The medical world’s attention has been drawn to a frightening development in India: at least a dozen cases of tuberculosis that cannot be treated by antibiotic drugs. Officials have said the patients have “little hope for survival.”
This is tragic news, directly affecting people whose only wrong was being born in the wrong place.
Tuberculosis is no small problem on the planet. There were almost 9 million new cases of TB last year, and that’s on top of 15 million cases of active TB. One-third of the world’s population has been exposed to TB. It remains one of the leading causes of death worldwide and is truly a massive problem that dwarfs much better known diseases for most Americans.
One reason tuberculosis is almost invisible to our country is the disease burden is very unevenly distributed. Asian and African countries have TB rates at 80 percent or higher. More prosperous countries, like the United States, have rates around 5 percent. It is not just bad luck for poor countries, but the nature of tuberculosis to love poverty. Tuberculosis is a pretty weak bug compared to strep throat, influenza or the average cold virus. By weak bug, I mean TB just isn’t very infectious. Someone with influenza coughs in an elevator and most everybody who hasn’t had a flu shot will be infected. Just a few influenza viruses are all it takes, and each cough spews out millions.
Tuberculosis is a much larger bug so it isn’t so easily suspended in the air for all to breathe. It is a really slow grower, so most of the time, when you are breathing in a few TB bacillus, your immune system kills them before they can take hold. It takes a prolonged exposure to a lot of TB to actually catch it. TB kind of wears you down, like a teenager.
The poorest countries have the best conditions for transmission because of severe housing shortage and conditions. In third world countries, multiple people will live in one room, where bad ventilation means the same air and germs are breathed over and over. TB has a real chance to spread in these conditions.
Poor countries also have high rates of malnutrition that weaken the immune system. A weak immune system is less likely to fight off TB. HIV, much more common in poor countries; complicates the picture by destroying the immune system of even well nourished people.
Surprisingly enough, modern medicine has been a very mixed blessing to the TB story in third world nations. This is not too unusual. We also thought we would save the world by passing out powdered infant formula a while back. There wasn’t enough for everyone, so it was diluted until it didn’t sustain life, and meanwhile breast milk dried up.
A similar unintended consequence occurs in TB treatment.
Insufficient amounts of TB drugs and not enough knowledge results in a lot of incomplete treatment. TB is a particularly dangerous infection to treat for a short time or with skipped doses of medication.
Because of its slow-growing tendencies, it is easy to wound, but very hard to kill. Wounded animals are dangerous and wounded germs are a million times more perilous. Genes get leaked by injured TB, and taken up by other bugs and new characteristics sometimes emerge. Drug resistance is TB’s favorite trick.
Multi-drug resistance is very useful to the TB bacillus, but also in some ways weakens the bug. So much of its metabolic machinery is used making resistance, it is actually slower growing and less infectious than run of the mill, “normal TB.” Multi-drug resistant TB is still TB. It is still not very infectious and takes a huge exposure and usually a weakened immune system to get the disease.
There is still some argument if this new TB can be spread. It seems all the cases of Totally Drug Resistant TB actually were created in that person by lousy healthcare. Kind of a survival of the fittest (TB) situation. There are no cases where it has been proven that this multi-resistant bug came from another TB carrier. That is very good news as it argues against wide spread multi-resistant infection.
So the sky is not falling and there’s no use running around in circles. You were blessed enough to be born in a country that doesn’t have the conditions to spread TB. Eat sensibly, get some sleep and exercise, and your immune system will stay in tip-top shape.