Tuberculosis is spread through the air by people who are sick with it and who cough and expel the tuberculosis organism into the air, where it floats around and gets inhaled by someone else. The organism can remain in the air for several hours.
Now, most people who become infected with tuberculosis don't get sick with it because, over the centuries, our bodies have developed immune defenses to control the infection. But people who have a weakened immune system or who are taking certain medicines are more susceptible. For example, people who have HIV or AIDS, who have cancer, who are taking drugs like steroids that suppress the immune system or who have diabetes are more susceptible.
How is tuberculosis diagnosed?
TB usually is suspected when symptoms are present and X-rays show the pneumonia that the infection causes, and then is confirmed by cultures of the sputum or other tissues that might be involved. The most important step is to suspect TB and get the culture.
Once diagnosed, what is the treatment?
Tuberculosis is typically treated with antibiotics that are given for six months. We initially use four antibiotics that rapidly bring the infection under control and then continue with just two antibiotics that eliminate the infection.
It is important to continue [taking the medicines] for all six months, or the patient can run the risk of relapse.
Some strains of TB are drug-resistant, and then we have to rely on antibiotics that are less effective and more toxic, and treat the disease for 18 to 24 months. In the United States, more than 95 percent of TB can be treated with the standard six-month antibiotics; resistant strains are not very prevalent here.
What if TB goes untreated?
If untreated, a majority of patients will eventually die. About one-fourth of patients may spontaneously clear the infection after a period of weeks or months. ... The remainder will be chronically ill with TB, and that may go on for years.
What is new in research into TB?
The current treatment of TB requires six months of antibiotics, and that is a very long time for people to take medicines, especially when they feel better. So, we have been working on more potent treatments that will shorten the length of time treatment takes.
My colleagues here at Hopkins have conducted experiments in mice with TB that show that the new drugs could shorten the time required to cure TB to three or four months. Now we are doing human clinical trials to see whether these new treatments will be successful.
Why do the protagonists of operas frequently have TB?
It is a disease that, particularly in the 1800s, had some romanticism attached to it. It was thought to be the disease of suffering lovers and starving artists and made its way into a number of operas and other works. But I can guarantee you that if Mimi in La Boheme had TB, she wouldn't have been able to sing any of those arias.
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