Abstract
Tuberculosis (TB) is a contagious bacterial syndrome portrayed by the development of nodules in the tissues, lungs in most cases. The disease is a major health threat of worldwide dimension and a fascinating target of basic research. Iterations existing between clinical studies and basic research can pave way towards improved control strategies that are urgently required. Numerous recommendations and discussions have been generated by medical experts and practitioners regarding the causes as well as symptoms of the disease. Despite the accessibility of an effective and cheap treatment, TB remains the basis of death of millions of people around the world.
Tuberculosis is among the most antique diseases of humankind and has co-evolved with mankind for several million of years. The oldest discovered molecular evidence of the disease was found in a fossil of an extinct bison known as the Pleistocene bison, a radiocarbon dated 17,800 plus 240 years and in 9000, year old remains of human which were found in a Neolithic settlement located in the Eastern Mediterranean. Albeit as early as 1689, Dr. Richard Morton noted that the pulmonary form was linked with ‘tubercles’ because of the variety of the disease symptoms, TB was not regarded a single ailment until the 1820s and its name was eventually changed to ‘tuberculosis’ in 1839 by J.L. Schonlein. The bacillus resulting to the disease known as Mycobacterium tuberculosis was discovered in 1882 by Robert Koch, a discovery that won him the Nobel Prize in medicine or psychology in 19051.
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TB is caused by a collection of closely linked bacterial species Mycobacterium tuberculosis complex. In the modern world, the major cause of the disease is Mycobacterium tuberculosis. Other members of the group complex that can lead to the problem include M. microti, M. bovis, as well as M. africanum. M. microti does not result to TB in people, M. africanum is highly rare, whereas M. bovis is the major cause of the disease in animal species in addition to having a wider host range. People are infected by M. bovis through milk, it products as well as meat from an infected animal2. It is approximated that in the pre-antibiotic period, M. bovis was the cause of about 6% of tuberculosis demises in human beings.
Regardless of the advanced techniques for diagnosis and treatment of TB, it is unfortunate that millions of human beings are still suffering and dying from this ailment. Research indicates that Tb is one of the top two infectious killing diseases in the globe after HIV/AIDS. Although tubercle bacilli was discovered approximately 130 years ago, a definitive knowledge of pathogenesis of tuberculosis still remains deficient. Even though the disease can affect individuals of any age, people with destabilized immune systems, for instance, those with HIV infection are at an increased threat. Because the immune system in healthy individuals wads off the causative bacteria, tuberculosis infection in such people is regularly asymptomatic3. The bacterium resides and reproduces in the macrophages, therefore avoiding the natural defense mechanisms in the patient’s serum. Infection with TB fundamentally results in two phases: tuberculosis disease or asymptomatic latent tuberculosis infection (LTBI).
Background
The early periods of Tb control were marked with non-availability of chemotherapeutic agents, lack of diagnostic x-ray facilities and tools, as well as absence of any TB control procedures and programs. The era lasted during the middle of the 20th century. During this time, since no treatments or drugs with drug combinations were effective or available against the disease, a sanatorium movement was started in Europe and spread across the globe fast. Famous rationale for sanatoria approved a regimen of rest, open fresh air, good nutrition, and high altitude that offered the principal chance that the patient’s immune structure was likely to ‘wall off’ segments of pulmonary tuberculosis infection4. For the treatment of the disease, Hermann Brehmer in 1863 opened the globe’s first sanatorium known as Brehmerschen Heilanstalt fur Lungenkranke located in Gorbersdorf Silesia, the current Poland.
Outdated policies and practices for treatment of tuberculosis put people at increased risk and death. One of the identified methods is use of retreatment regimes that potentially increase resistance to drug and compulsory hospitalization in the course of treatment. Medical experts currently observe that past policies of using rapid molecular tests have not reached the wide coverage required. Efforts to treat ‘consumption’ or phthisis’ over the years have been tales of frustration and tragedy5. A variety of dietary interventions, herbal concoctions, and climatic prescriptions dominated the past as the remedies provided for TB treatment. By contrast, purging and bleeding accelerated and amplified mortality rates.
At the turn of the 20th century, G.B. Shaw, through one of the actors in his play ‘A doctor’s Dilemma’, depicted the medical treatment of the disease in England as “an enormous commercial system of poison and quackery”. With the discovery of penicillin and sulfonamides in the 1930s, nonetheless, truly effective antimicrobial therapy became real. The next principal advance in therapy regarding the past practices and policies was the introduction of rifampicin (RIF). RIF was researched in Africa and Hong Kong displaying that practical combinations of SM, INH, EMB, RIF resulted in predictable treatments of over 95% of total cases in a period of eight to nine months5. This indicates that the method was a success as many doctors around the globe preferred it as compared to other methods during the years.
Current Research Efforts
Governments, stakeholders, and other non-governmental bodies are tasked with the responsibility of reducing if not stamping out tuberculosis because the disease has harvested many lives for many years. Recent rises in funding for the disease has led to substantial growth in the comprehension of the basic epidemiology and biology of the pandemic. It is unfortunate the knowhow has not led to any visible change on the current worldwide trends of tuberculosis6. In spite of the fact that Tb incidence seems to have stabilized in many nations, the total number of patients with such cases is on the rise as a function of the human population growth around the globe.
Of major interest are the continuing epidemics of multidrug-opposition TB, in addition to the synergies evident between the persistent epidemics of HIV/AIDS and TB and several other comorbidities such as diabetes. As the global understanding of the disease improves, medical experts and researchers are endeavoring to make better forecasts about the future trajectory of tuberculosis and to develop new tools to counter and control the ailment better and ultimately reverse worldwide trends7. Mathematical models are already being applied widely to research epidemiology of TB and assist in guiding control policies and procedures. Much theoretical emphasis has likewise been placed on trying to delineate the effect that drug opposition will have on global tuberculosis pandemic.
Some of the theoretical method has proved more complicated by including new biological insights retrieved empirically and via targeted experimental research. Initial theoretical researches on the multiplication of drug-resistant MTBC were founded on the assumption that numerous drug-opposing bacteria had an innate fitness drawback compared to drug-vulnerable strains8. Nevertheless, as is proving clear from molecular and experimental epidemiological examination, substantial heterogeneity is evident with respect to the reproductive achievement of drug-opposing strains. Newer mathematical approaches fundamentally are responsible for majority of this heterogeneity.
Discussions
One of the research materials displays diagnostic methods for tuberculosis and they are detection of mycobacteria and its antigenic products also referred to as direct method and the indirect method, which is the host particular immune reaction to the organism. The direct method involves microscopic evaluation of Ziehl-Neelsen (ZN) stained daubs is of both epidemiological importance in the assessment of a patient’s infectiousness. The advantage of this method is that it is cost effective and convenient and it is an approach likely to remain as one of the most effective techniques in diagnosis of the tuberculosis and in monitoring the treatment and progress of patients around the globe. The other method of diagnosis is the indirect method. It is a method that uses serological tests9. Most of the tests applied in the past have low sensitivity, specifically, in instances of HIV positive patients. Additionally, the assays were expensive and posed difficulties and challenges to users while distinguishing between M. tuberculosis (Mtb) with numerous other bacterium species contaminations in the past.
Given the drug groups supplied in the past, now, and in the future, it is considerably unlikely that the length of therapy will be able to be lessened to four months as indicated in the literature. To reduce therapy below this level will require active novel agents’ verses the semi dormant, periodically multiplying germs abandoned after the initial dramatic assassinations or an immunological mediator that significantly enhances the host’s cellular immunity. The materials provide extensive explanations over the nature and scope of the disease giving relating historical perspectives to the current ones and those expected in the future. Research indicates that fully treating and preventing further spread of Mycobacterium tuberculosis is core to the control and elimination of the disease. The research further indicates that if TB drugs are not taken correctly or stopped too soon, an individual may again develop the sickness or resistance to drugs, giving room to further spread of the dangerous disease. Tuberculosis, fundamentally accounts for 2million deaths annually, with the first being HIV/AIDS with a rate of 3million and malaria 2 million6.
The literature systematically lays down facts and summary about the disease by using various methods and techniques to evaluate the various symptoms of the disease, causes, diagnosis, and treatment methods. Since the applied research is peer-reviewed, disadvantages are almost non-available. The applied research materials explicitly depict that in 2014, over nine million people in the world were diagnosed with tuberculosis. The world recorded 1.5 million TB-recounted deaths. Literature also portrays tuberculosis as the leading killer of individuals with HIV globally. A total of 9,422 tuberculosis cases indicating a figure that represents a rate of 2.96 cases for every 100,000 people were reported in the United States two years ago. Both the case rate and TB cases reported reduced, representing a 2.2% and 1.5% decrease, respectively, in comparison to 201310. This represents the smallest dwindle in more than a decade, reports the research.
In the analysis of tuberculosis, the researchers have underlined the importance of awareness of symptoms that led to the disease. The authors have also analyzed the major treatment patterns and each of them has selected the best according to his or her studies. Some of the authors of the materials are doctors or medical practitioners, or experts in the medical field. It means that the information provided in all the materials is correct and has been approved for use. This information is relevant and of great importance to student medical practitioners and any other people who wish to gain an understanding of the killer disease11. The researchers have broken down all the information bit by bit, so that dummies with little understanding pertaining to the disease are able to comprehend what is being said.
Despite researchers claiming that concentrated method can be superior to the direct method of diagnosis, it is not being conducted in peripheral TB laboratories in poor countries due too the following concerns:
Limited financial and human resources
Viability of centrifugation in settings with asymmetrical power supply
Lack of adequate training capacity
Improper bio-safety arrangements
Eminent biohazard caused by centrifugation
The researchers in the literature do not include the above points in spite of the fact they are critical in the examination and diagnosis for tuberculosis for some low-income countries.
Recommendations
Tuberculosis is a major threat to lives of many people in the world. The disease has various symptoms, for instance, coughing blood, coughing that last for a period of over three weeks, chest pains and pains with breathing, fatigue, weight loss, fever, sweating during the night, loss of appetite, chills, among others. When one experiences such signs, it is important that he or she sees a doctor to receive medication before the condition worsens. Neglecting the early stages of tuberculosis may lead to bigger problems and finally death. It is therefore the role of the government and other stakeholders to join hands and inform the public about the disease. Poor people in rural and marginalized areas are essentially the worst hit by the pandemic because they are either less informed or do not have the finances to cater for the health conditions. Countries should ensure they increase the amount of funding to health departments to enable the sector the ability to sensitize people on the dangers and symptoms of tuberculosis.
The amount of money charged for rendering tuberculosis services and treatment should likewise be reduced or done away with because it poses a major barrier for poor people to access treatment in hospitals. Finally, individuals in the society should live as a community to help and teach one another about the consequences of not seeking early treatment in addition to being of assistance in times of financial crises.
References
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