$Unique_ID{BRK04295} $Pretitle{} $Title{Tuberculosis} $Subject{Tuberculosis TB Consumption Childhood Tuberculosis Primary TB Cutis Colliquativa Tuberculosis Tuberculous Gumma Disseminated Hematogenous Tuberculosis Miliary TB Tuberculosis Lichenoides Lichen Scrofulosorum Lymph Node Tuberculosis Papulonecrotic Tuberculosis Pulmonary Tuberculosis Pulmonary Atypical Tuberculosis Tuberculous Arthritis Tuberculosis of the Spine Pott Disease Pleural Tuberculosis Tuberculosis Peritonitis Tuberculous Meningitis Tuberculous Pericarditis } $Volume{} $Log{} Copyright (C) 1987, 1988, 1989, 1991, 1992, 1993 National Organization for Rare Disorders, Inc. 361: Tuberculosis ** IMPORTANT ** It is possible the main title of the article (Tuberculosis) is not the name you expected. Please check the SYNONYMS listing to find the alternate names, disorder subdivisions, and related disorders covered by this article. Synonyms TB Consumption Information on the following diseases can be found in the Related Disorders section of this report: AIDS Childhood Tuberculosis, also known as Primary TB Cutis Colliquativa Tuberculosis, also known as Tuberculous Gumma Disseminated Hematogenous Tuberculosis, also known as Miliary TB Tuberculosis Lichenoides, also known as Lichen Scrofulosorum Lymph Node Tuberculosis Papulonecrotic Tuberculosis Pulmonary Tuberculosis Pulmonary Atypical Tuberculosis Tuberculous Arthritis Tuberculosis of the Spine, also known as Pott Disease Pleural Tuberculosis Tuberculosis Peritonitis Tuberculous Meningitis Tuberculous Pericarditis General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Tuberculosis (TB) is an acute or chronic bacterial infection found most commonly in the lungs. The infection is spread like a cold, mainly through airborne droplets breathed into the air by a person infected with TB. The bacteria causes formation of small tissue masses called tubercles. In the lungs these tubercles produce breathing impairment, coughing and release of sputum. TB may recur after long periods of inactivity (latency) if not treated adequately. Many variations of TB exist and are distinguished by the area of the body affected, degree of severity and affected population. This disease today is considered curable and preventable. It is very rare in the United States but is on an upsurge. Symptoms Tuberculosis most commonly affects the lungs, producing breathing difficulties. It may also affect the kidneys, bones, lymph nodes, and membranes surrounding the brain. In some cases, it can spread throughout the body. In the initial stages patients may experience fever, loss of appetite, weight loss, weakness, and sometimes a dry cough. In the later stages of lung involvement, blood may appear in the sputum. Bleeding in the lungs may occur if an artery or tubercle (small tissue mass produced by the infection) ruptures. The patient can die of this infection if left untreated. Causes Tuberculosis is a bacterial infection usually caused by either Mycobacterium tuberculosis or Mycobacterium bovis. The Mycobacterium tuberculosis is the most common source of infection and is spread by airborne droplets breathed or coughed into the air by a person infected with active TB. In the past the disorder was caused in most cases by Mycobacterium bovis, a bacteria which was passed to humans through dairy products. Today, dairy and cattle are carefully inspected and tested for this type of TB, and infected products are not sold to the public in the United States. However, in less developed countries the TB infection is still passed to humans through dairy products. Affected Population In 1944, the Public Health Service launched a TB control program when the yearly number of cases in the United States averaged 126,000. In 1985, the number of cases had dropped to 22,201. However, health officials warn that TB is still a serious health problem, due in part to the rise of AIDS cases and the lowered resistance of AIDS patients to the TB infection. There are still approximately 2,000 deaths annually from TB in the United States which is more than all other infectious diseases excluding pneumonia and influenza. Areas with the highest incidence of AIDS victims such as New York City, California, Florida, and Texas are also the areas with the highest incidence of TB. TB may prove to be the first "opportunistic infection" related to AIDS with potential threat to the general public. An opportunistic infection is one that takes hold because the patient's immune system is weakened. (For more information on these disorders, choose "AIDS" and "Opportunistic Infection" as your search terms in the Rare Disease Database, and also see the AIDS Update area of NORD Services.) Recently, the southeast area of the United States and states bordering Mexico reported the highest Tuberculosis (TB) cases. Additionally, the recent influx of Southeast Asians, who have a high incidence of TB, now constitutes three to five percent of new cases in the U.S. Worldwide, TB is a major health problem with as many as four million new cases and three million deaths each year. The impact of TB is felt most by older and poorer people. Cases usually occur in individuals who were infected years ago, particularly the elderly. Many of these people grew up in the first decades of the century when eighty percent of the population had been infected (though not necessarily afflicted with an active case of TB) by the time they were thirty. The Centers for Disease Control (CDC) in Atlanta, GA currently estimates that ten million people worldwide have been infected by the tubercle bacillus, carrying a small but lifelong risk of developing active TB. There were 1,200 American children diagnosed with TB during 1984, leading to the conclusion that TB is still being spread by people with active infections. Every year thousands more children are apparently infected, but do not get the active disease, adding to the pool of those at risk of developing active TB in the future. Since 1984 the incidence of TB has been on the rise, especially in the elderly. Over 22,000 cases have been reported each year with over a third of the cases in individuals over sixty years of age. The elderly are susceptible to TB in two different ways: dormant germs from old infections becoming active again and new exposure at a time of life when immune defense is lower than in youth. In 1991, 25,709 cases were reported, a 9.4 perceny increase since 1989. Cases in children are also increasing. Other persons with suppressed immune systems, such as AIDS patients and persons taking drugs to suppress the body's immune response to transplants, are also at increased risk from exposure to TB. Related Disorders AIDS (Acquired Immune Deficiency Syndrome) involves progressive deterioration of the body's ability to ward off infection. Organisms which in a healthy person would either fail to cause disease, cause mild disease, or at least provoke immunity, can completely overwhelm the AIDS patient. Patients with AIDS can contract various life-threatening infections such as pneumocystis carinii pneumonia and Tuberculosis (TB). Additionally, they may develop a rare type of cancer called Kaposi's Sarcoma. Following is a list of the various subtypes of Tuberculosis: 1. Childhood Tuberculosis (TB, primary) involves first-time infection of TB. 2. Cutis Colliquativa Tuberculosis (Gumma, tuberculous) is a childhood type of TB involving lesions on the back and legs. 3. Disseminated Hematogenous Tuberculosis (TB, Miliary) is a serious form of TB with a sudden onset occurring mostly during early childhood. Many areas of the body are involved. 4. Tuberculosis Lichenoides (Lichen Scrofulosorum) occurs in children with a high immunity to TB. It is marked by red skin areas appearing chiefly on the trunk. 5. Lymph node Tuberculosis is an adult form of TB involving the lymph nodes. This disorder is marked by swelling and fever. 6. Papulonecrotic Tuberculosis occurs in adults. This form of TB involves the face, arms, legs, and trunk. Ulceration of the skin occurs causing small scars. This form of TB is likely to recur. 7. Pulmonary Tuberculosis is usually an active flare-up of some type of childhood TB affecting the lungs. 8. Pulmonary Atypical Tuberculosis is a type of TB caused by certain rarely seen Mycobacteria. This type of TB could extend to organs other than the lungs. 9. Tuberculous Arthritis involves the lungs initially then can spread to bones and joints and may be related to various other diseases including prior joint trauma, alcoholism, diabetes mellitus and chronic debilitating states that possibly predispose to activation of disease. 10. Tuberculosis of the Spine (Pott Disease) begins gradually and involves pain in the spinal nerve root and weight loss. More serious cases may cause paralysis. 11. Tuberculous Meningitis involves the central nervous system and is usually found in children aged one to five years although it may occur at any age. Headache and behavioral changes may be noticed initially. Later symptoms may include convulsive disorders, communicating hydrocephalus (accumulation of fluid in the brain cavity), mental retardation, and other neurological abnormalities. 12. Pleural Tuberculosis can occur in at least two forms usually in conjunction with Pulmonary TB. Surgical drainage may be required as well antituberculous treatment. 13. Genitourinary Tuberculosis (Tuberculous Pyelonephritis) is characterized by an initial lack of typical TB symptoms. When long established, this disorder may spread from the kidneys to the ureters, bladder, seminal vesicles, and prostate. 14. Tuberculous Peritonitis may spread from the lymph nodes, gastrointestinal tract or uterine tube and ovary to surrounding areas. Local tenderness and signs of infection are symptomatic of this type of TB. 15. Tuberculous Pericarditis is usually due to spread from infected mediastinal nodes (separating the lungs) and affects the membrane around the heart. Surgery may be necessary in the more serious cases of this type of TB. 16. Silicotuberculosis results from exposure to silicon dust. Therapies: Standard Continued testing of dairy herds as preventive therapy remains essential to the control of Tuberculosis. A tuberculin skin test, required for school-age children in the United States, is also extremely useful in identifying unsuspected cases of TB. Vaccination with BCG (a weakened strain of Mycobacterium tuberculosis) is useful in many parts of the world where the incidence of TB is high. However, this vaccine is used rarely in the United States. Antibiotic therapy with careful monitoring by a physician is necessary for cases of active tuberculosis. Hospitalizing or isolating a patient under treatment, as was done in the past, is usually no longer necessary to prevent the spread of TB. Hospitalization may be useful now in some cases for treating disabling symptoms or complications. Ten to fourteen days of antibiotic treatment is usually necessary before patients become noninfectious. The combined use of rifampin (RIF) and isoniazed (INH) for nine months is the current treatment of choice in cases of TB. Surgical treatment of some skin manifestations of TB may be of limited usefulness. Corticosteroid therapy (in conjunction with antibiotics) may be advantageous in some recurrent or very persistent cases, or in some cases that overlap with other diseases. Therapies: Investigational New methods of preventing Tuberculosis, and preventing the spread of existing cases of this disorder are under current investigation. The FDA has approved the following drug for testing as treatment for Tubuerculosis patients: The orphan drug Rifater (rifampin, isoniazid, pyrazinamide) is being tested for short-course treatment of Tuberculosis. The drug is manufactured by Marion Merrell Dow, Kansas City, MO. For information on additional therapies that have been designated as Orphan Drugs in the last few months, please return to the main menu of NORD Services and access the Orphan Drug Database. The orphan product Para-Aminosalicylic acid is being developed for the treatment of Tuberculosis infections. It is sponsored by the Jacobus Pharmaceutical Company of Princeton, NJ. The clinical trials are now underway. The drug Thalidomide is being tested in the treatment of clinical manisfestations of mycobacterial infection caused by mycobacterial Tuberculosis and non-tuberculosis mycobacteria. The drug is sponsored by Celgene Corp., 7 Powder Horn Dr., Warren, NJ, 07059. The orphan product, gabbromicina, is being developed by the University of Illinois at Chicago for the treatment of Tuberculosis. This disease entry is based upon medical information available through June 1993. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Tuberculosis, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 American Lung Association 1740 Broadway New York, NY 10019 (212) 315-8700 NIH/National Institute of Allergy and Infectious Diseases 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5717 Centers for Disease Control (CDC) 1600 Clifton Road, NE Atlanta, GA 30333 (404) 639-3534 References CURABLE, PREVENTABLE, BUT STILL A KILLER: TUBERCULOSIS: Annabel Hecht; FDA Consumer (Dec. 1986-Jan. 1987 issue). Pp. 7-10.