Modern Management of an Ancient Disease

What do Eleanor Roosevelt, the Bronte sisters, Franz Kafka, D. H. Lawrence, and Nelson Mandela have in common? How about Mimì, the heroine of Puccini’s opera La Bohème, Satine from Moulin Rouge, and Fantine from Les Mis? They and countless millions others reputedly suffered from tuberculosis, or TB.

EleanorRoosevelt_640x400 Typically, but not always a pulmonary illness, TB has afflicted human beings since antiquity: Some  spinal columns from Egyptian mummies from 2400 BCE are believed to have signs of tuberculosis.  Two thousand years later, TB afflicted ancient Rome, “The attacks of fever stick to her, her  cough grows upon her, she is in the highest degree emaciated and enfeebled.” So said Pliny the  Younger, a statesman of ancient Rome, describing the effects of tuberculosis.

 TB in the 21st Century

And today? TB is one of the world’s most widespread infections. Currently, over a third of the global population and an estimated 100,000 King County residents are infected with Mycobacterium tuberculosis, the bacterium that causes tuberculosis.

Most infected people have latent TB infection (LTBI), a dormant version doesn’t make the person ill, nor can it be spread to others. But anyone with LTBI has about a 10% lifetime chance of coming down with active disease.

Public Health investigates about 100 cases of active TB each year with the goal of assuring that ill people get proper treatment and are cured — and thus interrupt transmission of TB in the community. TB spreads when a person with infectious TB coughs. While it’s much harder to catch TB than the common cold, it can spread among people who spend a lot of time together – such as families, people living in shelters, or even members of a school community or work site.

Controlling TB in King County

To assure people are cured, the TB Control Program uses “direct observed therapy,” which means that TB staff watch people take medication. This is to ensure that the proper course of antibiotics is taken – for the person’s health, to prevent spread of TB from patients who do not adhere to the treatment, as well as minimize the risk of developing antibiotic resistant strains.

When a person is diagnosed with infectious TB, staff identify each person who may have had close contact with that person. Since it takes as many as 8 weeks for an infected person to test positive, evaluations often are conducted twice; the first immediately after notification, and the second at 8 weeks after the last exposure.

TB staff screen each of the person’s close contacts using a TB skin test or a blood test and treat if appropriate. To conduct a TB skin test, TB antigens are injected just under the top layer of skin. If the person has been exposed to TB, a red bump will emerge within a couple of days.

With our TB Control Program, we’re improving the community’s health and saving money by controlling the spread of TB, preventing outbreaks, and preventing the development of multi-drug resistant TB which can be very difficult and expensive to treat. Tuesday, March 24th is World TB Day. Learn more about TB at http://www.kingcounty.gov/health/tb or read our World TB Day press release.