CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0429/04295.txt

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$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
     [phone]

     American Lung Association
     1740 Broadway
     New York, NY  10019
     [phone]

     NIH/National Institute of Allergy and Infectious Diseases
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

References

CURABLE, PREVENTABLE, BUT STILL A KILLER:  TUBERCULOSIS:  Annabel Hecht; FDA
Consumer (Dec. 1986-Jan. 1987 issue).  Pp. 7-10.