Victims were pale and frail, blood stained their mouths, and after their death, their family members wasted away too, as if they were being fed upon. In the 18th and 19th centuries, if someone had those symptoms they may have been a vampire… or they may have just been infected with Mycobacterium tuberculosis (MTB), the bacterium that causes Tuberculosis (TB). A person with an active case of the lung disease would be pale and emaciated, coughing so hard that blood would come from their mouths. The cramped living spaces of the time and the transmission of MTB through the air allowed the disease to spread easily from victim to family members. The long course of infection meant that family members wouldn’t show symptoms until after the first victim had passed—allowing people to affect others beyond the grave just as the undead vampire does. Although infection with MTB won’t leave a bite mark on its victims’ necks, it has left its mark throughout history.
The Ancient History of Tuberculosis
Tuberculosis and humanity have a long shared history. Modern strains of MTB were present 4,000 years ago in Egyptian mummies, and the ancestor of these modern lineages could have been associated with the earliest migration of modern humans out of Africa 67,000 years ago. TB accompanied humans on other migrations throughout history. Human movements through the Silk Road between 114 BCE and 1450 CE spread one strain of MTB from East Asia to other parts of the world. Another strain was just one of many diseases Europeans brought to the Americas in the 15th century. Today, MTB strains found in different parts of the world are different in the way they react to antibiotics, cause disease (some strains are more severe than others), and spread from person to person.
The Cultural Response to TB
After Robert Koch discovered in 1883 that TB was caused by a bacterium, the public’s fears shifted from supernatural forces to infectious agents. TB was incurable before the 1943 discovery of the antibiotic streptomycin, which lead to public health policies that had lasting impacts on society. The fear of getting Tuberculosis from ice cream served in reusable glasses called “penny licks” led to the invention of waffle cones as edible, sanitary serving vessels. Sufferers of TB migrated out West to stay at many long-term medical facilities called sanatoriums built in the dry air of New Mexico and Colorado.. Efforts to control the spread of the disease also lead to the prevalence of shorter skirt hemlines, shaving, reclining chairs, and outdoor play grounds. The fact that the disease affected 1 in 4 individuals is reflected in the popular culture of the time—characters in everything from the opera La bohème to the novel Les Miserables died from the disease.
An International Health Crisis
Because of the availability of antibiotics and modern public health measures, for most of us in the United States, TB is only a disease that plagues characters in Victor Hugo novels. It is not a disease we worry about contracting today—especially when fears of Zika and Ebola Viruses dominate current news coverage. However, worldwide, TB has surpassed HIV/AIDS as the leading cause of death from an infectious agent, with 9.6 million people newly infected in 2014 alone.
What makes MTB such a problem in these countries? Poor nutrition, overcrowding, and persistent poverty allow the disease to spread and remain untreated. Those factors, however, are just the tip of the iceberg. Long courses (approximately 6 months) of antibiotics must be strictly followed to treat the disease. Poverty and lack of access to healthcare in these countries means that many people are unable to complete full courses of antibiotics. Interruptions in courses of antibiotics allow time for bacteria to mutate and become resistant to the antibiotic. This issue has led strains of MTB to evolve to the point where most or all current antibiotics are unable to treat it. For more about the problem of antibiotic resistance see this article from the Athens Science Observer. Prevention of TB is nearly impossible since the only vaccine available is ineffective against the most common strain. Co-infection with HIV, which lowers a person’s ability to fight off infections, has also exacerbated the epidemic as it allows MTB to overtake individuals who otherwise would never have succumbed to the illness.
What can be done to stop TB? Researchers are attempting to improve the current vaccine by using specific parts of the bacteria, called antigens, instead of the whole bacteria, to create a subunit vaccine. These small molecules, if chosen well, can induce a strong immune response. Faster and more reliable detection methods are being developed that diagnose the disease earlier and detect antibiotic resistance. Finding ways to combat antibiotic resistance, such as targeting specific bacterial populations within a host, will allow for more effective treatment.
TB has shaped the history of humanity, but we can shape the future of TB. STOP TB is a partnership among 1500 organizations in over 100 countries that has a Global Plan to eliminate TB by 2035. By Investing in innovative research as well as addressing social and economic issues in the countries with the highest burden of TB, we may be finally able to rid the world of a disease that’s been plaguing humanity for centuries.