) 015160
- Schiller - Nänie 015159
- Schiller - Ode to joy 005175
- Thoreau, Henry D - Misc quote - Be not simply good 001849
- Thoreau, Henry D - Walden - An ocean of subtle Intelligences 001848
- Thoreau, Henry D - Walden - Explore thyself 001845
- Thoreau, Henry D - Walden - Perhaps he hears a different drummer 001850
- Thoreau, Henry D - Walden - Simplification as a key to life 001844
- Thoreau, Henry D - Walden - The landscape of soul 001851
- Thoreau, Henry D - Walden - The Laws of Nature 001846
- Thoreau, Henry D - Walden - The reptile in us 001843
- Thoreau, Henry D - Walden - Time is but the stream I go a-fishing in 001852
- Thoreau, Henry D - Walden - What is man but a mass of thawing clay 004062
- Thoreau, Henry D - Walden - Where is heaven? 001847
Out of time
- Bronte, Emily - Yes, as I mused, the naked room The flickering firelight died away 002831
- Laubscher, B J F – Mrs. Greyling’s Near Death Experience 023307
- Lawrence, D H - The Rainbow 021638
- Madam Home - D D Home his life his mission - A Near death from tuberculosis 024599
Enlightenment
- Bronte, Emily - The Philosopher - I saw a spirit, standing 002830
- Herbert, George - from The Collar 022786
- Laubscher, B J F – Mrs. Greyling’s Near Death Experience 023307
- Lawrence, D H - The Rainbow 021638
- Novalis - Hymns to the Night 1 012614
- Novalis - Hymns to the Night 3 012616
In time
- Bozzano, Professor Ernesto - Psychic phenomena at the moment of death – 17 027257
- Bronte, Emily - Last Lines - With wide embracing love 002829
- Bronte, Emily - The Visionary 002828
- Davidson, Lucretia Maria - A Dream 026119
- Davidson, Lucretia Maria - Prophecy 026116
- Durville, Hector- Psychic Actions at a distance – 02 The remarkable remote healing of Mrs. Marie Durieu, diagnosed with heart failure and tuberculosis 028057
- Dying and TB 000590
- Farrelly, Frances - Diagnosing TB in the ear 004213
- Iyengar, Srinivasa Ramanujan 000467
- Jefferies, Richard - The Story of my Heart - The abyss 000633
- Keats, John - The Tapestry of Life 002337
- Madam Home - D D Home his life his mission - A Near death from tuberculosis 024599
- Madam Home - D D Home his life his mission – The death of D D Home 024678
- Mrs Shagren sees Mr. Hendrickson in her bedroom, Mr. Hendrickson sees Mrs Shagren in a dream 028017
- Snell, Joy – Ministry of Angels – She died of consumption and without sufferings 027297
- Snell, Joy – Ministry of Angels – The death of an old soldier who was in the last stages of tuberculosis 028051
- Susan and Jane and Ellen and Edward too 002550
- TB patient 000019
- The unrequited love of Monsieur D and Mademoiselle B 016683
- Thoreau, Henry D - Walden - Time is but the stream I go a-fishing in 001852
Prophecy
- Chopin - Prelude No. 15 in D flat major 'Raindrop' op. 28 025512
- Davidson, Lucretia Maria - Prophecy 026116
- Madam Home - D D Home his life his mission – The death of D D Home 024678
Dying
- Bozzano, Professor Ernesto - Psychic phenomena at the moment of death – 17 027257
- Charles Dyer 002539
- Dr. Paul Edwards describes the death of the lady with consumption 023491
- Dying and TB 000590
- Jim 002541
- Louis XVII of France hears celestial music as he dies 027857
- Madam Home - D D Home his life his mission – The death of D D Home 024678
- Mr Williams and Mrs Hooper 002535
- Sir William Barrett - Native American Indians - Happy hunting grounds 002547
- Sissy and Newton 002542
- Snell, Joy – Ministry of Angels – She died of consumption and without sufferings 027297
- Snell, Joy – Ministry of Angels – The death of an old soldier who was in the last stages of tuberculosis 028051
- Susan and Jane and Ellen and Edward too 002550
- TB patient 000019
- The unrequited love of Monsieur D and Mademoiselle B 016683
Environmental Influence
Other observations
- A family history of serious complications due to BCG vaccination 016554
- BCG vaccination in India and tuberculosis in children: newer facets. 016553
- Molecular confirmation of Bacillus Calmette Guerin vaccine related adverse events among Saudi Arabian children 016556
- Vaccine-associated paralytic poliomyelitis and BCG-osis in an immigrant child 016555