Tuberculosis the Emergence and Re-Emergence of Tuberculosis:

Tuberculosis The Emergence and Re-emergence of Tuberculosis: Prevalence of Multi-Drug-Resistant Tuberculosis in the 21st Century In the 2003 lung disease statistics, tuberculosis is considered the "foremost cause of death from a single infectious disease," wherein TB is prevalent among developing countries, causing 99% of deaths (ALA, 2004). Indeed, American Lung Association (2004) considers tuberculosis as the an "ancient scourge," gaining prevalence in the 19th century and resurging once again in the 21st century, despite medical technologies developed to curb the said airborne disease.

Tuberculosis is an airborne disease that is characterized chronic or acute bacterial infection that attacks the lungs, and can also affect other parts and vital organs of the body, such as the bones, skin, kidney, gastrointestinal tract, and the neck (affecting the lymph nodes) (Reichman, 2002:14). It is caused by Mycobacterium tuberculosis. Symptoms of TB are coughing, chest pain, shortness of breath, fever, chills, and fatigue (Microsoft Encarta 2002). The development and origins of TB dates back 8,000 to 10,000 years ago.

It was earlier detected in Egypt, where mummified corpses where found to contain traces of tubercles, nodes that develop at the onset of TB. However, a comprehensive history of TB by Reichman (2002) traces the development of the disease from cows. Similar to the development of the SARS and avian flu (bird flu) viruses, the disease was theorized in the late 20th century to have originated from cows, and has been transmitted from animals to cows when farmers started living in close quarters and communities with the animals.

The bacterium present among TB-carrying cows is the Mycobacterium bovis, which can be transmitted through the air (by breathing, sneezing, or coughing) to another living agent. Apart from being transmitted airborne, the bacterium was also transmitted through the cow's milk, thriving in the warm environment of the human body. As the bacteria learned to adapt and thrive inside the human body, specifically in the lungs, causing it to mutate and develop into another kind of bacterium -- the Mycobacterium tuberculosis.

Thus, TB became not only an animal disease, but a human disease as well (11). Reichmann discusses in detail the processes that happen inside the human body as the bacteria starts developing tubercles, which signifies the onset of TB. Once the bacteria thrive inside the body, it will begin multiplying itself. However, the body's defense cells, macrophages, prevent the onset of TB by clustering around the bacteria during its process of reproduction.

These macrophages, unfortunately, are eventually taken over by the TB bacteria, where they "break into the macrophages and begin multiplying inside them" (14). Once the macrophages are "devoured" by the bacteria, they start forming nodules, creating a lump called tubercle, eventually developing to TB. With the onset of TB, an individual's immune defenses start to weaken, specifically after 3 to 4 weeks of tubercle and TB development.

Since TB is an airborne disease, preventive methods adopted to stop the widespread occurrence of TB, such as the establishment of ventilation systems to prevent the airborne transmission of TB and vaccination of bacillus Calmette Guerin (BCG). Furthermore, with developments in medicine, drug therapy also helped alleviate the spread of TB, and it has become one of the most effective ways to resist and prevent the spread of M. tuberculosis.

But over time, over a century after the formulation of BCG vaccine and production of TB-resistant drugs, there have been a recurrence of this disease not only among developing countries (where TB is prevalent), but also in developed countries like the U.S. The recurrence of TB is now identified as the multi-drug-resistant tuberculosis, named as such because of its ability to resist the effects of anti-TB drugs. This phenomenon is addressed in as early as 20th century, and has remained to be a prevalent issue in the 21st century.

In his journal article for the New England Journal of Medicine, Frieden et. al. (1993) addresses this phenomenon, suggesting that the occurrence of drug-resistant TB is mainly caused by "infectious disease for prolonged periods after treatment has begun." He further comments that TB is not just a disease triggered by the physiological reactions of the body to the bacteria, but the environmental conditions (social conditions) where TB is most likely to occur is a significant factor for the recurrence of drug-resistant TB. For Frieden et.

al., "substance abuse, poverty, and crowded living conditions" also determine the susceptibility of individuals to TB: poor living conditions result to higher chances for TB to thrive and survive despite the effects of drug treatments. Indeed, the American Lung Association affirms Frieden's report in its presentation of Trends in Tuberculosis for 2003. Developing countries, which have poor living conditions due to poverty and inadequate health services, have the highest TB death rates at 99%, with a morbidity rate of 95%.

In the U.S., the socio-demographic statistics on TB occurrence among states also reflect Frieden's findings. People susceptible to drug-resistant TB are characterized as belonging to the age bracket of over 65 years, male, a minority member (comprising 80% of TB cases in the U.S.), specifically, non-Hispanic blacks. The general profile of ALA's statistics show that foreign-born males are susceptible to the disease, affirmed by the fact that in the U.S., most foreign-born males, as well as communities, live in poverty with poor living (and working) conditions.

These findings are also reiterated in a recent study by Hung (2002), which studied the incidence of drug-resistant TB among prison inmates in the U.S. Analysis of socio-demographic date yielded the findings that risk factors that determine susceptibility of drug-resistant TB among the respondents (prison inmates) are "race, citizenship and birthplace," which are all "positively correlated." These studies show that social and economic factors primarily affect the prevalence of TB, particularly drug-resistant TB.

The future of tuberculosis, as studies show, relies heavily not on vaccination and drug treatments, but at the initial observation of potential occurrence of the disease through the directly-observed therapy short-course (DOTS) (ALA, 2004). Through DOTS, TB patients are able to avail of medical help free of charge, and this is promoted among "lower income countries as part of the economic reforms" (Reichman, 2000:871).

Although this program has already been successfully managed in the U.S., the cost of drugs are still an impediment for patients in developing countries, further worsening the state of TB prevalence among poor nations. This is why support by the World.