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History explains why TB case caused such worldwide concern

Originally published on HistoryNet.com. Published Online: June 04, 2007 
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2007-06-03 | There's a reason why reports of a rare strain of tuberculosis attracted worldwide attention: a history perhaps as deadly as the plague.

DENVER – There's a reason why reports of a rare strain of tuberculosis attracted worldwide attention: a history perhaps as deadly as the plague.

More than 4,000 years ago, tuberculosis killed an Egyptian whose mummified remains were dug up; the case was first described in 1910. Hippocrates called it consumption in 460 B.C.

Pathologist Thomas Dormandy of London, author of "The White Death: The History of Tuberculosis," said TB may have killed more than the plague. Outbreaks of the Black Death were shorter, less frequent. The lack of credible records makes it impossible to say.

Tuberculosis remains a global health threat. 'It is a rough disease to deal with even with antibiotics because drug resistant strains develop," said Dormandy. It has claimed the lives of nameless millions, including many of the high and mighty, though the science used to confirm TB deaths in centuries past remains suspect.

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And in Africa "it is the most common terminal event for AIDS victims," said Dormandy. He said he became interested in it because of the tremendous

Though around for centuries, it spread mostly widely during the Industrial Revolution, though no one is certain why. "It is partly, I think, urban life and malnourishment. Most epidemics, especially TB are mysterious," Dormandy said.

He said became interested in the disease as a medical student when he visited sanatoria in Switzerland, and over the years realized it had been one of the great influences of European literature, art and thought during the 19th Century.

Even Nazi doctors sought to identify its origin and find a cure, using Jewish concentration camp victims.

Kings, writers, musicians and composers have all fallen to or suffered from TB. Among them: Chopin, Henry David Thoreau, Robert Louis Stevenson, Franz Kafka, King Edward VI of England, Eleanor Roosevelt, and Albert Camus, who won a Nobel Prize for his novel, "The Plague." Greta Garbo played a Parisian courtesan victim in the 1936 film Camille.

This month South African documentary photographer Damien Schumann showed photos of life with TB victims at a Cape Town gallery, including their handwritten texts detailing their lives.

More recent survivors of what has been the white plague, the king's evil and the pale avenger include singers Cat Stevens, Tom Jones and Judy Collins.

Even today, 1.7 million people die annually from the disease, according to a report last year by the University of California at Los Angeles's School of Public Health. Thirty million people are believed to be carriers, with 8 million new cases each year. The World Health Organization estimates that each person suffering untreated TB can infect 10 to 15 people each year.

And there are mounting numbers of people infected with extremely drug-resistant strains, like Andrew Speaker of Atlanta, who was hospitalized last week at Denver's National Jewish Medical and Research Center.

Those strains, known as XDR-TB, are a threat globally and to efforts to contain the disease in the United States, according to the Centers for Disease Control. It says there were 74 cases like Speaker's in the United States between 1993 and 2004. South Africa has reported more 300 cases. The CDC says it cannot determine whether most cases stemmed from contact with infected people or inadequate treatment of less virulent forms of TB.

Tuberculosis' death rate peaked at 60 percent, beginning to decline even, before antibiotics that could stop the disease were developed during World War II.

In the 1900s, the haunted, pale appearance of victims and their slow, lingering deaths, sometimes spitting out blood, made TB a popular subject for European books, plays and opera, including "La Boheme." Edgar Allan Poe, who lost his mother and many friends to it, was influenced by the disease.

English writer John Bunyan called it "the captain of all these men of death." Thomas Mann's Nobel Prize-winning "Magic Mountain" tells of people going to a mountain sanitarium in Switzerland to "take the cure."

Dr. Robert Koch, a German, identified the bacterium that causes the disease in 1882.

"If the importance of a disease for mankind is measured by the number of fatalities it causes, then tuberculosis must be considered much more important than those most feared infectious diseases, plague, cholera and the like. One in seven of all human beings dies from tuberculosis," Koch found. He was awarded the Nobel Prize for medicine in 1905.

Microbiologist Selman Waksman was awarded the Nobel in 1952 for the discovery of streptomycin, the first drug to effectively halt the disease.

Some countries vaccinate their populations against TB, though vaccines are rarely used in the United States – usually for children living with a TB-infected adult. Dormandy said the vaccine is not 100 percent effective like smallpox but is effective.

After a 30-year decline in cases, the CDC reported there was a TB epidemic in the United States between 1985-1992. Much like AIDS, patients need treatment with a cocktail of four to six drugs for up to 24 months, while an HIV infection can cause TB to become active.

Copyright 2007. The Associated Press.



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