The Signs, Symptoms and Treatment of Tuberculosis

Tuberculosis: Consumption from Antiquity to Today

Coughing, hemoptysis, fever, pain in the chest, fatigue, loss of appetite, and weight loss (“Learn…): all symptoms of a disease that has ravaged humanity since ancient times – tuberculosis. Often referred to as MTB or simply TB (abbreviation for tubercle bacillus), tuberculosis is an oftentimes fatal infectious disease caused by assorted strains of mycobacteria, the most common of which being Mycobacterium tuberculosis (note the direct usage of the disease’s layman name) (Kumar 516-522). This genus of bacterium is aerobic and largely nonmotile, meaning they prosper in air but are largely nonmobile, save for Mycobacterium marinum, which appears to be motile within macrophages (Ryan). This point provides insight into how tuberculosis is spread: through the air. The bacteria involved in the tuberculosis infection is released when any gas or fluid comes from the lungs of an infected individual. As such, tuberculosis is somewhat difficult to catch if not constantly exposed to it. In fact, the Center for Disease control — henceforth referred to as the “CDC” — claims that tuberculosis is not spread by “shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, or kissing” (“Learn…). Though dubious as these claims may seem, the organization “The Truth About TB” reaffirms this stance, stating in their “Questions & Answers” column that one must have “close contact” with the “lungs or throat” of an individual infected with tuberculosis to so much as gain exposure to the bacteria that causes the infection. And even in the case of exposure, the column goes on to further deliberate that around sixty percent of healthy adults’ immune systems are capable of killing the mycobaterium if they do inhale it (“My…). This phenomenon is to the credit of the fact that tuberculosis is caused by strains of bacteria and therefore not as infectious as a malady spread through viral means such as the common cold or human immunodeficiency virus (HIV).

But this information begs the question of what happens when an individual is truly infected by tuberculosis — and is non-asymptomatic, as many are. The infection begins when the mycobateria take up residence in the pulmonary alveoli, an anatomical structure found in the lung. Here, the bacteria invades and replicates in the endosomoes of bronchial macrophages. If successful — not eliminated by the macrophage’s endocytosis response — tuberculosis will begin affecting the diseased person (Kumar). The disease is primarily a pulmonary disorder, and it will, therefore, in the event of an active infection, affect mostly the lungs and throat (“Learn…). Tuberculosis has been known to cause chest pain and mild to extremely prolonged coughing fits which produce sputum (also referred to as phlegm) and, in some cases, hemoptysis — the coughing up of blood. The expulsion of blood from the lungs is most often caused by strain due to the coughing fits that are common in tuberculosis infections, but, though it is uncommon, can be the result of an inflammatory pulmonary artery aneurysm. Danish physician Fritz Waldemar Rasmussen first observed eleven cases of pulmonary aneurysms in individuals with tuberculosis in 1868, giving the event the name “Rasmussen’s aneurysm.” The aneurysm in question is an important cause for unusually massive hemoptysis in those infected with tuberculosis (Corr). As with most infections, tuberculosis brings about fever in its host; however, more unique symptoms include night sweats and what the CDC refers to as “no appetite.”

All these symptoms, of course, bring up the issue of just how the disease kills an individual it has infected. Tuberculosis is classified as a granulomatous inflammatory disease. In infections such as these, macrophages, T lymphocytes, B lymphocytes, and fibroblasts “congeal” in a way to form granulomas, surrounded by lymphocytes. This results in eventual necrosis in the lungs — to the naked eye, this necrosis appears to be likened to a soft, white cheese. This is called caseous necrosis (Grosset). The infection will also induce the formation of tubercles, small nodules that are signs of the tuberculosis infection on the lungs. The center of these tubercles feature “abnormal cell death,” which contributes heavily to the necrotic tendencies of the disease (Kumar). All this means the most common way to die of tuberculosis is pulmonary failure; however, suffocation from phlegm buildup and immune system complications are also major common causes of death in those with tuberculosis. In fact, populations with high rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have the issue of tuberculosis infections running rampant throughout their communities. In Sub-Saharan Africa, where HIV/AIDS is incredibly common, around five to ten percent of afflicted individuals will develop tuberculosis during their lifetimes with HIV/AIDS. More often than not, a successful tuberculosis infection in a person with HIV/AIDS will spell death for the individual (Corbett). If tuberculosis mycobacterium gains entry into the bloodstream through tissue that has been damaged, it gain spread and produce many areas of infection throughout the body, each appearing as small, pale tubercles in the tissues it has infected (Crowley 374). This form of tuberculosis is incredibly dangerous, but most common in persons with underdeveloped or weakened immune systems — i.e. children or HIV/AIDS patients (Corbett). Even with treatment, this form of the disease has a high fatality rate, around thirty percent (Crowley 374). As with most cases, untreated “miliary tuberculosis,” as it is called, is most often fatal, but can be so in a shorter amount of time than more run-of-the-mill “renditions” of the disease. This remains uncomforting to those that have tuberculosis in the first place, because it is not really an ideal situation.

However, those that have had tuberculosis in the past seem to have more of a raw deal than those that have it today. There are, by all means, methods to successfully treat tuberculosis — means of which that will covered further — but, the reality of the matter is that mycobacterium tuberculosis has been a rather large thorn in the collective side of humanity for some time now. Fragments of spinal columns collected from Egyptian mummies, dead since 2400 BCE, show “definite signs” of tuberculosis infection (“A History…). The term, and a personal favorite of the present author, “phthisis,” defined as “consumption,” was first used in Greek literature. Around 460 BCE, Hippocrates declared phthisis to be something of pandemic, “the most widespread disease of the times” (“A History…). He even went so far to write something slightly contentious, a warning to his doctoral colleagues that advised against seeing tuberculosis patients in the later stages of the disease for fear that their ensuing deaths might damage the reputations of the physicians in attendance.

But all was not lost when it came to tuberculosis — that is, as long as one believes that two-thousand years of inept stumbling through medical darkness on the topic of tuberculosis should be considered progress. For it was Sylvius in his Opera Medica of 1679 that first began to exact pathological and anatomical details of the disease (“A History…). He identified the consistent presence of tubercles in patients with the disease. The earliest description of the infectious nature of the disease appears in Italian medical writings of the time period. An edict in the interest of public health was issued by the Republic of Lucca in 1699 declaring that tuberculosis-infected corpses must be cleaned and the deceased accounted for properly. It read as follows: “...[H]enceforth, human health should no longer be endangered by objects remaining after the death of a consumptive. The names of the deceased should be reported to the authorities, and measures undertaken for disinfection” (“A History…).

By 1720, further attempts to more accurately understand tuberculosis were being made by Benjamin Marten, an English doctor, who, in his publication A New Theory of Consumption, conjectured that the disease could be caused by “wonderfully minute living creatures” (“A History…), i.e., bacteria. It is said that for the early eighteenth century, Dr. Marten’s publication displays a great deal of insight into the state of tuberculosis.

The first real step against tuberculosis was the “sanatorium cure” (“A History…) in which that an individual isolates him or herself away from civilization and in “fresh air,” so to speak. The first documented attempt at this “cure” was carried out in 1854 by a Hermann Brehmer, a Silesian suffering from tuberculosis. He himself traveled to the Himalayan Mountains to further study botany while trying to purge his system of the ailment. He came down from his mountain cured of the disease, and published a rather dubious doctoral dissertation under the name Tuberculosis is a Curable Disease (“A History…). It was this dissertation that led to many patients of the disease to be treated in the midst of trees and good nutrition; the development of sanatoria proved to be a powerful weapon in the battle against tuberculosis.

The years following produced many more breakthroughs in the understanding of tuberculosis. Humanity began to reveal truths about the disease’s transmission in 1865 with Jean-Antoine Villeman’s discoveries; Robert Koch in 1882 discovered a way to stain Mycobacterium tuberculosis in such a way that it was viewable by microscope; and, the sanatoria method was working to a decent effect (“A History…) But it would not until the middle of World War II that a final and momentous breakthrough would come about in the treatment of tuberculosis — chemotherapy.

For thousands of years, a bacterium threatened humanity, but it would seem that its years were numbered. The chemotherapy of infectious diseases was not a new concept for the time. Penicillins and sulfonamides had been used for several years, but Selman A. Waksman’s study of soil bacteria and fungi since 1914 would be the work that paid off in the treatment of tuberculosis (“A History…). He and his team at Rutgers University in New Jersey were able to successfully identify an effective anti-tuberculosis antibiotic in the form of actinomycin; however, this proved to be too toxic for humans or animals. Nevertheless, success would come in 1943 when streptomycin combined with Mycobacterium tuberculosis of low toxicity formed the first anti-tuberculosis antibiotic. On November 20, 1944, it was administered to a critically ill patient. His recovery was almost immediately impressive (“A History…). Bounds of scientific advancements have been made since then, and tuberculosis is now considered completely manageable, and, yes, curable.

Today’s tuberculosis is not nearly as dangerous as its past self. After receiving a positive result on a Mantoux tuberculin skin test, a series of antibiotics are prescribed and, generally speaking, the usual patient makes a full recovery. Chemotherapy today includes, as the CDC puts it, four regimens of antibiotics including isoniazid (INH), rifampin (RIF), and rifapentine (RPT). Bed rest and a proper diet are also recommended (“Treatment…).

In conclusion, it seems that with proper science and medical understanding, even something as once-threatening as tuberculosis is conquerable. Perhaps the same is true with all ailments, and the story of tuberculosis long-standing feud with humanity can give the human race some hope. Because after all, they won.