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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]
yes, this is snow

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

Grief, loneliness, unrequited love, rejection, depression
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? 

Keats sied at the age of 25 from TB,
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 infection

Related observations