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Medical education does not exist to provide students with a way of making a living but to ensure the health of the community Rudolf Virchow.

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Presentation on theme: "Medical education does not exist to provide students with a way of making a living but to ensure the health of the community Rudolf Virchow."— Presentation transcript:

1 Medical education does not exist to provide students with a way of making a living but to ensure the health of the community Rudolf Virchow

2 Tuberculosis has been killing millions for centuries

3 Picture: World Lung Foundation Symptoms of untreated active TB Persistent cough and Low grade-fever Difficulty in breathing Blood in sputum Severe weight loss Night sweats Cambodian TB patient

4 Credit: Marsha Miller, the University of Texas at Austin TB is an ancient human disease! Recent evidence supports a diagnosis of TB in this 500,000 year old young male Homo erectus Bone lesions indicative of TB

5 TB is an ancient human disease! TB spinal lesions have also been found in Egyptian mummies

6 It is estimated that from , TB killed 1 billion people. The annual death rate in the late 1800s was 7 million. TB Ward, Ellis Island "Forgotten Ellis Island, photographer Stephen Wilkes Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926

7 After urbanization as many as one-quarter of all European deaths in the 1800 s may have resulted from TB TB Ward, Ellis Island

8 The famous and the infamous died of TB John Keats Frederic Chopin Anton Chekhov Emily Bronte Simon Bolivar Henry Thoreau

9 The famous and the infamous died of TB along with countless millions known only to their families Eleanor Roosevelt DH Lawrence Franz Kafka George Orwell Eugene ONeill

10 In 1900 TB was still the second leading cause of death in the US CDC

11 Now infectious diseases are much less prominent as causes of death and TB has dropped off the list CDC

12 American Red Cross. "The Next to Go: Fight Tuberculosis." [American Red Cross], "'Stamp' Out Tuberculosis: Buy Christmas Seals." National Tuberculosis Association, "Prevent Disease: Careless Spitting, Coughing, Sneezing, Spread Influenza and Tuberculosis." Rensselaer County Tuberculosis Association (Troy, N.Y.), [ca. 1925] In the early to mid 1900s TB remained a major public health challenge in the US

13 In the US TB is now an almost forgotten disease US TB deaths in 2004: 657 CDC

14 In the US TB is now an almost forgotten disease US TB deaths in 2004: 657 US Influenza deaths in 2004: 1100 US deaths due to asthma in 2004: 3816 CDC

15 Stats from WHO; slide from TBAlliance But not in the developing world!

16 TB is present world-wide but Incidence rates differ dramatically CDC

17 Partners in Health and Harvard Medical School Dept. of Social Medicine Program in Infectious Disease and Social Change For this Peruvian family mourning a child dead to TB the disease is certainly not forgotten

18 Two billion people --one third of the worlds population-- are infected with the bacteria that causes TB World Lung Foundation (2008)

19 Stats:NIAID/NIH Pix: World Lung Foundation Worldwide TB causes: 5% of all deaths ~10% of all adult deaths Morocco India South Africa China

20 Left untreated, a person with active TB will infect other people per year World Lung Foundation (2008) and

21 Left untreated, a person with active TB will infect other people per year World Lung Foundation (2008) and new infections occur at a rate of one per second!

22 In most cases TB starts as an infection of the lungs = pulmonary TB

23 X-rays used to be the primary means of diagnosis

24 Now TB exposure is diagnosed by a skin test

25 A positive test result simply means you have been exposed to TB* at some point and have developed antibodies to it *=Active case Previously cured Inactive case Vaccinated with BCG

26 The next step is a sputum culture

27 The next frontier: DNA testing to identify different strains of TB and assess drug resistance Dbtechno.com

28 The next frontier: DNA testing to identify different strains of TB and assess drug resistance July 2008: WHO unveils $26 million program to create labs in poor nations that can do DNA tests Cost: $5 per test Time frame: 24 hours Rather than weeks to months!

29 However, the TB bacterium can also Infect many other organs, causing distinct diseases

30 However, the TB bacterium can also Infect many other organs, causing distinct diseases Renal TB

31 However, the TB bacterium can also Infect many other organs, causing distinct diseases Renal TB Lupus vulgaris

32 Potts disease = tuberculous spondylitis Credit: Dr Laughlin DawesDr Laughlin Dawes www3.shropshire-cc.gov.uk/.../med/med_i03.htm TB infecting the spine

33 Miliary TB is disseminated throughout the body Here it is presenting in the eye viewtopic.php?t=11673

34 Scrofula: TB of the lymph nodes of neck King Henry IV of France touching sufferers of scrofula. André de Laurens, 1609

35 As late as the 1800s, causes and cures of TB remained mysterious

36 TB sanitoria were built all around the US

37 Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 housed over 400 patients, from infants to adults. Waverly Hills closed in 1961 library.louisville.edu This may seem like ancient history to you

38 Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 housed over 400 patients, from infants to adults. Waverly Hills closed in 1961 library.louisville.edu But they remained in operation until after one of your professors was born

39 Gravely Building on the other side of the hospital was a TB sanitorium


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