One of the top 10 causes of death worldwide, with over 4,000 victims every day. What many people know: Tuberculosis (TB), formerly also known as "consumption", is an infectious bacterial disease that primarily affects the lungs and, if left untreated, can lead to death.
What many do not know: Although TB has long been considered "defeated", it still represents a huge health problem. Because it is still the most common killing infectious disease in the world. According to reliable estimates, every third person is infected with the pathogen, the mycobacterium tuberculosis.
What many should know: How, where and when can you become infected with TB? Who is particularly at risk? How is this disease going? What are the options for diagnosis and therapy? The answers to these questions and much more information can be found here.
Tuberculosis (TB) is an infectious disease caused by a bacterium (mycobacterium tuberculosis). The pathogen was discovered by Robert Koch in 1882 and is very similar to that of leprosy. Untreated, TB disease leads to death in half of all patients in less than two years. Along with HIV / AIDS, TB is one of the most common killer infectious diseases worldwide. It is the most common for AIDS patients
The infection with the pathogen Mycobacterium tuberculosis usually takes place as a droplet infection via the respiratory tract with the formation of a "primary complex" in the lungs. Or to put it simply: tuberculosis spreads from person to person through the air. When people with pulmonary tuberculosis cough, sneeze, or spit, they throw TB bacteria into the air. A person only has to inhale a few of these germs to become infected.
If the immune system is intact, the tuberculosis pathogens can survive in the body for decades without the disease breaking out. During this so-called latent infection, those affected are not contagious. But there is a constant risk that the disease will turn into active tuberculosis if the immune system is weakened - for example due to undernourishment or malnutrition, poor hygiene conditions, sustained high levels of exertion or stress or serious illnesses. Many of these factors interact with poverty, which is why TB is considered “poverty associated” and affects the most vulnerable groups in society
The combination of HIV and TB is particularly dangerous: If an HIV-positive patient comes into contact with TB bacteria, they will contract TB much more often than a person without HIV infection. At the same time, TB causes an HIV infection to progress faster. The diagnosis is often made very late because the HIV infection makes the diagnosis of TB very difficult. TB is a leading cause of death in people infected with HIV.
The globally standardized therapy for tuberculosis disease consists of taking isoniazid, rifampicin, ethambutol and pyrazinamide for at least six months - ethambutol and pyrazinamide of which, however, only in the first two months. In 2010, the WHO issued new treatment guidelines for the treatment of multi-drug-resistant tuberculosis. TB therapy is free of charge in most countries. However, because of the disease, the patients often have no income and still often have to bear costs such as medication for side effects or transport to the health station. Therefore, some patients cannot afford the therapy or they stop the treatment before it is finished. However, this increases the risk that TB will develop into a resistant form (see Resistance in tuberculosis). Again and again, however, it is errors on the part of the national health systems that are responsible for the interrupted use of medication and thus for the risk of resistance developing.
It is assumed that without treatment, every third person affected will die of tuberculosis after months or years. One in two survivors retains permanent lung damage or damage to other organs. A renewed outbreak of the disease in patients who have not been fully treated is possible at any time as soon as the immune system is weakened again.
If antibiotics are not taken regularly or if antibiotic therapy is stopped before all bacteria have been killed, the surviving bacteria develop resistance to the drugs. The drugs are thus ineffective. According to the World Health Organization WHO, around 500,000 people developed resistant tuberculosis in 2019.
As a result, TB patients affected by resistance have to take special, often less effective drugs with mostly serious side effects. The therapy time is also extended from six months to up to two years. These drugs are also often significantly more expensive. If this therapy is not carried out to the end, the pathogens develop further resistances, whereby the choice of effective alternative drugs (“second line”) and thus the chance of a successful treatment are considerably reduced.
There is the "BCG vaccination" against tuberculosis. However, the effectiveness of this vaccine is mainly limited to certain forms of TB in young children (such as tuberculous meningitis). So, it does not generally protect against infection with TB bacteria.
Because of the low number of cases in Germany, vaccination is not recommended in this country.
Although treatable, tuberculosis (TB) is still one of the top ten causes of death worldwide. According to estimates by the World Health Organization, around 1.4 million people died of TB in 2019, and around 10 million were newly diagnosed in the same year, including around 1.2 million children. People with a weakened immune system are particularly at risk. A third of the world's population - two billion people, i.e. about one in three! - is infected with the TB bacterium, but most of them will never get sick.
Most of the TB cases occur in the populous countries of Asia. But also, in many countries in southern Africa, tuberculosis is still a widespread disease that costs many lives. Unfortunately, there has been a special development for years in the countries of the former Soviet Union: Fewer people fall ill here, but 20 to 50 percent of diagnosed patients have difficult-to-treat resistant tuberculosis (as of 2019).
The data published each year by WHO in the Global Tuberculosis Report is based on figures reported by national TB control programs or ministries of health. But these are not always actually registered cases: Because many national health systems are poorly equipped and there is a lack of qualified medical staff, it is often not all sick people who are recorded and extrapolations for the statistics are made on the basis of our own studies.
Antibiotic resistance in tuberculosis.
If antibiotics are not taken regularly or if antibiotic therapy is stopped before all bacteria have been killed, the surviving bacteria develop resistance to the drugs. The drugs are thus ineffective. According to the World Health Organization WHO, around 500,000 people contracted multi-drug-resistant tuberculosis in 2018.
As a result, TB patients affected by resistance have to take special, often less effective drugs with mostly serious side effects. The therapy time is also extended from six months to up to two years. These drugs are also often significantly more expensive. If this therapy is not carried out to the end, the pathogens develop further resistances, whereby the choice of effective alternative drugs (“second line”) and thus the chance of a successful treatment are considerably reduced.
There are these types of resistant TB:
If the bacterial strain is resistant to one of the four antibiotics in the standard therapy, this must be exchanged and the therapy extended.
Here the TB pathogens have developed resistance to rifampicin and isoniazid, the two most important drugs in standard therapy. The bacteria are often resistant to other drugs. After a very elaborate test of the effectiveness of individual drugs, at least four drugs that are still effective must be combined for therapy.
In addition to the resistance of the MDR-TB, bacterial strains of the XDR-TB also have resistance to the drug group of the so-called fluoroquinolones. As a result, the choice of substitute drugs is extremely limited.
Alternative drugs: expensive and usually poorly tolerated
Many of the alternative drugs are expensive due to their existing patent protection and unaffordable for most people in developing countries. Side effects occur often and severely, for example severe damage to the nervous system or hearing damage or even deafness.
Diagnosing resistant TB is also very complex and expensive. In developing countries there are only a few laboratories that can clearly identify isoniazid resistance in MDR-TB and XDR-TB. Many patients die during MDR treatment, which lasts up to two years, because the bacteria had additional resistance in the sense of XDR-TB.
In addition, there may be resistance to alternative drugs. The affected patients can only hope that the new drugs being researched will soon be fully developed and tested ( see “Research” fact sheet ). However, the often poorly trained health systems in developing and emerging countries will not be able to provide these expensive but life-saving drugs. For example, tuberculosis can cost those affected by poverty their lives.
Tuberculosis (TB) has long been a neglected disease, meaning insufficient resources have been invested in research. Only a few years ago, the World Health Organization (WHO) sounded the alarm: If nothing more is done about TB immediately, the disease can no longer be treated - because the pathogen is becoming less and less sensitive to the few antibiotics available. According to the WHO Global Tuberculosis Report, around 500,000 people contracted multi-drug-resistant tuberculosis in 2019 alone. The number of unreported cases is probably many times higher, since in many places it is not yet possible to diagnose resistant TB ( see fact sheet “Resistance” ).
The new awareness has already set things in motion: Increasing investments are being made in the development of reliable rapid tests, for example in the “GeneXpert”. The WHO has recommended this for the diagnosis of TB since 2010. It shows within hours whether a person is infected with TB and at the same time shows whether the pathogen is resistant to the most important antibiotic rifampicin. In the projects of RedAid Nigeria, this diagnostic method is often used.
New drugs - but not for everyone
There has also been progress in the treatment of TB patients: two new drugs have been approved for the treatment of tuberculosis since 2014, Bedaquiline and Delaminid. Another drug, Pretomanid, was developed by the non-profit organization “TB Alliance” and approved in 2019 for the treatment of extremely resistant tuberculosis. The drug clofazimin, known from the fight against leprosy, is also effective in TB - the pathogens causing leprosy and TB belong to the same bacterial strain. Studies are currently being carried out in various countries to find out in which combination the new drugs can be used in the shortest possible duration of treatment.
All of this gives hope. But viewed globally, not all people have access to the new drugs. Some of these drugs are very expensive. As long as health systems and patients in poor regions of the world cannot afford these drugs, tuberculosis will remain a disease of poverty and one of the world's greatest health problems.
Tuberculosis (TB, formerly also known as consumption) is a usually slow infection of the lungs and other organs caused by Mycobacterium tuberculosis. Along with HIV and malaria, TB is one of the most common infectious diseases worldwide: According to the World Health Organization (WHO), around 10 million people are newly infected every year. The transmission usually takes place through a droplet infection.
If the immune system is intact, these bacteria can survive in the body for decades without a patient falling ill with TB (so-called latent infection). Undernourishment or malnutrition, poor hygiene conditions, constant high levels of exertion or stress or serious illnesses such as HIV / AIDS or diabetes lead to a weakening of the immune system: the illness can break out. Many of these factors interact with poverty, which is why TB is considered “poverty associated” and affects the most vulnerable groups in society.
Symptoms of the disease are persistent coughing, sometimes with bloody sputum, feeling weak, night sweats, fever, loss of appetite and weight loss. For many patients, this may initially be perceived as a cold. In addition, in many cases people in developing countries have no or only very limited access to health care. If someone does not go to the doctor, there can also be social reasons — for example the fear of stigmatization.
The diagnosis of a TB infection can only be confirmed by the direct detection of tuberculosis bacteria, for example by microscopic examination of sputum (coughed up secretion of the airway mucous membrane). The relatively fast GeneXpert test method, the use of which is also recommended by the WHO, has been used more and more for a number of years: the molecular biological analyzer can also reliably detect a lower number of pathogens and at the same time identify simple (not multiple) resistances. It is therefore particularly suitable for people who are already suspected of having a resistant TB strain. Also in the projects of the RedAid/DAHW Deutsche Lepra- und Tuberkulosehilfe e. V., GeneXpert is being used more and more.
However, TB diseases often go undetected at first because not enough bacteria have been coughed up. X-ray examinations can help with the diagnosis. Newer blood tests such as the gamma interferon test are also available. Although they are easy to use, they cannot differentiate between a pure infection with the TB pathogen and an outbreak of tuberculosis.
The globally standardized therapy for tuberculosis disease consists of taking the four antibiotics rifampicin, isoniazid, ethambutol and pyrazinamide for at least six months - the last two, however, only in the first two months. In 2019, the WHO issued new treatment guidelines for the treatment of multi-drug-resistant tuberculosis. TB therapy is free in most countries. However, because of the disease, the patients often have no income and still often have to bear costs such as medication for side effects or transport to the health station. Therefore, some patients cannot afford the therapy or they stop the treatment before it is finished. However, this increases the risk that TB will develop into a resistant form.
Without treatment, one in three patients dies of tuberculosis, and one in two survivors retains permanent damage to their internal organs. A renewed outbreak of the disease in patients who have not been fully treated is possible at any time as soon as the immune system is weakened again.
Although treatable, tuberculosis (TB) is still one of the top ten causes of death worldwide. According to estimates by the World Health Organization, around 1.4 million people died of TB in 2019, and around 10 million were newly diagnosed in the same year, including around 1.2 million children.
Most of the TB cases occur in the populous countries of Asia. But also, in many countries in southern Africa, tuberculosis is still a widespread disease that costs many lives. Unfortunately, there has been a special development for years in the countries of the former Soviet Union: Fewer people fall ill here, but 20 to 50 percent of diagnosed patients have resistant tuberculosis that is difficult to treat (see fact sheet “TB Resistance”).
The data published each year by WHO in the Global Tuberculosis Report is based on figures reported by national TB control programs or ministries of health. But these are not always actually registered cases: Because many national health systems are poorly equipped and there is a lack of qualified medical staff, it is often not all sick people who are recorded and extrapolations for the statistics are made on the basis of our own studies.
The situation is particularly difficult in slums, refugee settlements or remote regions: Here people are often not registered at all, and access to health centers, which are usually kilometers away, is difficult or even impossible. Due to the massive diagnosis gap, the WHO assumes that around 30 percent of all TB cases worldwide (equivalent to around three million) in 2018 were not tested or diagnosed at all. Still a far too high number - but compared to the previous year with an "unreported figure" of around 40 percent, a positive trend that can be attributed to improvements in diagnostics, especially in India and Indonesia.
Tuberculosis (TB, formerly also known as consumption) is a usually slow infection of the lungs and other organs caused by Mycobacterium tuberculosis. Along with HIV and malaria, TB is one of the most common infectious diseases worldwide: According to the World Health Organization (WHO), around 10 million people are newly infected every year. The transmission usually takes place through a droplet infection.
If the immune system is intact, these bacteria can survive in the body for decades without a patient falling ill with TB (so-called latent infection). Undernourishment or malnutrition, poor hygiene conditions, constant high levels of exertion or stress or serious illnesses such as HIV / AIDS or diabetes lead to a weakening of the immune system: the illness can break out. Many of these factors interact with poverty, which is why TB is considered “poverty associated” and affects the most vulnerable groups in society.
The Global Fund
In 2002, the Global Fund (“The Global Fund”) was set up to finance national measures against the global epidemics of AIDS, tuberculosis and malaria. This partnership between governments, civil society, the private sector and affected communities works closely with other bilateral and multilateral organizations to complement existing efforts to combat the three infectious diseases. In 2018, 5.2 million TB sufferers were treated with support from the Global Fund. By mid-2019, the Global Fund provided financial resources totaling almost 42 billion US dollars worldwide, with Germany contributing more than 2.5 billion euros (source BMZ).
Numbers of new TB cases
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There are many variations of passages of Lorem Ipsum available, but the majority have suffered alteration in some form
