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EDITORIAL
Year : 2013  |  Volume : 1  |  Issue : 3  |  Page : 103-104

Tuberculosis: An ancient disease with a modern perspective


Department of Medical Education and Postgraduate Studies, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia

Date of Web Publication30-Oct-2013

Correspondence Address:
Imran A Siddiqui
Department of Medical Education and Postgraduate Studies, Saudi Commission for Health Specialties, PO Box 94656, Riyadh 11614
Saudi Arabia
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DOI: 10.4103/1658-600X.120837

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How to cite this article:
Siddiqui IA. Tuberculosis: An ancient disease with a modern perspective. J Health Spec 2013;1:103-4

How to cite this URL:
Siddiqui IA. Tuberculosis: An ancient disease with a modern perspective. J Health Spec [serial online] 2013 [cited 2019 Jul 20];1:103-4. Available from: http://www.thejhs.org/text.asp?2013/1/3/103/120837

Tuberculosis (TB) is an ancient disease because evidence of its presence has been found in the spines of thousands-of-years-old Egyptian mummies, as well as in the people of both ancient Greece and Imperial Rome. When the bone and soft tissue samples from 85 ancient Egyptian mummies were obtained from different tomb complexes in Upper Egypt and analyzed for the presence of ancient Mycobacterium tuberculosis (MTB) complex DNA (aDNA) and further characterized by spoligotyping (a PCR-based technique), it was confirmed that an even higher frequency of this disease was present in the ancient population. [1] This disease gained the name of the white plague because 100% of the population was infected resulting in 25% of all deaths in Europe during the 17 th and 18 th centuries. In 1882, Robert Koch confirmed the infectious character of the disease by discovering the bacteria, Mycocabacterium using a newly developed methylene blue stain. Streptomycin was the first antibiotic isolated in 1943 by Albert Scahtz in the laboratory of Selman Abraham Waksman at Rutgers University and the first widely accepted randomized curative trial was carried out in 1946-1947. [2]

With the advances of science, especially medical science, many research studies have been done on each and every aspects of the disease such as the causative organism, diagnosis, treatment, prevention and development of vaccines. In 1993, the World Health Organization (WHO) declared TB a public health emergency, and in response to which efforts to improve TB care and control intensified. In 1999, WHO developed the DOTS strategy comprising five elements including political commitment with increased and sustained financing, case detection through quality-assured bacteriology, standardised treatment with supervision and patient support, and an effective drug supply and standardised system of recording and reporting the number of cases detected and outcomes of treatment. WHO's current approach to care and control the disease is the Stop TB Strategy which was launched in 2006 with the goal of dramatically reducing the global burden of TB by 2015, and achieving universal access to high quality care for all people with TB, protection of vulnerable populations and reduction of the socioeconomic burden associated with TB. Despite these global scientific and societal efforts, TB is still posing a significant threat to human populations. According to the latest estimates by WHO, in 2011, 8.7 million people fell ill with this disease and 1.4 million died from the disease. [3] Furthermore, the bacille Calmette-Guérin (BCG) vaccine, developed in 1921, is now widely used in developing countries to immunize infants against TB, although it is only partially effective. Therefore, there is a great need to develop a booster vaccine for BCG or a new effective vaccine with 100% efficacy.

Today, global TB control is facing major challenges. Firstly, the syndemic interaction between the human immunodeficiency virus (HIV) and TB epidemics has deadly consequences, especially in Africa, where the prevalence of HIV infection is high, and co-infection with MTB has reached 79%. In 2011, about 430,000 people died of HIV-associated TB, and almost 25% of deaths among people with HIV are due to TB. In the same year, there were an estimated 1.1 million new cases of HIV-positive TB, 79% of who were living in Africa. Secondly, another critical issue is drug resistant TB including both multidrug-drug resistance (MDR) which fails to respond to standard first line drugs and extensively drug-resistance (XDR) which fails to respond to both first-line and second-line drugs. The MDR-TB is treatable using second-line drugs, but drugs in the second line are limited and their availability is not guaranteed in many places in the world. For XDR-TB there are only a few effective drugs available but accessibility to these drugs is again a problem. In any of the types of drug-resistant TB, the length of the treatment is longer than usual; the cost is higher and can produce severe adverse drug reactions in patients. In 2011, there were about 310,000 cases of MDR-TB among reported cases with pulmonary TB around the world. Almost 60% of these cases were in India, China and the Russian Federation. It is estimated that about 9% of MDR-TB cases had XDR-TB. [3]

Now, the WHO has set an important goal of eliminating TB by 2050 described as "Millennium Developmental Goal of Eliminating TB by 2050". [4] The first target in achieving this goal is to reduce the prevalence and deaths due to TB by 2015 to 50% compared with the baseline of 1990. If at the end of 2013, we are still reporting several million people falling ill due to TB, it means that there are several critical gaps present in the global TB control efforts. Although the WHO seems to be very efficient in providing support and leadership to control TB, these challenges need to be addressed by national TB programmes with focused attention and tailored approaches. The goal of eliminating TB by 2050 depends on the development of new diagnostic tools, drugs and vaccines. We hope that the WHO, researchers and governments will work in close collaboration with each other to develop new diagnostic tests for both drug-resistant and drug-susceptible TB, better and shorter treatment for all forms of TB and vaccines more effective than BCG.

 
  References Top

1.Zink AR, Sola C, Reischl U, Grabner W, Rastogi N, Wolf H, et al. Characterization of Mycobacterium tuberculosis complex DNAs from Egyptian mummies by spoligotyping. J Clin Microbiol 2003;41:359-67.  Back to cited text no. 1
    
2.Schatz A, Bugle E, Waksman SA. Exp Biol Med 1994;55:66-9.  Back to cited text no. 2
    
3.World Health Organization. Tuberculosis, Fact Sheet No. 104. 2012.  Back to cited text no. 3
    
4.World Health Organization. Global tuberculosis report 2012.  Back to cited text no. 4
    




 

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