One fourth of the world’s population is infected with Tuberculosis and over one million people worldwide died from it last year alone.1
Tuberculosis, also known as phthisis, tabes, or consumption, is caused by the bacteria Mycobacterium tuberculosis.2 It is spread when droplets are sneezed or exhaled and primarily affects the lungs while also targeting the kidneys, bones, lymph nodes, and even the brain.2 Tuberculosis is an ancient disease that has been plaguing the earth for millenia. It was documented in Egypt over 5000 years ago, with the 2600 year old mummy of Irtyersenu showing evidence of a tuberculosis caused death.3
Over the course of history, tuberculosis has hit in epidemic waves. The present wave begun in the 16th century in England where it was the cause for about twenty percent of deaths. The disease spread throughout Europe and reach North America by 1900.4 There was a rise in tuberculosis during this time that was most likely due to the shift from rural to urban living. With this shift, came the creation of ‘town dairies’– buildings in the middle of the town that housed the dairy cows once kept in pastures. Many of these cows were tubercular, and putting them in the middle of towns provided the means for zoonotic transmission of the disease.4 Furthermore, with industrialization and the shift to towns and cities came issuses of overcrowding, poor sanitation and public health, poverty, and immigration that increased the virulence of the pathogen.
In England, buildings at one point were taxed on the number of windows they had. The fewer windows, the less a building was taxed.4 This, no doubt, increased transmission of an susceptibility to tuberculosis as tenets of a building, all living in close proximity, had almost non-existent means of ventilation. Seeing as tuberculosis is transmitted through respiration, such conditions are perfect for the spread from one person to another.
Compounding this issue were the matters of overcrowding and immigration. Take the United States, for example. Big cities like New York and Boston were teeming with immigrants looking for a fresh start and a better life. Many arrived with very little to their names. Some, like many Irish escaping the potato blight, came to find work in order to pay off debts. Such individuals lived in poverty in the densely packed cities. They often lived in tenement houses that had few windows and poor ventilaiton and sanitaiton. In short, the lived in squalid conditions that were breeding grounds for the spread of disease. As a result of impoverished living, affected individuals had weakened immune systems, making them more susceptible to contracting tuberculosis.
Individuals suffering from medical conditions such as HIV are especially at risk for tuberculosis as they have particularily weakened immune systems. The Centers for Disease Control and Prevention have identified tuberculosis as the leading cause of death among the HIV infected population as well as finging that HIV infection is the biggest risk factor for the progression of latent tuberculosis to tuberculosis.5
Poverty still, to this day, negatively plays a role in susceptibility to tuberculosis. Since tuberculosis can be multi-drug resistant (MDR) or even extensively drug resistant (XDR), infected patients must undergo treatment with a plethora of various drugs to combat the disease. The issue, however, is that in resource poor countries, such treatments may come at too high of a cost. Clinics that offer treatment may be few and far between and the costs associated with taking time off of work and traveling for treatments are often too high for impoverished individuals.6 As a result, they may not seek the help they desparately need. Other times, the treatments themselves cost too much to afford. In a first world country like the United States, the cost of treatment alone for regular tuberculosis is roughly $17,000 over the course of 6-9 months. This price jumps drastically when dealing with XDR at $482,000 for 32 month treatment.7 There is also the issue of compliance. There are stigmas around individuals with tuberculosis in resource poor countries and the infected will do whatever they can to keep their affliction a secret to avoid such stigmas.6 For individuals that begin their treatments, if they do not adhere to the regime and take the full course of drugs, the bacteria will devlop a resistance to the drugs that otherwise could rid them of the disease.8
Ultimately, however, this is not just a disease of poverty. It can and had infected all manner of humans- rich and poor alike. Circumstances of life such as poverty and poor health increase the likelihood of contracting tuberculosis and play a role in its adaptation to resist treaments. It is however, caused by just a bacterium– one that we know could be treated and with the proper regime and plan could potentially be wiped out. More money and resources should be invested worldwide into treatment, diagnostic, and research efforts for tuberculosis. There should be a greater effort by developed countries to make treatment more readily available and affordable in poverty-striken regions of the world. This is a disease of not just one section of the world and one population, but one that has taken its toll across all boards. So we, as a human family, regardless of nationality, political beliefs and affiliations, race, ethnicity, religious background, or any other dividing factor need to band together to combat this plague.