By the name of tuberculosis is designated the infectious disease caused by bacilli of the Mycobacterium genus, included in the so-called Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis and M. africanum) and by other opportunistic mycobacterial species potentially pathogenic for humans. The author reviews the historical evolution of the disease, as well as its pathogenesis, diagnosis and treatment, with special attention to pharmacological therapy.
Attacked by Tuberculosis
Throughout its history, the human species has been periodically attacked by different microorganisms that have endangered its own existence. Although some of them, like the agents that produce tuberculosis or malaria, have been causing millions of deaths annually, occasionally the emergence or re-emergence of a microorganism ends up causing an unexpected and catastrophic pandemic with unpredictable consequences.
The same thing happened in the recently completed twentieth century, during which two unexpected health cataclysms were added to the old epidemics. One of them is already remote, the influenza pandemic that began in 1918 and that in less than 3 years caused the death of approximately 25 million people around the world.
The other great pandemic of the twentieth century began less than 20 years ago, when in the summer of 1981 a homosexual man was treated in the United States for an opportunistic infection due to a severe immunodeficiency not explained by the knowledge that was available to date. It is surprising that the later identified as human immunodeficiency virus (HIV) has been able to spread in such a way throughout the world in less than two decades, causing such a number of infected, sick and dead. It is also surprising because it is not a microorganism that is transmitted by air or digestive, but only by human interrelation, which theoretically should slow down its expansion and dissemination in the community. At present there is no part of the world that is free of this new pathogen, whose devastating effects are still difficult to predict for the future. All this has led to accept that this terrible pandemic took much longer among the human species, especially in some disadvantaged areas of the planet such as sub-Saharan Africa.
In fact, if a microorganism that was capable of behaving like a true friend of Mycobacterium tuberculosis had been designed, it would not have turned out as perfect as HIV, capable of selectively attacking by killing or altering in function those cells of our immune system capable of defending ourselves of the aggression of Koch’s bacillus.
Tuberculosis oldest endemic disease
Nowadays, it is already accepted that the oldest endemic disease that affects humanity, the one produced by tuberculosis, and the most recent pandemic established in the human species, the one produced by HIV, are uniting their pathogenic effects in such a way that are the leading cause of death in large areas of the world, it is estimated that important regions of the poorest countries of the world are going to be literally deserted young population in the coming decades by the deadly association of these two pathogens.
The contagion with drug-resistant bacilli produces a resistant tuberculosis that is only diagnosed when, after 3-5 months of treatment, it is proven that it has not been effective
One of the most serious human infectious disease – Tuberculosis
In the new millennium, tuberculosis remains the most important human infectious disease that exists in the world, despite the efforts that have been invested for its control in the last decade. In reality, the current situation of tuberculosis in the world is a faithful reflection of the enormous economic and social differences that exist between the different countries. Thus, despite its universal distribution and its very poor epidemiological situation, the vast majority of developed countries consider this disease as surpassed and have stopped fighting against it. However, tuberculosis is a global problem and it will not be possible to think about its eradication until it disappears from the whole of the earth. The industrialized countries, which have fought effectively against tuberculosis in recent decades, have made the mistake of believing that the fight against this disease ended within the limits of their borders and have not helped, as they should, the countries poor to overcome this disease. Nowadays, with massive migrations and with the ease that exists to travel, the industrialized countries are paying the hard credit to attend to an increase in their tuberculosis rates due to the disease that immigrants are bringing from areas where tuberculosis It is still endemic.
The treatment of tuberculosis and current prevention measures against this disease are very effective and have managed to control the endemic in rich countries, but these measures are expensive and need a costly health structure. Precisely its high cost has prevented the correct use in poor countries, thus losing its effectiveness.
How to properly treat tuberculosis?
If the treatment of tuberculosis is not done correctly, the bacilli can become resistant to the drugs used. The contagion with drug-resistant bacilli produces a resistant tuberculosis that is only diagnosed when, after 3-5 months of treatment, it is proven that it has not been effective. Then it becomes necessary to start again using this time less effective, more toxic drugs and whose management needs a lot of experience on the part of the doctor. This frequently leads to the patient dying or having a chronic tuberculosis with contagious capacity for the rest of his life.