mycobacterium tuberculosis

            While there are some that would write off Mycobacterium Tuberculosis (hereafter referred to simply as TB) as a concern of the past, there is mounting evidence that is presents a very real threat to present day lives. It is an issue that still affects people all over the world, and in developed nations very similar to the United States, people are dying because TB goes undiagnosed for far too long. It is the responsibility of the CDC to not only ensure that an epidemic of TB doesn’t affect America on an unprecedented scale, but to make sure that everyone—from scientists to civilians—are aware of what is at stake.  As such, awareness of TB needs to be made more widespread, and additional funding needs to be allocated for its research in order to preserve a safer future for all citizens.

            Contrary to the image of TB as mostly harmless, “tuberculosis remains one of the most prevalent infection diseases in the word” (Surikova et al., 963). One of the chief effects of this prevalence is its deadly impact on wildlife: “the control of bovine tuberculosis…has preoccupied agricultural policy in the UK for more than three decades,” and the subsequent cost to taxpayers is “74 million pounds per year” (Mathews et al., 357). While an observer might ask how this affects American policy, the answer is simple: with the prevalence of international travel, the TB problems experienced by other nations—“worldwide, the incidence of TB in humans is rising” (Mathews et al., 357)—rapidly become American problems. Put quite bluntly: we may very well be importing a disease, all while telling ourselves that the threat of this disease is negligible.

            The idea that TB is no longer a viable health threat is mostly connected to the prevalence of vaccinations keeping Americans safe. However, the research of Hans-Willi Mittrucker and his fellow researchers indicated that there is a “need for new biomarkers for evaluation of tuberculosis vaccine efficacies” (12434) due to the relatively unpredictable nature of the correlation between vaccine-induced T-cell responses and protection from TB. In short: while there is no need to immediately panic, the very real fact that protection from TB is not fully understood points to the need for more research. Such research might have saved lives in Italy: according to G.B. Migliori and his fellow researchers, “the bacteriological confirmation at diagnosis and, particularly, at the end of treatment, is sub-optimal” (719). They concluded that awareness among physicians needed to be raised so that these cases could be adequately treated. Again, an outside observer might question how this Italian situation affects the American situation regarding TB, and the answer is quite simple: the Italians of the time were very much in the same spot that American doctors are in now. Once they have grown complacent regarding the health threat of TB, it is that much more difficult to diagnose it, particularly once it has nearly run its course. Doctors scramble to make a diagnosis of something they consider a contemporary threat, unable to notice the seemingly archaic TB still claiming lives.

            How bad is the threat to America, exactly? The answer is unknown, but as of four years ago, “the proportion of extrapulmonary TB cases” had increased, in seeming defiance of the overall decline in TB as a whole (715). Additionally, “extrapulmonary TB continues to be a persistent problem in the inner city” (715). This is unfortunate, because not only does it buck the stereotype of TB being a threat only in the undeveloped and rural areas of America, it means that major population centers stand a higher chance of being infected by TB.

            Now that the threat is established, what treatment options are available? According to Jean-Emmanuel Huggonet and his fellow researchers, “meropenum and clavulante” are two new FDA-approved drugs that may combat TB (1215). On the surface, this would seem to be nothing but positive news: after all, it means that citizens are that much closer to being safe from TB. However, the development of these drugs begs the question: what better ways of combating TB could be created if the resources were made available? According to Lowell Young, “Still, totally new drug treatments or even those that are modest improvements within well-known classes…will not be easily introduced into resource-limited clinical settings” (4577). The limited resources available for TB research affects not only the research itself, but the public awareness of the issue. With these factors being rather symbiotic, reduced public awareness means reduced public and private funding, and it will then not be overly long before America faces an epidemic that struck while all of the movers and shakers of the country were looking elsewhere.

            The threat of TB is not one that will simply go away. As I have illustrated, it is a pervasive threat to the lives and safety of citizens of countries all over the world, and the United States is no different. Even the fact that outbreaks of cases has gone down in recent years can be a double-edged sword, as complacency regarding the threat of an outbreak greatly increases the chance that doctors will be unprepared for such an outbreak. However, with increased funding to research this issue, two goals can be accomplished at once: more about TB will be discovered and more treatments will be formulated. In the meantime, keeping research current will help keep doctors aware of this issue, as opposed to tucking incidents of TB away as simple footnotes in the history of their brave new world. Finally, it would be advisable for a campaign of public awareness regarding TB to be enacted: once citizens are aware of the risks they face, they can help sidestep the need for impressive diagnoses and treatments through one simply, one hundred percent effective method: prevention.

Works Cited

Fiona Mathews, David W. Macdonald, G. Michael Taylor, Merryl Gelling, Rachel A. Norman,

Paul E. Honess, Rebecca Foster, Charlotte M. Gower, Susan Varley, Audrey Harris, Simonette Palmer, Glyn Hewinson, Joanne P. Webster.  “Bovine Tuberculosis (Mycobacterium bovis) in British Farmland Wildlife: The Importance to Agriculture.”  Proceedings: Biological Sciences, 273:1584 (2006): 357-365

Hugonnet, Jean-Emmanuel., Lee W. Tremblay, Helena I. Boshoff, Clifton E. Barry, 3rd, John S.

Blanchard. “Meropenem-Clavulanate Is Effective Against Extensively Drug resistant Mycobacterium Tuberculosis.” Science, 323:5918 (2009), 1215 – 1218

Kourbatova, Ekaterina, Michael K. Leonard Jr., Javier Romero, Colleen Kraft, Carlos del Rio.

“Risk Factors for Mortality among Patients with Extrapulmonary Tuberculosis at an Academic Inner-City.” European Journal of Epidemiology, 21:9 (2006), 715-721

Migliori, G. B.,  M. Ambrosetti, G. Besozzi, B. Farris, S. Nutini, L. Saini, M. Confalonieri, M.

Bugia. “Microbiological Confirmation of Tuberculosis Cases at Diagnosis and at the End of Treatment in Italy.” European Journal of Epidemiology, 16:8 (2000),  719-724

Mittrücker, Hans-Willi, Ulrich Steinhoff, Anne Köhler, Marion Krause, Doris Lazar, Peggy

Mex, Delia Miekley, Stefan H. E. Kaufmann. “Poor Correlation between BCG Vaccination-Induced T Cell Responses and Protection against Tuberculosis.” Proceedings of the National Academy of Sciences of the United States of America, 104:30 (2007): 12434-12439

Surikova, O.V., D. S. Voitech, G. Kuzmicheva, S. I. Tatkov, I. V. Mokrousov, O. V. Narvskaya,

M. A. Rot, D. van Soolingen, M. L. Filipenko. “Efficient Differentiation of Mycobacterium tuberculosis Strains of the W-Beijing Family from Russia Using Highly Polymorphic VNTR Loci Efficient Differentiation of Mycobacterium tuberculosis Strains of the W-Beijing Family from Russia Using Highly Polymorphic VNTR Loci.” European Journal of Epidemiology, 20:11 (2005): 963-974

Young, Lowell. “Reconsidering Some Approved Antimicrobial Agents for Tuberculosis.”

Antimicrobial Agents and Chemotherapy,  53:11 (2009), 4577-4579

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