It killed Mozart. Andrew Jackson. Eleanor Roosevelt. St. Francis of Assisi. Tuberculosis, a noxious disease spread by hardy bacteria spewed in coughs and sneezes, was once the world`s greatest killer. Known then as the white plague-or consumption-it killed 80,000 people a year in the United States alone at the turn of the century. A cure was found in the `50s, but decades after Americans thought TB was passe, the disease has returned.
After dropping below 23,000 in the mid-1980s, the number of newly reported active TB cases rose to 23,945 in 1989 and 25,701 in 1990, according to the federal Centers for Disease Control. Even higher numbers are expected when final figures are compiled for last year.
The increase is attributed to homelessness, drug and alcohol addiction, AIDS, poverty and infected immigrants from countries where TB is not controlled. In proportion to population, New York, Hawaii, California and Florida had the highest 1990 rates.
People who live on the margins do not generally have enough order in their lives to take the pills required to control TB. At least one city has tried luring patients to clinics with promises of beer; another sends a social worker by daily to watch the infected patients swallow their pills.
”It`s back and in some very, very deadly forms,” said Don Kopanoff, associate director of the Division of Tuberculosis Elimination at the Centers for Disease Control in Atlanta. ”Only now is word getting out that we really have a problem.”
Part of the problem is a wicked strain of TB known as multiple drug resistant (MDR). The disease is spreading through certain areas of the United States, including Miami and New York. Most of the patients who develop this variety also have AIDS, said Kopanoff. This strain, however, is easily picked up by anyone exposed to these drug-resistant patients, so the patients should be effectively isolated, he said.
It takes up to eight weeks to determine if a person has the MDR strain and sometimes the disease kills as quickly as four weeks after the diagnosis is made. It is difficult to treat even a primary TB infection that is resistant to regular TB drugs.
Drug-resistant TB also occurs in patients who have received partial treatment, then stop taking their medication.
In the dark days of the white plague, they knew nothing of what caused it, spread it or how to treat it: Patients most commonly were wrapped in a feather bed behind a fiery stove in an airtight room. Creosote and whiskey were the favored medicines.
The invention of the stethoscope in 1818 was the first step toward conquering TB, and barbaric treatments eventually gave way to fresh air and bed rest followed by light exercise in the early 1900s.
X-rays, invented in 1896, ultimately became a great weapon in fighting TB. Mobile medical vans would visit communities to offer chest X-rays for early TB detection and treatment. Skin tests for early detection were also developed and in the 1950s were given to hundreds of thousands of school children.
Tuberculosis bacteria usually invade the body through microscopic droplets expelled by coughs and sneezes of someone with TB but people rarely get the disease through limited casual contact. You may hold the bacteria in your lungs and never contract the disease; many healthy people never realize they have a primary TB infection. Today, a TB skin test can detect this primary stage and drugs effectively control the infection so that it never advances to the disease stage.
The tuberculosis disease occurs after a primary infection has been fought off by the lungs and the bacteria, still present, are reactivated. The reactivation is not completely understood but is probably linked to poor health, malnutrition or age. The bacteria spread and the body`s reaction to fight the bacteria creates soft, cheeselike areas, which eventually move up the respiratory tract with the mucous layer and are coughed out as sputum.
Early symptoms include coughing (it may be as slight as a lingering cold) and sputum production and if untreated lead to chest pain, appetite loss, night sweats, fatigue and fever. Untreated patients eventually cough large amounts of blood.
Antibiotics to keep the bacteria from multiplying were discovered in the late 1940s and early 1950s and soon led to the control of tuberculosis in America. The most popular drugs used in TB treatment today were discovered then: isoniazid, rifampin and streptomycin. Patients are usually treated with more than one drug because the bacteria may become resistant to the effects of one drug.
During the `60s and `70s, states closed their TB sanitariums or converted them to other uses.
”At the time, it was a good idea,” said Kopanoff. ”TB was being treated more and more on an outpatient basis. But the money they saved by closing the TB sanitariums, they diverted to other programs instead of giving it to TB control. They gave little thought that they still had TB to contend with. And with good, effective anti-TB drugs, everybody, including the federal government, got complacent.”
