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Tuberculosis (TB) is an infection disease usually caused by the bacterium Mycobacterium tuberculosis (or, rarely. by other species of Mycobacterium). In western countries tuberculosis is no longer a major problem, as it was a century ago, but in many developing countries it is still a prevalent disease; everv year about two million people still die of it.

Tuberculosis can be prevented by vaccination, and the introduction of BCG vaccine some forty years ago has contributed considerably to the decline in incidence of TB. Vaccination can be carried out at birth or between the ages of ten and thirteen if a skin test shows a person is not immune.

Although tuberculosis may affect most organs of the body, by far the most common form of the disease involves the lungs. It is spread almost entirely by organisms coughed out of the lungs of people harbouring the tubercle bacillus. Until relatively recently the majority of people became infected with tuberculosis before reaching adulthood, although very few of them were actually ill. Cow's milk used to be a common source of infection but milk is now pasteurized and tested for the tubercle bacillus, and most herds are now free from TB.

When a person first inhales tubercle bacilli an infection may be set up. A small area of tuberculous pneumonia then develops, but this is nearly always overcome by the body's natural defences. A small scar remains, sometimes visible on X­rays. In many cases the disease never develops beyond this first stage, but occasionally natural resistance is unable to overcome the infection, which may spread from the lung through the bloodstream 10 other organs of the body. Even when the infection appears 10 have been overcome, a small number of living tubercle bacilli may remain dormant in the apparently healed lung, and the infection recurs, per­haps years later. It is likely that most cases of tuberculosis of the lungs in adults represent a secondary stage of an infection present since childhood.

The adult with tuberculosis, whether a reactivation of a childhood infection or a new infection, develops a new area of pneumonia, usually in the upper part of the lung. This behaves differently from other kinds of pneumonia because the tubercle bacillus has the ability to destroy lung tissue, leaving cavities which may grow larger until much of the lung has been destroyed. The effects of tuberculosis in an adult result partly from loss of lung tissue and in part from the general ill-effects of a serious infection.

Other common sites of tuberculosis are the bones (particularly the spine), the kidneys, the fallopian tubes and lymph nodes. When infection spreads through the blood­stream, minute tuberculous abscesses may develop in nearly all the organs of the body (miliary tuberculosis) and, most dangerously, in the membranes surrounding the brain (tuberculous meningitis).


There are often no symptoms during the primary stage of the disease; or there may be a flu-like illness not associated with TB at the time. If the disease progresses, the destruction of lung tissue causes a dry cough and bleeding, so that the phlegm becomes bloodstained. Coughing up blood is the most common reason for patients with tuberculosis to consult their doctor. Breathlessness occurs only when a large amount of lung has been destroyed and the 'disease is at an advanced stage.


One method of detecting tuberculosis is to carry out a tuberculin skin test. In this, a small amount of a protein extracted from the tubercle bacteria is injected into the skin; those who have, or have had, tuberculosis develop a small painless red lump at the site of the injection. To diagnose a case of pulmonary tuberculosis, the sputum is examined under a microscope so that the tubercle bacilli can be seen and identified. Tuberculosis is also diagnosed with X-rays. Many of those who have an abnormal X-ray or a positive tuberculin test have a disease which has been overcome by the body's defences and may be considered inactive. These people 'require no treatment with antituberculous drugs, but may be kept under observation in case the disease flares up later.


Before the discovery of antituberculous drugs, the main treatment was bed-rest, nourishing food and other treatments aimed at slowing the spread of the disease. Today drug therapy is the main treatment, usually given over a long period - a year or more. Unfortunately the tubercle bacilli can become resistant to antituberculous drugs, so that a drug that at first seems to be curing a particular case may become ineffective after a few months. However, it is very unusual for resistance to develop against two or three drugs at once, and for this reason several different antituberculous drugs are usually given together. If resistant organisms do develop, they may infect other people who will then start their disease with resistant organisms which cannot be treated with that particular drug.

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