Tuberculosis
30653
226032802
2008-07-16T15:04:02Z
TimVickers
1635280
Reverted edits by [[Special:Contributions/122.52.171.10|122.52.171.10]] ([[User talk:122.52.171.10|talk]]) to last version by Ajh16
{{Infobox_Disease
| Name = Tuberculosis
| Image = Tuberculosis-x-ray-1.jpg
| Caption = Chest [[X-ray]] of a patient suffering from tuberculosis
| DiseasesDB = 8515
| ICD10 = {{ICD10|A|15||a|15}}-{{ICD10|A|19||a|15}}
| ICD9 = {{ICD9|010}}-{{ICD9|018}}
| ICDO =
| OMIM = 607948
| MedlinePlus = 000077
| MedlinePlus_mult = {{MedlinePlus2|000624}}
| eMedicineSubj = med
| eMedicineTopic = 2324
| eMedicine_mult = {{eMedicine2|emerg|618}} {{eMedicine2|radio|411}}
| MeshName = Tuberculosis
| MeshNumber = C01.252.410.040.552.846
}}
'''Tuberculosis''' (abbreviated as '''TB''' for ''tubercle bacillus'' or '''T'''u'''b'''erculosis<!-- Do not link to the genus [[Bacillus]] -->) is a common and deadly [[infectious disease]] caused by [[mycobacterium|mycobacteria]], mainly ''[[Mycobacterium tuberculosis]]''. Tuberculosis most commonly attacks the lungs (as [[Lung|pulmonary]] TB) but can also affect the [[central nervous system]], the [[lymphatic system]], the [[circulatory system]], the [[genitourinary system]], [[bone]]s, [[joint]]s and even the [[skin]]. Other mycobacteria such as ''[[Mycobacterium bovis]]'', ''[[Mycobacterium africanum]]'', ''[[Mycobacterium canetti]]'', and ''[[Mycobacterium microti]]'' can also cause tuberculosis, but these species do not usually infect healthy adults.<ref name="Harrison">{{cite book | author = Raviglione MC, O'Brien RJ | chapter = Tuberculosis | title = Harrison's Principles of Internal Medicine | editor = Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Isselbacher KJ, eds. | edition = 16th ed. | publisher = McGraw-Hill Professional | year = 2004 | pages = 953–66 | doi =10.1036/0071402357 | isbn = 0071402357 }}</ref>
One third of the [[World population|world's current population]] has been infected by TB, and new infections occur at a rate of one per second.<ref name="WHO2004data">[[World Health Organization]] (WHO). [http://www.who.int/mediacentre/factsheets/fs104/en/index.html Tuberculosis Fact sheet N°104 - Global and regional incidence.] March 2006, Retrieved on [[6 October]] [[2006]].</ref> Not everyone infected develops the full-blown disease; [[asymptomatic]], latent infection is most common. However, one in ten latent infections will progress to active disease, which, if left untreated, kills more than half of its victims.
In 2004, mortality and morbidity statistics included 14.6 million chronic active cases, 8.9 million new cases, and 1.6 million deaths, mostly in [[Developing nation|developing countries]].<ref name="WHO2004data"/> In addition, a rising number of people in the [[Developed country|developed world]] are contracting tuberculosis because their [[immune system]]s are compromised by [[immunosuppressive drug]]s, [[substance abuse]], or [[HIV]]/[[AIDS]].
The rise in HIV infections and the neglect of TB control programs have enabled a resurgence of tuberculosis.<ref>{{cite journal |author=Iademarco MF, Castro KG |title=Epidemiology of tuberculosis |journal=Seminars in respiratory infections |volume=18 |issue=4 |pages=225–40 |year=2003 |pmid=14679472 |doi=10.1017/S0950268801005532}}</ref> The emergence of [[Antibiotic resistance|drug-resistant]] strains has also contributed to this new epidemic with, from 2000 to 2004, 20% of TB cases being resistant to standard treatments and 2% resistant to [[Tuberculosis treatment#Treatment of MDR-TB|second-line drugs]].<ref name="MMWR2006">{{cite journal |title=Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs—worldwide, 2000–2004 |journal=MMWR Morb Mortal Wkly Rep |volume=55 |issue=11 |pages=301–5 |year=2006 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm | pmid = 16557213}}</ref> TB incidence varies widely, even in neighboring countries, apparently because of differences in health care systems.<ref name=Sobero_2006>{{cite journal |author=Sobero R, Peabody J |title=Tuberculosis control in Bolivia, Chile, Colombia and Peru: why does incidence vary so much between neighbors? |journal=Int J Tuberc Lung Dis |volume=10 |issue=11 |pages=1292–5 |year=2006 | pmid = 17131791}}</ref> The [[World Health Organization]] declared TB a global health emergency in 1993, and the Stop TB Partnership developed a [[Global Plan to Stop Tuberculosis]] that aims to save 14 million lives between 2006 and 2015.<ref>[[World Health Organization]] (WHO). [http://www.stoptb.org/globalplan/ Stop TB Partnership.] Retrieved on [[3 October]] [[2006]].</ref>
==Other names==
In the past, tuberculosis has been called '''consumption''', because it seemed to consume people from within, with a [[hemoptysis|bloody cough]], fever, [[pallor]], and long relentless wasting. Other names included '''phthisis''' (Greek for consumption) and '''phthisis pulmonalis'''; '''[[scrofula]]''' (in adults), affecting the lymphatic system and resulting in swollen neck glands; '''tabes mesenterica''', TB of the abdomen and '''[[lupus vulgaris]]''', TB of the skin; '''wasting disease'''; '''white plague''', because sufferers appear markedly pale; '''king's evil''', because it was believed that a king's touch would heal scrofula; and '''[[Pott's disease]]''', or '''gibbus''' of the spine and joints.<ref name=Britannica1911>[http://www.1911encyclopedia.org/Tuberculosis Tuberculosis] ''Encyclopedia Britannica,'' 11th ed.</ref><ref>[http://www.antiquusmorbus.com/English/English.htm Rudy's List of Archaic Medical Terms] English Glossary of Archaic Medical Terms, Diseases and Causes of Death. Accessed [[9 October]] [[2006]]</ref> ''[[Miliary tuberculosis]]''—now commonly known as '''disseminated TB'''—occurs when the infection invades the circulatory system resulting in lesions which have the appearance of [[millet]] seeds on X-ray.<ref name=Britannica1911/><ref>[http://www.nlm.nih.gov/medlineplus/ency/article/000624.htm Disseminated tuberculosis] NIH Medical Encyclopedia. Accessed [[9 October]] [[2006]]</ref>
==Symptoms==
{{Further|[[Tuberculosis classification]]}}
When the disease becomes active, 75% of the cases are [[pulmonary]] TB. Symptoms include chest pain, [[hemoptysis|coughing up blood]], and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, [[night sweats]], [[appetite loss]], weight loss, pallor, and often a tendency to fatigue very easily.<ref name="WHO2004data"/>
In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB more common in [[immunosuppressed]] persons and young children. Extrapulmonary infection sites include the [[pleura]], the [[central nervous system]] in [[meningitis]], the [[lymphatic system]] in [[scrofula]] of the neck, the [[genitourinary system]] in urogenital tuberculosis, and bones and joints in [[Pott's disease]] of the spine. An especially serious form is disseminated TB, more commonly known as [[miliary tuberculosis]]. Although extrapulmonary TB is not contagious, it may co-exist with pulmonary TB, which ''is'' contagious.<ref name=CDCcourse>[[Centers for Disease Control and Prevention]] (CDC), Division of Tuberculosis Elimination. [http://www.cdc.gov/nchstp/tb/pubs/corecurr/default.htm Core Curriculum on Tuberculosis: What the Clinician Should Know.] 4th edition (2000). Updated August 2003.</ref>
==Bacterial species==
{{main|Mycobacterium tuberculosis}}
[[Image:Mycobacterium tuberculosis.jpg|300px|right|thumb|Scanning electron micrograph of ''[[Mycobacterium tuberculosis]]'']]
The primary cause of TB, ''[[Mycobacterium tuberculosis]]'', is an [[aerobic organism|aerobic]] [[bacterium]] that [[cell division|divides]] every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour.<ref name=Cox_2004>{{cite journal |author=Cox R |title=Quantitative relationships for specific growth rates and macromolecular compositions of ''Mycobacterium tuberculosis'', ''Streptomyces coelicolor'' A3(2) and ''Escherichia coli'' B/r: an integrative theoretical approach |journal=Microbiology |volume=150 |issue=Pt 5 |pages=1413–26 |year=2004 |url=http://mic.sgmjournals.org/cgi/content/full/150/5/1413?view=long&pmid=15133103#R35 | pmid = 15133103 | doi = 10.1099/mic.0.26560-0 <!--Retrieved from CrossRef by DOI bot-->}}</ref> (For example, one of the fastest-growing bacteria is a strain of ''[[E. coli]]'' that can divide roughly every 20 minutes.) Since MTB has a cell wall but lacks a [[phospholipid]] [[Bacterial cell structure|outer membrane]], it is [[Tuberculosis classification|classified]] as a [[Gram-positive]] bacterium. However, if a [[Gram stain]] is performed, MTB either stains very weakly Gram-positive or does not retain dye due to the high lipid & mycolic acid content of its cell wall.<ref name=Madison_2001>{{cite journal |author=Madison B |title=Application of stains in clinical microbiology |journal=Biotech Histochem |volume=76 |issue=3 |pages=119–25 |year=2001 |pmid=11475314 |doi=10.1080/714028138}}</ref> MTB is a small rod-like [[bacillus]] that can withstand weak [[disinfectant]]s and survive in a [[Endospore|dry state]] for weeks. In nature, the bacterium can grow only within the cells of a [[host (biology)|host]] organism, but ''M. tuberculosis'' can be cultured ''[[in vitro]]''.<ref name=Parish_1999>{{cite journal |author=Parish T, Stoker N |title=Mycobacteria: bugs and bugbears (two steps forward and one step back) |journal=Mol Biotechnol |volume=13 |issue=3 |pages=191–200 |year=1999 | pmid = 10934532 | doi = 10.1385/MB:13:3:191 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
Using [[histology|histological]] stains on expectorate samples from [[phlegm]] (also called sputum), scientists can identify MTB under a regular microscope. Since MTB retains certain stains after being treated with acidic solution, it is classified as an [[acid-fast bacillus]] (AFB).<ref name=Madison_2001>{{cite journal |author=Madison B |title=Application of stains in clinical microbiology |journal=Biotech Histochem |volume=76 |issue=3 |pages=119–25 |year=2001 | pmid = 11475314 |doi=10.1080/714028138}}</ref> The most common staining technique, the [[Ziehl-Neelsen stain]], dyes AFBs a bright red that stands out clearly against a blue background. Other ways to visualize AFBs include an [[auramine-rhodamine stain]] and [[Fluorescence microscope|fluorescent microscopy]].
The ''M. tuberculosis'' complex includes three other TB-causing [[mycobacterium|mycobacteria]]: ''[[Mycobacterium bovis|M. bovis]]'', ''[[Mycobacterium africanum|M. africanum]]'' and ''[[Mycobacterium microti|M. microti]]''. The first two only very rarely cause disease in [[immunocompetent]] people. On the other hand, although ''M. microti'' is not usually [[pathogen]]ic, it is possible that the [[prevalence]] of ''M. microti'' infections has been underestimated.<ref name=Niemann_2000>{{cite journal |author=Niemann S, Richter E, Dalügge-Tamm H, Schlesinger H, Graupner D, Königstein B, Gurath G, Greinert U, Rüsch-Gerdes S |title=Two cases of ''Mycobacterium microti'' derived tuberculosis in HIV-negative immunocompetent patients |journal=Emerg Infect Dis |volume=6 |issue=5 |pages=539–42 |year=2000 |pmid = 10998387}}</ref>
Other known pathogenic [[Mycobacterium|mycobacteria]] include ''[[Mycobacterium leprae]]'', [[Mycobacterium avium complex|''Mycobacterium avium'']] and ''M. kansasii''. The last two are part of the [[nontuberculous mycobacteria]] (NTM) group. Nontuberculous mycobacteria cause neither TB nor [[leprosy]], but they ''do'' cause pulmonary diseases resembling TB.<ref name=ALA_1997>{{cite journal |author= |title=Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association |journal=Am J Respir Crit Care Med |volume=156 |issue=2 Pt 2 |pages=S1–25 |year=1997 |pmid = 9279284}}</ref>
===Evolution===
During its [[evolution]], ''M. tuberculosis'' has lost numerous coding and non-coding regions in its [[genome]], losses that can be used to distinguish between strains of the bacteria. The implication is that ''M. tuberculosis'' strains differ geographically, so their genetic differences can be used to track the origins and movement of each strain.<ref name=Rao_2005>{{cite journal |author=Rao K, Kauser F, Srinivas S, Zanetti S, Sechi L, Ahmed N, Hasnain S |title=Analysis of genomic downsizing on the basis of region-of-difference polymorphism profiling of Mycobacterium tuberculosis patient isolates reveals geographic partitioning |journal=J Clin Microbiol |volume=43 |issue=12 |pages=5978–82 |year=2005 | pmid = 16333085 | doi = 10.1128/JCM.43.12.5978-5982.2005 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
==Transmission==
{{Further|[[Transmission (medicine)]]}}
When people suffering from active pulmonary TB cough, sneeze, speak, or spit, they expel infectious [[particulate|aerosol]] droplets 0.5 to 5 [[µm]] in diameter. A single sneeze, for instance, can release up to 40,000 droplets.<ref name=Cole_1998>{{cite journal |author=Cole E, Cook C |title=Characterization of infectious aerosols in health care facilities: an aid to effective engineering controls and preventive strategies |journal=Am J Infect Control |volume=26 |issue=4 |pages=453–64 |year=1998 |pmid=9721404 | doi = 10.1016/S0196-6553(98)70046-X <!--Retrieved from CrossRef by DOI bot-->}}</ref> Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low and the inhalation of just a single bacterium can cause a new infection.<ref>{{cite journal |author=Nicas M, Nazaroff WW, Hubbard A |title=Toward understanding the risk of secondary airborne infection: emission of respirable pathogens |journal=J Occup Environ Hyg |volume=2 |issue=3 |pages=143–54 |year=2005 |pmid=15764538 | doi = 10.1080/15459620590918466 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
[[Image:Aerosol from Sneeze.jpg| thumb | left | 250px |Tuberculosis is spread by [[aerosol]]s created by coughing or sneezing.]]
People with prolonged, frequent, or intense contact are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis can infect 10–15 other people per year.<ref name="WHO2004data"/> Others at risk include people in areas where TB is common, people who inject drugs using unsanitary needles, residents and employees of high-risk congregate settings, medically under-served and low-income populations, high-risk racial or ethnic minority populations, children exposed to adults in high-risk categories, patients [[immunocompromised]] by conditions such as [[HIV]]/[[AIDS]], people who take immunosuppressant drugs, and health care workers serving these high-risk clients.<ref name=Griffith_1996>{{cite journal |author=Griffith D, Kerr C |title=Tuberculosis: disease of the past, disease of the present |journal=J Perianesth Nurs |volume=11 |issue=4 |pages=240–5 |year=1996 | pmid = 8964016 | doi = 10.1016/S1089-9472(96)80023-2 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
Transmission can only occur from people with active—not latent—TB. The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the [[virulence]] of the ''M. tuberculosis'' [[strain (biology)|strain]].<ref name=CDCcourse/> The chain of transmission can therefore be broken by isolating patients with active disease and starting effective anti-tuberculous therapy. After two weeks of such treatment, people with [[Antibiotic resistance|non-resistant]] active TB generally cease to be contagious. If someone does become infectous, then it will take at least from 21 days, or 3–4 weeks, before the new infectous person can transmit the disease to others.<ref>{{cite web
|url=http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=3|title=Causes of Tuberculosis|accessdate=2007-10-19|date=2006-12-21|last=|first=|publisher=[[Mayo Clinic]]}}</ref>
TB can also be transmitted by eating meat if the cattle is infected with TB. Mycobacterium bovis causes TB in cattle. Details below.
==Pathogenesis==
[[Image:TB in sputum.png|thumb|300px|''[[Mycobacterium tuberculosis]]'' (stained red) in sputum]]
About 90% of those infected with ''Mycobacterium tuberculosis'' have [[asymptomatic]], latent TB infection (sometimes called LTBI), with only a 10% lifetime chance that a latent infection will progress to TB disease. However, if untreated, the death rate for these active TB cases is more than 50%.<ref name =TDRreport>Onyebujoh, Phillip and Rook, Graham A. W. [http://www.who.int/tdr/dw/tb2004.htm World Health Organization Disease Watch: Focus: Tuberculosis.] December 2004. Accessed [[7 October]] [[2006]].</ref>
TB infection begins when the mycobacteria reach the [[Pulmonary alveolus|pulmonary alveoli]], where they invade and replicate within alveolar [[macrophages]].<ref name=Houben>{{cite journal |author=Houben E, Nguyen L, Pieters J |title=Interaction of pathogenic mycobacteria with the host immune system |journal=Curr Opin Microbiol |volume=9 |issue=1 |pages=76–85 |year=2006 | pmid = 16406837 | doi = 10.1016/j.mib.2005.12.014 <!--Retrieved from CrossRef by DOI bot-->}}</ref> The primary site of infection in the lungs is called the [[Ghon focus]]. Bacteria are picked up by [[dendritic cell]]s, which do not allow replication, although these cells can transport the bacilli to local ([[mediastinal]]) [[lymph node]]s. Further spread is through the bloodstream to the more distant tissues and organs where secondary TB lesions can develop in lung apices, peripheral lymph nodes, kidneys, brain, and bone.<ref name=Herrmann_2005>{{cite journal |author=Herrmann J, Lagrange P |title=Dendritic cells and Mycobacterium tuberculosis: which is the Trojan horse? |journal=Pathol Biol (Paris) |volume=53 |issue=1 |pages=35–40 |year=2005 | pmid = 15620608}}</ref> All parts of the body can be affected by the disease, though it rarely affects the [[heart]], [[skeletal muscle]]s, [[pancreas]] and [[thyroid]].<ref>{{cite journal |author=Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15857515 |title=Tuberculous dilated cardiomyopathy: an under-recognized entity? |journal=BMC Infect Dis |volume=5 |issue=1 |pages=29 |year=2005 |pmid=15857515 | doi = 10.1186/1471-2334-5-29 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
Tuberculosis is classified as one of the [[granuloma]]tous inflammatory conditions. [[Macrophage]]s, [[T cell|T lymphocytes]], [[B cell|B lymphocytes]] and [[fibroblast]]s are among the cells that aggregate to form a [[granuloma]], with [[lymphocytes]] surrounding the infected macrophages. The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system. Within the granuloma, T lymphocytes (CD4+) secrete [[cytokines]] such as [[interferon gamma]], which activates macrophages to destroy the bacteria with which they are infected.<ref name=Kaufmann_2002>{{cite journal |author=Kaufmann S |title=Protection against tuberculosis: cytokines, T cells, and macrophages |journal=Ann Rheum Dis |volume=61 Suppl 2 |issue= |pages=ii54–8 |year=2002 | pmid = 12379623}}</ref> T lymphocytes (CD8+) can also directly kill infected cells.<ref name=Houben/>
Importantly, bacteria are not always eliminated within the granuloma, but can become dormant, resulting in a latent infection. Another feature of the granulomas of human tuberculosis is the development of cell death, also called [[necrosis]], in the center of [[Tubercle (anatomy)|tubercles]]. To the naked eye this has the texture of soft white cheese and was termed [[caseous]] [[necrosis]].<ref name=Grosset>{{cite journal |author=Grosset J |title=Mycobacterium tuberculosis in the extracellular compartment: an underestimated adversary |journal=Antimicrob Agents Chemother |volume=47 |issue=3 |pages=833–6 |year=2003 | pmid = 12604509 | doi = 10.1128/AAC.47.3.833-836.2003 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
If TB bacteria gain entry to the bloodstream from an area of damaged tissue they spread through the body and set up many foci of infection, all appearing as tiny white tubercles in the tissues. This severe form of TB disease is most common in infants and the elderly and is called [[miliary tuberculosis]]. Patients with this disseminated TB have a fatality rate of approximately 20%, even with intensive treatment.<ref name=Kim_2003>{{cite journal |author=Kim J, Park Y, Kim Y, Kang S, Shin J, Park I, Choi B |title=Miliary tuberculosis and acute respiratory distress syndrome |journal=Int J Tuberc Lung Dis |volume=7 |issue=4 |pages=359–64 |year=2003 | pmid = 12733492}}</ref>
In many patients the infection waxes and wanes. Tissue destruction and necrosis are balanced by healing and [[fibrosis]].<ref name=Grosset/> Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material. During active disease, some of these cavities are joined to the air passages [[bronchi]] and this material can be coughed up. It contains living bacteria and can therefore pass on infection. Treatment with appropriate [[antibiotic]]s kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.<ref name=Grosset/>
==Diagnosis==
{{details|Tuberculosis diagnosis}}
[[Image:Mantoux tuberculin skin test.jpg|thumb|right|350px|[[Mantoux test|Mantoux tuberculin skin test]]]]
Tuberculosis can be a difficult disease to diagnose, mainly due to the difficulty in culturing this slow-growing organism in the laboratory (4–12 weeks for blood culture). A complete medical evaluation for TB must include a medical history, a chest X-ray, and a physical examination. [[Tuberculosis radiology]] is used in the diagnosis of TB. It may also include a [[Mantoux test|tuberculin skin test,]] a [[serological]] test, microbiological smears and cultures. The interpretation of the tuberculin skin test depends upon the person's risk factors for infection and progression to TB disease, such as exposure to other cases of TB or immunosuppression.<ref name=CDCcourse/>
Currently, latent infection is diagnosed in a non-immunized person by a tuberculin skin test, which yields a delayed hypersensitivity type response to [[Mantoux test|an extract]] made from ''M. tuberculosis''. Those immunized for TB or with past-cleared infection will respond with delayed hypersensitivity parallel to those currently in a state of infection, so the test must be used with caution, particularly with regard to persons from countries where TB immunization is common.<ref name=Rothel_2005>{{cite journal |author=Rothel J, Andersen P |title=Diagnosis of latent Mycobacterium tuberculosis infection: is the demise of the Mantoux test imminent? |journal=Expert Rev Anti Infect Ther |volume=3 |issue=6 |pages=981–93 |year=2005 | pmid = 16307510 | doi = 10.1586/14787210.3.6.981}}</ref> New TB tests are being developed that offer the hope of cheap, fast and more accurate TB testing. These use [[polymerase chain reaction]] detection of bacterial DNA and antibody assays to detect the release of [[interferon gamma]] in response to mycobacteria.<ref nameNahid_2006>{{cite journal |author=Nahid P, Pai M, Hopewell P |title=Advances in the diagnosis and treatment of tuberculosis |journal=Proc Am Thorac Soc |volume=3 |issue=1 |pages=103–10 |year=2006 | pmid = 16493157 | doi = 10.1513/pats.200511-119JH}}</ref> These tests are not affected by immunization, so generate fewer [[false positive]] results.<ref>{{cite journal |author=Pai M, Zwerling A, Menzies D |title=Systematic Review: T-Cell-Based Assays for the Diagnosis of Latent Tuberculosis Infection: An Update |journal=Ann. Intern. Med. |volume=149 |issue=3 |pages=1-9 |year=2008 |month=June |pmid=18593687}}</ref> Rapid and inexpensive diagnosis will be particularly valuable in the developing world.
==Progression==
Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and begin to multiply. In primary TB disease—1–5% of cases—this occurs soon after infection. However, in the majority of cases, a latent infection occurs that has no obvious symptoms. These dormant bacilli can produce tuberculosis in 2–23% of these latent cases, often many years after infection.<ref name=Parrish_1998>{{cite journal |author=Parrish N, Dick J, Bishai W |title=Mechanisms of latency in Mycobacterium tuberculosis |journal=Trends Microbiol |volume=6 |issue=3 |pages=107–12 |year=1998 | pmid = 9582936 | doi = 10.1016/S0966-842X(98)01216-5 <!--Retrieved from CrossRef by DOI bot-->}}</ref> The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In patients co-infected with ''M. tuberculosis'' and HIV, the risk of reactivation increases to 10% per year.<ref name =TDRreport/>
Other conditions that increase risk include drug injection, mainly due to the lifestyle of [[IV drug users]]; recent TB infection or a history of inadequately treated TB; chest X-ray suggestive of previous TB, showing fibrotic lesions and nodules; [[diabetes mellitus]]; [[silicosis]]; prolonged [[corticosteroid]] therapy and other immunosuppressive therapy; head and neck cancers; [[hematology|hematologic]] and [[Reticuloendothelial system|reticuloendothelial]] diseases, such as [[leukemia]] and [[Hodgkin's lymphoma|Hodgkin's disease;]] end-stage kidney disease; intestinal bypass or [[gastrectomy]]; chronic [[malabsorption]] syndromes; or low body weight.<ref name=CDCcourse/>
[[Twin study|Twin studies]] in the 1950s showed that the course of TB infection was highly dependent on genetics. At that time, it was rare that one identical twin would die and the other live.<ref>New Scientist, [[16 June]] [[2007]] [http://www.newscientist.com/article/mg19426086.100-this-week-50-years-ago.html]</ref>
Some drugs, including [[rheumatoid arthritis]] drugs that work by blocking [[tumor necrosis factor-alpha]] (an inflammation-causing [[cytokine]]), raise the risk of activating a latent infection due to the importance of this cytokine in the immune defense against TB.<ref name=Mutlu_2006>{{cite journal |author=Mutlu G, Mutlu E, Bellmeyer A, Rubinstein I |title=Pulmonary adverse events of anti-tumor necrosis factor-alpha antibody therapy |journal=Am J Med |volume=119 |issue=8 |pages=639–46 |year=2006 | pmid = 16887405 | doi = 10.1016/j.amjmed.2006.01.015 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
==Treatment==
{{details|Tuberculosis treatment}}
Treatment for TB uses [[antibiotics]] to kill the bacteria. The two antibiotics most commonly used are [[rifampicin]] and [[isoniazid]]. However, instead of the short course of antibiotics typically used to cure other bacterial infections, TB requires much longer periods of treatment (around 6 to 12 months) to entirely eliminate mycobacteria from the body.<ref name=CDCcourse/> Latent TB treatment usually uses a single antibiotic, while active TB disease is best treated with combinations of several antibiotics, to reduce the risk of the bacteria developing [[antibiotic resistance]].<ref name=OBrien>{{cite journal |author=O'Brien R |title=Drug-resistant tuberculosis: etiology, management and prevention |journal=Semin Respir Infect |volume=9 |issue=2 |pages=104–12 |year=1994 | pmid = 7973169}}</ref> People with latent infections are treated to prevent them from progressing to active TB disease later in life. However, treatment using Rifampin and Pyrazinamide is not risk-free. The [[Centers for Disease Control and Prevention]] (CDC) notified healthcare professionals of revised recommendations against the use of rifampin plus pyrazinamide for treatment of latent tuberculosis infection, due to high rates of hospitalization and death from liver injury associated with the combined use of these drugs.<ref name=MMWR_2003>{{cite journal |author= |title=Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection—United States, 2003 |journal=MMWR Morb Mortal Wkly Rep |volume=52 |issue=31 |pages=735–9 |year=2003 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5231a4.htm | pmid = 12904741}}</ref>
Drug resistant tuberculosis is transmitted in the same way as regular TB. Primary resistance occurs in persons who are infected with a resistant strain of TB. A patient with fully-susceptible TB develops secondary resistance (acquired resistance) during TB therapy because of inadequate treatment, not taking the prescribed regimen appropriately, or using low quality medication.<ref name=OBrien/> Drug-resistant TB is a public health issue in many developing countries, as treatment is longer and requires more expensive drugs. [[Multi-drug resistant TB]] ('''MDR-TB''') is defined as resistance to the two most effective first line TB drugs: [[rifampicin]] and [[isoniazid]]. [[Extensively drug-resistant tuberculosis|Extensively drug-resistant TB]] ('''XDR-TB''') is also resistant to three or more of the six classes of second-line drugs.<ref name="MMWR2006"/>
In ancient times, available treatments focused more on dietary parameters. [[Pliny the Elder]] described several methods in his ''[[Natural History (Pliny)|Natural History]]'': "wolf's liver taken in thin wine, the lard of a sow that has been fed upon grass, or the flesh of a she-ass taken in broth".<ref>Pliny the Elder, Natural History, quoted at {{cite web|url=http://books.google.com/books?id=GO8tcTpgj-0C|title=Roman Civilization|author=Naphtali Lewis, Meyer Reinhold}}</ref> While these particular remedies haven't been tested scientifically, it has been demonstrated that malnourished mice receiving a 2% protein diet suffer far higher mortality from tuberculosis than those receiving 20% protein receiving the same infectious challenge dose, and the progressively fatal course of the illness could be reversed by restoring the mice to the normal diet.<ref>{{cite journal|title=Effects of protein calorie malnutrition on tuberculosis in mice|author=John Chan, Yu Tian, Kathryn E. Tanakadagger, Ming S. Tsang, Keming Yu, Padmini Salgame, Dinah Carroll, Yvonne Kress, Rachel Teitelbaum, and Barry R. Bloom|journal=Proc Natl Acad Sci U S A|date=1996-12-10|volume=93|issue=25|pages=14857–61|doi=10.1073/pnas.93.25.14857|pmid=8962145}}</ref> Moreover, statistics for immigrants in South London reveal an 8.5 fold increased risk of tuberculosis in (primarily [[Hindu]] [[Asian]]) [[lacto vegetarian]]s, who frequently suffer protein malnutrition, compared to those of similar cultural backgrounds who ate meat and fish daily.<ref>{{cite journal|title=Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians|journal=Thorax|date=1995-02|volume=50|issue=2|pages=175–80|pmid=8962145|author=Strachan DP, Powell KJ, Thaker A, Millard FJ, Maxwell JD}}</ref>
==Prevention==
TB prevention and control takes two parallel approaches. In the first, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. In the second approach, children are [[vaccination|vaccinated]] to protect them from TB. Unfortunately, no [[vaccine]] is available that provides reliable protection for adults. However, in tropical areas where the levels of other species of mycobacteria are high, exposure to [[nontuberculous mycobacteria]] gives some protection against TB.<ref name=Fine_2001>{{cite journal |author=Fine P, Floyd S, Stanford J, Nkhosa P, Kasunga A, Chaguluka S, Warndorff D, Jenkins P, Yates M, Ponnighaus J |title=Environmental mycobacteria in northern Malawi: implications for the epidemiology of tuberculosis and leprosy |journal=Epidemiol Infect |volume=126 |issue=3 |pages=379–87 |year=2001 | pmid = 11467795 | doi = 10.1017/S0950268801005532 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
===Vaccines===
Many countries use [[Bacillus Calmette-Guérin]] (BCG) vaccine as part of their TB control programs, especially for infants. This was the first vaccine for TB and developed at the [[Pasteur Institute]] in [[France]] between 1905 and 1921.<ref name=Bonah>{{cite journal |author=Bonah C |title=The 'experimental stable' of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933 |journal=Stud Hist Philos Biol Biomed Sci |volume=36 |issue=4 |pages=696–721 |year=2005 | pmid = 16337557 |doi=10.1016/j.shpsc.2005.09.003}}</ref> However, mass vaccination with BCG did not start until after [[World War II]].<ref name=Comstock>{{cite journal |author=Comstock G |title=The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research |journal=Clin Infect Dis |volume=19 |issue=3 |pages=528–40 |year=1994 | pmid = 7811874}}</ref> The protective efficacy of BCG for preventing serious forms of TB (e.g. [[meningitis]]) in children is greater than 80%; its protective efficacy for preventing pulmonary TB in adolescents and adults is variable, ranging from 0 to 80%.<ref name=Bannon_1999>{{cite journal |author=Bannon M |title=BCG and tuberculosis |journal=Arch Dis Child |volume=80 |issue=1 |pages=80–3 |year=1999 | pmid = 10325767}}</ref>
In [[South Africa]], the country with the highest prevalence of TB, BCG is given to all children under age three.<ref>[http://web.archive.org/web/20070630073246/http://www.who.int/immunization_monitoring/data/south_africa.pdf WHO/UNICEF Review of National Immunization Coverage 1980–2005: South Africa] (PDF). World Health Organization (August 2006). Retrieved on [[2007-06-08]].</ref> However, BCG is less effective in areas where mycobacteria are less [[prevalence|prevalent]]; therefore BCG is not given to the entire population in these countries. In the USA, for example, BCG vaccine is not recommended except for people who meet specific criteria:<ref name=CDCcourse/>
*Infants or children with negative skin test results who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to [[Multidrug resistance|multidrug-resistant]] TB.
*Healthcare workers considered on an individual basis in settings in which a high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and were not successful.
BCG provides some protection against severe forms of pediatric TB, but has been shown to be unreliable against adult pulmonary TB, which accounts for most of the disease burden worldwide. Currently, there are more cases of TB on the planet than at any other time in history and most agree there is an urgent need for a newer, more effective vaccine that would prevent all forms of TB—including drug resistant strains—in all age groups and among people with HIV.<ref>Sadoff, Jerry. Advances in Tuberculosis Vaccine Strategies. Nature Reviews Microbiology. Vol. 4. June 2006.</ref>
Several new vaccines to prevent TB infection are being developed. The first [[genetic recombination|recombinant]] tuberculosis [[vaccine]] entered [[clinical trial]]s in the United States in 2004, sponsored by the [[National Institute of Allergy and Infectious Diseases]] (NIAID).<ref>[[National Institute of Allergy and Infectious Diseases]] (NIAID).[http://www.nih.gov/news/pr/jan2004/niaid-26.htm First U.S. Tuberculosis Vaccine Trial in 60 Years Begins.] ''National Institutes of Health News'' [[26 January]] [[2004]]. Retrieved on [[19 October]] [[2007]].</ref> A 2005 study showed that a [[DNA vaccine|DNA TB vaccine]] given with conventional [[chemotherapy]] can accelerate the disappearance of bacteria as well as protect against re-infection in mice; it may take four to five years to be available in humans.<ref name=Ha_2005>{{cite journal |author=Ha S, Jeon B, Youn J, Kim S, Cho S, Sung Y |title=Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis |journal=Gene Ther |volume=12 |issue=7 |pages=634–8 |year=2005 | pmid = 15690060 | doi = 10.1038/sj.gt.3302465 <!--Retrieved from CrossRef by DOI bot-->}}</ref> A very promising TB vaccine, [[MVA85A]], is currently in [[clinical trial|phase II trials]] in South Africa by a group led by [[Oxford University]],<ref name=Ibanga_2006>{{cite journal |author=Ibanga H, Brookes R, Hill P, Owiafe P, Fletcher H, Lienhardt C, Hill A, Adegbola R, McShane H |title=Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design |journal=Lancet Infect Dis |volume=6 |issue=8 |pages=522–8 |year=2006 |doi= 10.1016/S1473-3099(06)70552-7| pmid = 16870530}}</ref> and is based on a genetically modified [[vaccinia]] virus. Many other strategies are also being used to develop novel vaccines. In order to encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and [[advance market commitments]].<ref>Webber, David and Kremer, Michael. [http://www.who.int/bulletin/archives/79(8)735.pdf Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives (PDF).] ''Bulletin of the World Health Organization'' 79(8), 2001, pp. 693–801.</ref><ref>Barder, Owen; Kremer, Michael; Williams, Heidi. [http://www.bepress.com/ev/vol3/iss3/art1 "Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases,"] ''The Economists' Voice'', Vol. 3 (2006) Issue 3.</ref>
The [[Bill and Melinda Gates Foundation]] has been a strong supporter of new TB vaccine development. Most recently, they announced a $200 million grant to the [[Aeras Global TB Vaccine Foundation]] for clinical trials on up to six different TB vaccine candidates currently in the pipeline.<ref>[http://www.aeras.org/news/Gatesgrant2007.html Aeras Receives New Grant from the Gates Foundation]</ref>
==Epidemiology==
[[Image:TB incidence.png|thumb|350px|Annual number of new reported TB cases. Data from WHO.<ref name=WHOreport>[[World Health Organization]] (WHO). [http://www.who.int/tb/publications/global_report/en/index.html Global tuberculosis control - surveillance, planning, financing WHO Report 2006.] Retrieved on [[13 October]] [[2006]].</ref>]][[Image:Tuberculosis reported cases 2006.PNG|thumb|350px|World TB incidence. Cases per 100,000; Red = >300, orange = 200–300; yellow = 100–200; green 50–100; blue = <50 and grey = n/a. Data from [[WHO]], 2006.<ref name=WHOreport>[[World Health Organization]] (WHO). [http://www.who.int/tb/publications/global_report/en/index.html Global tuberculosis control - surveillance, planning, financing WHO Report 2006.] Retrieved on [[13 October]] [[2006]].</ref>]]According to the World Health Organization (WHO), nearly 2 billion people—one third of the world's population—have been exposed to the tuberculosis pathogen.<ref>[[National Institute of Allergy and Infectious Diseases]] (NIAID). [http://www3.niaid.nih.gov/topics/tuberculosis/Research/researchFeatures/history/historical_killer.htm] [[26 October]] [[2005]]. Retrieved on [[3 October]] [[2006]]. "According to the World Health Organization (WHO), nearly 2 billion people, one-third of the world's population, have TB."</ref> Annually, 8 million people become ill with tuberculosis, and 2 million people die from the disease worldwide.<ref name=CDC>[[Centers for Disease Control]]. [http://www.cdc.gov/od/oc/Media/pressrel/fs050317.htm Fact Sheet: Tuberculosis in the United States.] [[17 March]] [[2005]], Retrieved on [[6 October]] [[2006]].</ref> In 2004, around 14.6 million people had active TB disease with 9 million new cases. The annual [[Incidence (epidemiology)|incidence]] rate varies from 356 per 100,000 in [[Africa]] to 41 per 100,000 in the [[Americas]].<ref name="WHO2004data"/> Tuberculosis is the world's greatest infectious killer of women of reproductive age and the leading cause of death among people with [[HIV]]/[[AIDS]].<ref>Stop TB Partnership. [http://www.prnewswire.co.uk/cgi/news/release?id=95088 London tuberculosis rates now at Third World proportions.] ''PR Newswire Europe Ltd.'' [[4 December]] [[2002]]. Retrieved on [[3 October]] [[2006]].</ref>
In 2005, the country with the highest estimated [[incidence]] of TB was [[Swaziland]], with 1262 cases per 100,000 people. [[India]] has the largest number of infections, with over 1.8 million cases.<ref>[http://www.who.int/entity/tb/publications/global_report/2007/pdf/full.pdf Global tuberculosis control: surveillance, planning, financing.] WHO report 2007. Geneva, World Health Organization (WHO/HTM/TB/2007.376)</ref> In developed countries, tuberculosis is less common and is mainly an urban disease. In the United Kingdom, TB incidences range from 40 per 100,000 in [[London]] to less than 5 per 100,000 in the rural South West of England;<ref>[http://www.statistics.gov.uk/StatBase/ssdataset.asp?vlnk=5963&Pos=1&ColRank=1&Rank=224 Notification rates of tuberculosis: by NHS Regional Office area, 1990-2001: Regional Trends 37] Office for National Statistics Retrieved on [[13 October]] [[2006]].</ref> the national average is 13 per 100,000. The highest rates in [[Western Europe]] are in [[Portugal]] (42 per 100,000) and [[Spain]] (20 per 100,000). These rates compare with 113 per 100,000 in [[Tuberculosis in China|China]] and 64 per 100,000 in [[Brazil]]. In the United States, the overall tuberculosis case rate was 4.9 per 100,000 persons in 2004.<ref name=CDC/>
The incidence of TB varies with age. In Africa, TB primarily affects adolescents and young adults.<ref>[[World Health Organization]] (WHO). [http://www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf Global Tuberculosis Control Report, 2006] - Annex 1 Profiles of high-burden countries. (PDF) Retrieved on [[13 October]] [[2006]].</ref> However, in countries where TB has gone from high to low incidence, such as the United States, TB is mainly a disease of older people.<ref>[[Centers for Disease Control and Prevention]] (CDC). [http://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm 2005 Surveillance Slide Set.] ([[September 12]], [[2006]]) Retrieved on [[13 October]] [[2006]].</ref>
There are a number of known factors that make people more susceptible to TB infection: worldwide the most important of these is [[HIV]]. Co-infection with HIV is a particular problem in [[Sub-Saharan Africa]], due to the high incidence of HIV in these countries.<ref name=WHOreport/><ref>{{cite journal
|volume=358
|pages=1089–1092
|year=2008
|issue=11
|title=Tuberculosis in Africa—combating an HIV-driven crisis
|author=Chaisson RE, Martinson NA
|journal=N Engl J Med
|url=http://content.nejm.org/cgi/content/full/358/11/1089?query=TOC
|doi=10.1056/NEJMp0800809
|pmid=18337598}}</ref> Smoking more than 20 [[cigarette]]s a day also increases the risk of TB by two to four times.<ref>{{cite journal
|title=Smoking and tuberculosis: the epidemiological association and pathogenesis
|author=Davies PDO, Yew WW, Ganguly D, ''et al.''
|year=2006
|volume=100
|pages=291–8
|journal=Trans R Soc Trop Med Hyg
|pmid=16325875 | doi = 10.1016/j.trstmh.2005.06.034 <!--Retrieved from CrossRef by DOI bot-->
}}</ref><ref>{{cite journal
|author=Jha P, Jacob B, Gajalakshmi V, ''et al.''
|title=A nationally representative case–control study of smoking and death in India
|journal=N Engl J Med
|volume=358
|pages=1137–1147
|year=2008
|issue=11
|url=http://content.nejm.org/cgi/content/full/358/11/1137?query=TOC | doi = 10.1056/NEJMsa0707719 <!--Retrieved from CrossRef by DOI bot-->
|pmid=18272886
}}</ref> Diabetes mellitus is also an important risk factor that is growing in importance in developing countries.<ref>{{cite journal
|author=Restrepo BI
|title=Convergence of the tuberculosis and diabetes epidemics: renewal of old acquaintances
|journal=Clin Infect Dis
|year=2007
|volume=45
|pages=436–8
|url=http://www.journals.uchicago.edu/CID/journal/issues/v45n4/51190/51190.html | doi = 10.1086/519939 <!--Retrieved from CrossRef by DOI bot-->
|format={{dead link|date=June 2008}} – <sup>[http://scholar.google.co.uk/scholar?hl=en&lr=&q=intitle%3AConvergence+of+the+tuberculosis+and+diabetes+epidemics%3A+renewal+of+old+acquaintances&as_publication=Clin+Infect+Dis&as_ylo=2007&as_yhi=2007&btnG=Search Scholar search]</sup>
}}</ref>
==History==
[[Image:Mummy at British Museum.jpg|left|thumb|300px|Tubercular decay has been found in the spines of [[Egypt]]ian [[mummy|mummies]]. Pictured: Egyptian mummy in the British Museum]]
Tuberculosis has been present in humans since [[Ancient history|antiquity]]. The earliest unambiguous detection of ''Mycobacterium tuberculosis'' is in the remains of bison dated 18,000 years before the present.<ref name=Rothschild_2001>{{cite journal |author=Rothschild B, Martin L, Lev G, Bercovier H, Bar-Gal G, Greenblatt C, Donoghue H, Spigelman M, Brittain D |title=Mycobacterium tuberculosis complex DNA from an extinct bison dated 17,000 years before the present |journal=Clin Infect Dis |volume=33 |issue=3 |pages=305–11 |year=2001 | pmid = 11438894 | doi = 10.1086/321886 <!--Retrieved from CrossRef by DOI bot-->}}</ref> However, whether tuberculosis originated in cattle and then transferred to humans, or diverged from a common ancestor, is currently unclear.<ref name=Pearce-Duvet_2006>{{cite journal |author=Pearce-Duvet J |title=The origin of human pathogens: evaluating the role of agriculture and domestic animals in the evolution of human disease |journal=Biol Rev Camb Philos Soc |volume=81 |issue=3 |pages=369–82 |year=2006 | pmid = 16672105 |doi=10.1017/S1464793106007020}}</ref> Skeletal remains show prehistoric humans (4000 [[Before Christ|BC]]) had TB, and tubercular decay has been found in the spines of [[mummy|mummies]] from 3000–2400 BC.<ref name=Zink_2003>{{cite journal |author=Zink A, Sola C, Reischl U, Grabner W, Rastogi N, Wolf H, Nerlich A |title=Characterization of Mycobacterium tuberculosis complex DNAs from Egyptian mummies by spoligotyping |journal=J Clin Microbiol |volume=41 |issue=1 |pages=359–67 |year=2003 | pmid = 12517873 | doi = 10.1128/JCM.41.1.359-367.2003 <!--Retrieved from CrossRef by DOI bot-->}}</ref> Phthisis is a Greek term for tuberculosis; around 460 BC, [[Hippocrates]] identified phthisis as the most widespread disease of the times involving coughing up blood and fever, which was almost always fatal.<ref>Hippocrates. [http://web.archive.org/web/20050211173218/http://classics.mit.edu/Hippocrates/aphorisms.mb.txt Aphorisms.] Accessed [[7 October]] [[2006]].</ref> Genetic studies suggest that TB was present in [[South America]] for about 2,000 years.<ref name=Konomi_2002>{{cite journal |author=Konomi N, Lebwohl E, Mowbray K, Tattersall I, Zhang D |title=Detection of mycobacterial DNA in Andean mummies |journal=J Clin Microbiol |volume=40 |issue=12 |pages=4738–40 |year=2002 | pmid = 12454182 | doi = 10.1128/JCM.40.12.4738-4740.2002 <!--Retrieved from CrossRef by DOI bot-->}}</ref> In South America, the earliest evidence of tuberculosis is associated with the [[Paracas]]-Caverna culture (circa 750 BC to circa 100 AD).<ref>[http://memorias.ioc.fiocruz.br/98sup/6psa.html "South America: Prehistoric Findings"]. ''Memorias do Instituto Oswaldo Cruz'', Vol. 98 (Suppl.I) January 2003. Retrieved on [[2007-02-08]].</ref>
===Folklore===
Before the [[Industrial Revolution]], tuberculosis may sometimes have been regarded as [[vampirism]]. When one member of a family died from it, the other members that were infected would lose their health slowly. People believed that this was caused by the original victim draining the life from the other family members. Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits. People with TB often have symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin and coughing blood, suggesting the idea that the only way for the afflicted to replenish this loss of blood was by sucking blood.<ref name=Sledzik_1994>{{cite journal |author=Sledzik P, Bellantoni N |title=Brief communication: bioarcheological and biocultural evidence for the New England vampire folk belief |journal=Am J Phys Anthropol |volume=94 |issue=2 |pages=269–74 |year=1994 |url=http://users.net1plus.com/vyrdolak/tableone.htm | pmid = 8085617 | doi = 10.1002/ajpa.1330940210 <!--Retrieved from CrossRef by DOI bot-->}}</ref> Another folk belief attributed it to being forced, nightly, to attend [[fairy]] revels, so that the victim wasted away owing to lack of rest; this belief was most common when a strong connection was seen between the fairies and the dead.<ref name=Briggs>[[Katharine Mary Briggs|Katharine Briggs]], ''An Encyclopedia of Fairies'' "Consumption" ([[Pantheon Books]], 1976) p. 80. ISBN 0-394-73467-X</ref> Similarly, but less commonly, it was attributed to the victims being "hagridden"—being transformed into horses by witches (hags) to travel to their nightly meetings, again resulting in a lack of rest.<ref name=Briggs/>
TB was romanticized in the nineteenth century. Many people believed TB produced feelings of euphoria referred to as "Spes phthisica" or "hope of the consumptive". It was believed that TB sufferers who were artists had bursts of creativity as the disease progressed. It was also believed that TB sufferers acquired a final burst of energy just before they died which made women more beautiful and men more creative.<ref name="StudiesLiteraryImagination-Clark">Lawlor, Clark. "Transatlantic Consumptions: Disease, Fame and Literary Nationalism in the Davidson Sisters, Southey, and Poe". ''Studies in the Literary Imagination'', Fall 2003. Available at [http://findarticles.com/p/articles/mi_qa3822/is_200310/ai_n9310101 findarticles.com.] Retrieved on [[2007-06-08]].</ref> In the early 20th century, some believed TB to be caused by [[masturbation]].<ref>Laumann, Edward O. (1994) [http://books.google.com/books?id=72AHO0rE2HoC&printsec=frontcover#PPA80,M1 The Social Organization of Sexuality: Sexual Practices in the United States] University of Chicago Press p 80, ISBN 0-22647-020-2</ref>
===Study and treatment===
The study of tuberculosis dates back to ''[[The Canon of Medicine]]'' written by [[Avicenna|Ibn Sina]] (Avicenna) in the 1020s. He was the first physician to identify pulmonary tuberculosis as a [[Infectious disease|contagious disease]], the first to recognise the association with diabetes, and the first to suggest that it could spread through contact with [[soil]] and [[water]].<ref>Y. A. Al-Sharrah (2003), "The Arab Tradition of Medical Education and its Relationship with the European Tradition", ''Prospects'' '''33''' (4), [[Springer Science+Business Media|Springer]].</ref><ref>[[George Sarton]], ''Introduction to the History of Science''. <br> ([[cf.]] Dr. A. Zahoor and Dr. Z. Haq (1997). [http://www.cyberistan.org/islamic/Introl1.html Quotations From Famous Historians of Science], Cyberistan.)</ref> He developed the method of [[quarantine]] in order to limit the spread of tuberculosis.<ref>David W. Tschanz, MSPH, PhD (August 2003). "Arab Roots of European Medicine", ''Heart Views'' '''4''' (2).</ref>
Although it was established that the pulmonary form was associated with 'tubercles' by [[Dr Richard Morton]] in 1689,<ref name="WhoNamedIt-Calmette">Who Named It? [http://www.whonamedit.com/doctor.cfm/2413.html Léon Charles Albert Calmette.] Retrieved on [[6 October]] [[2006]].</ref><ref name="MedHist1970-Trail">{{cite journal |author=Trail R |title=Richard Morton (1637–1698) |journal=Med Hist |volume=14 |issue=2 |pages=166–74 |year=1970 | pmid = 4914685}}</ref> due to the variety of its symptoms, TB was not identified as a single disease until the 1820s and was not named 'tuberculosis' until 1839 by [[Johann Lukas Schönlein|J. L. Schönlein]].<ref>Zur Pathogenie der Impetigines. Auszug aus einer brieflichen Mitteilung an den Herausgeber. [Müller’s] ''Archiv für Anatomie, Physiologie und wissenschaftliche Medicin''. 1839, page 82.</ref> During the years 1838–1845, Dr. John Croghan, the owner of [[Mammoth Cave]], brought a number of tuberculosis sufferers into the cave in the hope of curing the disease with the constant temperature and purity of the cave air: they died within a year.<ref>[http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html Kentucky: Mammoth Cave long on history.] ''[[CNN]]''. [[27 February]] [[2004]]. Accessed [[8 October]] [[2006]].</ref> The first TB [[sanatorium]] opened in 1859 in [[Görbersdorf|Görbersdorf, Germany]] (today [[Sokołowsko|Sokołowsko, Poland]]) by Hermann Brehmer.<ref name =sanatoria>{{cite journal |author=McCarthy OR |title=The key to the sanatoria |journal=J R Soc Med |volume=94 |issue=8 |pages=413–7 |year=2001 | pmid = 11461990}}</ref>
In regard to this claim, ''The Times'' for [[January 15]], [[1859]], page 5, column 5, carries an advertisement seeking funds for the Bournemouth Sanatorium for Consumption, referring to the balance sheet for the past year, and offering an annual report to prospective donors, implying that this sanatorium was in existence at least in 1858.
[[Image:RobertKoch.jpg|right|thumb|200px|Dr. Robert Koch discovered the tuberculosis bacilli.]]
The bacillus causing tuberculosis, ''Mycobacterium tuberculosis'', was identified and described on [[March 24]], [[1882]] by [[Robert Koch]]. He received the [[Nobel Prize in physiology or medicine]] in 1905 for this discovery.<ref>[[Nobel Foundation]]. [http://nobelprize.org/nobel_prizes/medicine/laureates/1905/ The Nobel Prize in Physiology or Medicine 1905.] Accessed [[7 October]] [[2006]].</ref> Koch did not believe that bovine (cattle) and human tuberculosis were similar, which delayed the recognition of infected milk as a source of infection. Later, this source was eliminated by the [[pasteurization]] process. Koch announced a [[glycerine]] extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it 'tuberculin'. It was not effective, but was later adapted as a test for pre-symptomatic tuberculosis.<ref name=Waddington_2004>{{cite journal |author=Waddington K |title=To stamp out "so terrible a malady": bovine tuberculosis and tuberculin testing in Britain, 1890–1939 |journal=Med Hist |volume=48 |issue=1 |pages=29–48 |year=2004 | pmid = 14968644}}</ref>
The first genuine success in immunizing against tuberculosis was developed from attenuated bovine-strain tuberculosis by [[Albert Calmette]] and [[Camille Guérin]] in 1906. It was called "BCG" ([[Bacillus Calmette-Guérin|Bacillus of Calmette and Guérin]]). The BCG vaccine was first used on humans in 1921 in [[France]],<ref name=Bonah/> but it was not until after [[World War II]] that BCG received widespread acceptance in the [[United States|USA]], [[Great Britain]], and [[Germany]].<ref name=Comstock/>
Tuberculosis, or "consumption" as it was commonly known, caused the most widespread public concern in the 19th and early 20th centuries as an [[endemic (epidemiology)|endemic]] disease of the urban poor. In 1815, one in four deaths in England was of consumption; by 1918 one in six deaths in France were still caused by TB. In the 20th century, tuberculosis killed an estimated 100 million people.<ref>[http://birdflubook.com/a.php?id=40&t=p Torrey EF and Yolken RH. 2005. Their bugs are worse than their bite. Washington Post, [[April 3]], p. B01.]</ref> After the establishment in the 1880s that the disease was contagious, TB was made a [[notifiable disease]] in Britain; there were campaigns to stop spitting in public places, and the infected poor were "encouraged" to enter [[sanatorium|sanatoria]] that resembled prisons; the sanatoria for the middle and upper classes offered excellent care and constant medical attention.<ref name =sanatoria/> Whatever the purported benefits of the fresh air and labor in the sanatoria, even under the best conditions, 50% of those who entered were dead within five years (1916).<ref name =sanatoria/>
[[Image:TB poster.jpg|left|thumb|200px|Public health campaigns tried to halt the spread of TB]]
The promotion of [[Christmas Seals]] began in Denmark during 1904 as a way to raise money for tuberculosis programs. It expanded to the United States and Canada in 1907–08 to help the National Tuberculosis Association (later called the [[American Lung Association]]).
In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into [[spittoon]]s.
In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the [[Medical Research Council (UK)|Medical Research Council]] was formed in Britain in 1913 its initial focus was tuberculosis research.<ref>[[Medical Research Council (UK)]]. [http://www.mrc.ac.uk/YourHealth/StoriesDiscovery/Tuberculosis/index.htm MRC's contribution to Tuberculosis research.] Accessed [[2 July]] [[2007]].</ref>
It was not until 1946 with the development of the antibiotic [[streptomycin]] that effective treatment and cure became possible. Prior to the introduction of this drug, the only treatment besides sanatoria were surgical interventions, including the [[pneumothorax]] technique—collapsing an infected lung to "rest" it and allow lesions to heal—a technique that was of little benefit and was largely discontinued by the 1950s.<ref name=Wolfart_1990>{{cite journal |author=Wolfart W |title=Surgical treatment of tuberculosis and its modifications—collapse therapy and resection treatment and their present-day sequelae |journal=Offentl Gesundheitswes |volume=52 |issue=8–9 |pages=506–11 |year=1990 | pmid = 2146567}}</ref> The emergence of multidrug-resistant TB has again introduced surgery as part of the treatment for these infections. Here, surgical removal of chest cavities will reduce the number of bacteria in the lungs, as well as increasing the exposure of the remaining bacteria to drugs in the bloodstream, and is therefore thought to increase the effectiveness of the chemotherapy.<ref name=Lalloo_2006>{{cite journal |author=Lalloo U, Naidoo R, Ambaram A |title=Recent advances in the medical and surgical treatment of multi-drug resistant tuberculosis |journal=Curr Opin Pulm Med |volume=12 |issue=3 |pages=179–85 |year=2006 | pmid = 16582672 | doi = 10.1097/01.mcp.0000219266.27439.52 <!--Retrieved from CrossRef by DOI bot-->}}</ref>
Hopes that the disease could be completely eliminated have been dashed since the rise of [[Antibiotic resistant|drug-resistant]] strains in the 1980s. For example, tuberculosis cases in Britain, numbering around 117,000 in 1913, had fallen to around 5,000 in 1987, but cases rose again, reaching 6,300 in 2000 and 7,600 cases in 2005.<ref>{{cite web | url =http://www.hpa.org.uk/infections/topics_AZ/tb/epidemiology/table1.htm | title = Tuberculosis – Respiratory and Non-respiratory Notifications, England and Wales, 1913-2005 | publisher = Health Protection Agency Centre for Infections | date = 21 March 2007 | accessdate = 2007-08-01}}</ref> Due to the elimination of public health facilities in New York and the emergence of HIV, there was a resurgence in the late 1980s.<ref name=Paolo_2004>{{cite journal |author=Paolo W, Nosanchuk J |title=Tuberculosis in New York city: recent lessons and a look ahead |journal=Lancet Infect Dis |volume=4 |issue=5 |pages=287–93 |year=2004 | pmid = 15120345 |doi=10.1016/S1473-3099(04)01004-7}}</ref> The number of those failing to complete their course of drugs is high. NY had to cope with more than 20,000 "unnecessary" TB-patients with [[Multidrug resistance|multidrug-resistant]] strains (resistant to, at least, both Rifampin and Isoniazid). The resurgence of tuberculosis resulted in the declaration of a global health emergency by the World Health Organization in 1993.<ref>[[World Health Organization]] (WHO). [http://www.who.int/tb/hiv/faq/en/index.html Frequently asked questions about TB and HIV.] Retrieved [[6 October]] [[2006]].</ref>
==Infection of other animals==
{{main|Mycobacterium bovis}}
Tuberculosis can be carried by [[mammal]]s; domesticated species, such as cats and dogs, are generally free of tuberculosis, but wild animals may be carriers. In some places, regulations aiming to prevent the spread of TB restrict the ownership of [[novelty pet]]s; for example, the [[United States of America|U.S.]] state of [[California]] forbids the ownership of pet [[gerbil]]s.<ref>14 CA ADC § 671 Barclays official California code of regulations; Title 14. Natural resources; Division 1. Fish and game commission – Department of fish and game; Subdivision 3. General regulations; Chapter 3. Miscellaneous.</ref>
[[Mycobacterium bovis]] causes TB in cattle. An effort to eradicate bovine tuberculosis from the cattle and deer herds of [[New Zealand]] is underway. It has been found that herd infection is more likely in areas where infected [[vector species]] such as Australian [[Possums|brush-tailed possums]] come into contact with [[Livestock|domestic livestock]] at farm/bush borders.<ref name=Tweddle_1994>{{cite journal |author=Tweddle N, Livingstone P |title=Bovine tuberculosis control and eradication programs in Australia and New Zealand |journal=Vet Microbiol |volume=40 |issue=1–2 |pages=23–39 |year=1994 | pmid = 8073626 | doi = 10.1016/0378-1135(94)90044-2 <!--Retrieved from CrossRef by DOI bot-->}}</ref> Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a "two-pronged" approach to ridding New Zealand of the disease.
In the [[Republic of Ireland]] and the [[United Kingdom]], [[Eurasian Badger|badger]]s have been identified as one vector species for the transmission of bovine tuberculosis. As a result, governments have come under pressure from some quarters, primarily dairy farmers, to mount an active campaign of eradication of badgers in certain areas with the purpose of reducing the incidence of bovine TB. The effectiveness of culling on the incidence of TB in cattle is a contentious issue, with proponents and opponents citing their own studies to support their position.<ref>The Department of Agriculture & Food (Ireland). [http://www.agriculture.ie/index.jsp?file=animal_health/TB.xml Disease Eradication Schemes - Bovine Tuberculosis and Brucellosis.] Retrieved on [[8 May]] [[2006]].</ref><ref>Cassidy, Martin. [http://news.bbc.co.uk/1/hi/northern_ireland/4044897.stm Badgers targeted over bovine TB.] ''[[BBC News]]'' [[2 December]] [[2004]]. Retrieved on [[8 May]] [[2006]].</ref><ref>National Federation of Badger Groups (Ireland). [http://www.badger-killers.co.uk/Ireland/Ireland_news.html Cattle blamed for massive increase in bovine TB.] Retrieved on [[8 May]] [[2006]].</ref> For instance, a study by an Independent Study Group on badger culling reported on [[18 June]] [[2007]] that it was unlikely to be effective and would only make a “modest difference” to the spread of TB and that "badger culling cannot meaningfully contribute to the future control of cattle TB"; in contrast, another report concluded that this policy would have a significant impact.<ref>{{cite web |url=http://www.publications.parliament.uk/pa/cm200708/cmselect/cmenvfru/130/130i.pdf |title=Badgers and cattle TB: the final report of the Independent Scientific Group on Cattle TB |accessdate=2008-07-04 |publisher=House of Commons Environment, Food and Rural Affairs Committee}}</ref> On July 4th 2008, the UK government decided against a proposed random culling policy.<ref>{{cite web |url=http://news.bbc.co.uk/2/hi/uk_news/england/7489413.stm |title=Farmers' anger on cull rejection |accessdate=2008-07-04 |publisher=BBC News |date=4 July 2008 }}</ref>
==See also==
<div class="references-small" style="-moz-column-count:3; column-count:3;">
*[[2007 tuberculosis scare]]
*[[Abreugraphy]]
*[[ATC code J04]] Drugs for treatment of TB
*[[Buruli ulcer]] and [[leprosy]]: other diseases caused by mycobacteria
*[[Latent tuberculosis]]
*[[List of tuberculosis victims]]
*[[Mycobacterium Tuberculosis Structural Genomics Consortium]]
*[[National Center for HIV, STD, and TB Prevention]]
*[[Nontuberculous mycobacteria]]
*[[Overcrowding]]
*[[Philip D'Arcy Hart]]
*[[The Global Fund to Fight AIDS, Tuberculosis and Malaria]]
*[[Tuberculosis in history and art]]
*[[UNITAID]]
* [[Nosocomial infection]]
</div>
==References==
<!-- ---------------------------------------------------------------
See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a
discussion of different citation methods and how to generate
footnotes using the<ref> & </ref> tags and the {{Reflist}} template
-------------------------------------------------------------------- -->
{{reflist|2}}
==Further reading==
<div class="references-small" style="-moz-column-count:2; column-count:2;">
* {{cite journal | author = Blumberg HM, Leonard MK, Jasmer RM | title = Update on the treatment of tuberculosis and latent tuberculosis infection | journal = JAMA | volume = 293 | issue = 22 | pages = 2776–84 | year = 2005 | pmid = 15941808 | doi = 10.1001/jama.293.22.2776}}
* {{cite book | last = Dormandy | first = Thomas | title = The White Death | publisher = New York University Press | location = New York | year = 2000 | isbn = 0814719279 }}
* {{cite journal | author = Joint Tuberculosis Committee of the British Thoracic Society | title = Control and prevention of tuberculosis in the United Kingdom: code of practice 2000 | journal = Thorax | volume = 55 | issue = 11 | pages = 887–901 | year = 2000 | pmid = 11050256 | url = http://thorax.bmjjournals.com/cgi/content/abstract/55/11/887 | doi = 10.1136/thorax.55.11.887 <!--Retrieved from CrossRef by DOI bot-->}}
* {{cite book | last = Kidder | first = Tracy | title = [[Mountains Beyond Mountains]] | publisher = Random House Trade Paperbacks | location = New York | year = 2004 | isbn = 0812973011 }} A nonfiction account of treating TB in Haiti, Peru, Russia, and elsewhere.
* {{cite book | last = Lawlor | first = Clark | title = Consumption and Literature | publisher = Palgrave Macmillan | location = Basingstoke | year = 2007 | isbn = 0230020038 }}
* {{cite journal | author = Nemery B, Yew WW, Albert R, ''et al'' | title = Tuberculosis, nontuberculous lung infection, pleural disorders, pulmonary function, respiratory muscles, occupational lung disease, pulmonary infections, and social issues in AJRCCM in 2004 | journal = Am. J. Respir. Crit. Care Med. | volume = 171 | issue = 6 | pages = 554–62 | year = 2005 | pmid = 15753485 | doi = 10.1164/rccm.2412009}}
* {{Citation
| last = Ryan
| first = Frank
| title = The Forgotten Plague: How the Battle Against Tuberculosis Was Won — and Lost
| place = Boston, MA
| publisher = [[Little, Brown and Company]]
| year = 1993
| isbn = 0-316-76380-2
}}. First published in the United Kingdom as ''Tuberculosis: The Greatest Story Never Told''.
*{{cite journal | author = Walton D, Farmer P | title = MSJAMA: the new white plague | journal = JAMA | volume = 284 | issue = 21 | pages = 2789 | year = 2000 | pmid = 11105192 | doi = 10.1001/jama.284.21.2789}}
</div>
==External links==
{{commonscat|Tuberculosis}}
* {{dmoz|Health/Conditions_and_Diseases/Infectious_Diseases/Mycobacterial/Tuberculosis/}}
*[[Centers for Disease Control and Prevention]] (CDC), Division of Tuberculosis Elimination. [http://www.cdc.gov/tb/pubs/corecurr/default.htm Core Curriculum on Tuberculosis: What the Clinician Should Know.] 4th edition (2000). Updated August 2003.
*[[Central Asia Health Review]] (CAHR). [http://www.cahr.info/index_files/page0021.htm High Prevalence of Multi-Drug Resistant Tuberculosis in Uzbekistan]
*(CDC) - Division of Tuberculosis Elimination [http://www.cdc.gov/nchstp/tb/default.htm News and updates.]
*(CDC) - [http://www.cdc.gov/tb/faqs/default.htm Questions and Answers About TB, 2007.]
* [http://www.hpa.org.uk/infections/topics_az/tb/menu.htm Health Protection Agency], England
*BioHealthBase Bioinformatics Resource Center. [http://www.biohealthbase.org/ Database of ''Mycobacterium tuberculosis''] genome sequences and related information.
*Kaiser Family Foundation. [http://www.globalhealthfacts.org/topic.jsp?i=9 Tuberculosis.] Globalhealthfacts.org.
*[[Nobel Prize|The Nobel Prize Website.]] [http://nobelprize.org/educational_games/medicine/tuberculosis/tbc/index.html Tuberculosis Educational Game]
*[[United States Agency for International Development]] (USAID). [http://www.tbcta.org/Home/ The Tuberculosis Coalition for Technical Assistance (TBCTA).]
*[[World Health Organization]] (WHO). [http://www.who.int/tb/en/ Tuberculosis.]
* Tuberculosis and HIV: HIV InSite Knowledge Base [http://hivinsite.org/InSite?page=kb-00&doc=kb-05-01-06 chapter] and [http://hivinsite.org/InSite?page=kbr-05-01-06 related resources].
* [http://mtbsysborg.igib.res.in Mycobacterium tuberculosis SysbOrg at the Institute of Genomics and Integrative Biology]
*[http://www.osdd.org Open Source Drug Discovery Initiative for TB]
*[http://www.tuberculosistextbook.com/ Tuberculosis 2007] - a textbook that focuses on research, diagnosis and treatment of tuberculosis
{{featured article}}
{{Bacterial diseases }}
<!-- interwikik -->
<!-- en-US -->
[[Category:Deaths by tuberculosis| ]]
[[Category:Bacterial diseases]]
[[Category:Pulmonology]]
[[Category:Tuberculosis|Tuberculosis]]
[[Category:Health problems in India]]
[[Category:Health in Africa]]
{{Link FA|de}}
{{Link FA|pt}}
[[af:Tuberkulose]]
[[ar:درن]]
[[ast:Tuberculosis]]
[[gn:Mba'asy po'i]]
[[ay:Tisiku]]
[[az:Vərəm]]
[[bm:Sɔgɔsɔgɔnicɛ]]
[[bn:যক্ষ্মা]]
[[zh-min-nan:Hì-lô-pēⁿ]]
[[bs:Tuberkuloza]]
[[bg:Туберкулоза]]
[[ca:Tuberculosi]]
[[cs:Tuberkulóza]]
[[da:Tuberkulose]]
[[de:Tuberkulose]]
[[et:Tuberkuloos]]
[[el:Φυματίωση]]
[[es:Tuberculosis]]
[[eo:Tuberkulozo]]
[[eu:Tuberkulosi]]
[[fa:سل]]
[[fr:Tuberculose]]
[[ga:Eitinn]]
[[gd:A' Chaitheamh]]
[[gl:Tuberculose]]
[[ko:결핵]]
[[hy:Թոքախտ]]
[[hi:तपेदिक]]
[[hr:Tuberkuloza]]
[[io:Tuberkulozo]]
[[id:Tuberkulosa]]
[[ia:Tuberculosis]]
[[is:Berklar]]
[[it:Tubercolosi]]
[[he:שחפת]]
[[kn:ಕ್ಷಯ]]
[[ka:ტუბერკულიოზი]]
[[ku:Tûberkûloz]]
[[la:Phthisis]]
[[lb:Tuberkulos]]
[[lt:Tuberkuliozė]]
[[ln:Tuberculose]]
[[hu:Tuberkulózis]]
[[mt:Tuberkulożi]]
[[mr:क्षय रोग]]
[[ms:Penyakit Batuk Kering]]
[[nl:Tuberculose]]
[[ja:結核]]
[[no:Tuberkulose]]
[[nn:Tuberkulose]]
[[pl:Gruźlica]]
[[pt:Tuberculose]]
[[qu:Qhaqya unquy]]
[[ru:Туберкулёз]]
[[sq:Tuberkulozi]]
[[simple:Tuberculosis]]
[[sk:Tuberkulóza]]
[[sl:Tuberkuloza]]
[[sr:Туберкулоза]]
[[sh:Tuberkuloza]]
[[su:Tuberkulosis]]
[[fi:Tuberkuloosi]]
[[sv:Tuberkulos]]
[[tl:Tuberculosis]]
[[ta:காச நோய்]]
[[te:క్షయ]]
[[th:วัณโรค]]
[[vi:Lao]]
[[tr:Verem]]
[[uk:Туберкульоз]]
[[wa:Pitizeye des djins]]
[[yi:טובערקולאז]]
[[zh-yue:肺癆]]
[[zh:結核]]