tuberculosis consumption :: Article CreatorTuberculosis Was Once A Disease In Decline, But A Resurgence In Cases Has Health Officials Puzzled
An outbreak of tuberculosis, or TB – a lung disease that is often accompanied by a hacking cough – began in January 2024 in Kansas City, Kansas, and two nearby counties and continues as of early March 2025. To date, 147 people have been reportedly diagnosed with TB in the outbreak, with 67 becoming ill. The remaining 80 people diagnosed with TB in Kansas contracted the illness but showed no symptoms, which is called a latent infection.
TB is the leading infectious cause of death around the world, outpaced only by COVID-19 during the first three years of the pandemic.
The Conversation asked microbiologists Karen Dobos and Marcela Henao-Tamayo, both from Colorado State University, to explain why this ancient disease seems to be making a comeback.
READ MORE: The day we discovered the cause of the 'white death'
What's the history of TB?
Mycobacterium tuberculosis is the organism that causes the disease tuberculosis in humans. The disease has been infecting humans for thousands of years. Researchers found evidence of the disease 9,000 years ago in the excavated remains of people who lived in the Eastern Mediterranean region during that time.
Reports of TB date back to around 410-400 B.C.E., when the physician Hippocrates termed the disease phthisis, an archaic word that means a progressive "wasting away," due to the way people with the disease become emaciated.
WATCH: New treatments yield hope for stopping tuberculosis, world's leading infectious killer
TB was also known as consumption for the same reason. Similarly, it was called the white plague or white death – due to anemia from the disease, with people appearing pallid or chalky – leading to near-certain death. Untreated active TB, meaning cases that are symptomatic, is highly lethal.
About half of all people with untreated active TB die from the disease, whereas treatment reduces the death rate to 12 percent.
One of the more colorful phrases describing TB is "the king's evil." This is a form of TB that also causes neck swelling and lesions, a condition called scrofula. During the Middle Ages, people believed that the touch of a king could cure a person from this form of TB through miraculous intervention.
TB infections, which are typically found in the lungs, have risen since the COVID-19 pandemic.Kateryna Kon/Science Photo Library via Getty Images
Finally, TB was most ominously called the "robber of youth" due to its historical propensity to afflict people 15 to 30 years old.
In 1865, Jean Antoine Villemin, an army physician in Paris, demonstrated that TB could be transmitted from infected animals to healthy ones through inoculation. Before these studies, the cause of TB was presumed to be primarily constitutional, by either an inherent predisposition or from unhealthy or immoral lifestyles.
READ MORE: Can new medications shift the battle against drug-resistant TB?
The microorganism causing TB was ultimately discovered in 1882 by the German physician Robert Koch. Koch announced his findings on March 24, 1882, a day globally recognized as World TB Day.
How does TB spread?
Tuberculosis is spread by small infectious droplets in the air. A TB patient may emit these droplets by coughing, singing and potentially from regular breathing that occurs during sleep or resting.
One form of TB can be spread through unpasteurized dairy products. While rare, there have been reports of TB transmission through bone grafts, in which healthy, donated bone material is used to replace damaged bones.
Close-up view of an infection by Mycobacterium tuberculosis. Kateryna Kon/Science Photo Library via Getty Images
The origin of the TB outbreak in Kansas remains unknown as of early March 2025. The outbreak has disproportionately affected those in low-income communities, and two people have died from it.
READ MORE: How Boston stamped out a TB outbreak thanks to bartenders and barbers
Importantly, a patient with untreated TB can infect 10 to 15 others.
Could the COVID-19 pandemic be a factor?
The COVID-19 pandemic has played a pivotal role in the resurgence of TB. Cases increased globally by 4.6 percent from 2020 to 2023, reversing decades of steady declines in the disease. In the U.S. Alone, TB cases rose by more than 15 percent from 2022 to 2023.
WATCH: Global leaders pledge billions to combat infectious diseases after COVID causes setbacks
During mandatory shutdowns, people were less able to access health care centers for early diagnosis of TB or to fill prescriptions for treatment, perhaps due to the fear of contracting COVID-19 while visiting a medical care facility. COVID-19-related disruptions in care resulted in nearly 700,000 excess deaths from TB.
Access to health care may not be the only factor behind this uptick. Medical supply shortages and delays in shipment may have also played a role. For example, the U.S. Experienced shortages of one of the primary TB drugs between 2021 and 2023.
What are the main treatments?
Multidrug treatment is currently the only way to cure TB and stop its spread.
READ MORE: Nonprofit drug maker produces TB antibiotic after private companies wouldn't
Prior to the late 1930s, when the first antibiotic for TB treatment was developed, TB treatments included bloodletting and consumption of cod liver oil. The most popular treatment involved isolated sanatoriums in high-altitude areas such as the Adirondacks and the Rocky Mountains, where the cold, dry air was believed to be a cure. Scholars at the time suggested that the potential for cure was due to these environments being more invigorating for the body and providing more restful sleep. There is no evidence to support these beliefs.
Streptomycin was the first antibiotic treatment to become available for TB, in the 1940s. However, the microorganism quickly became drug resistant. A second antibiotic, called isoniazid, was developed as a first-line treatment against TB in the 1950s. Again, the microorganism became drug resistant.
READ MORE: How Dr. Arthur Conan Doyle cracked the case of the tuberculosis 'remedy'
Two- and four-drug combinations are now used to treat both latent infections and active disease. Treatment of active TB requires at least six months of uninterrupted therapy. Disruptions in treatment result in further spread of TB and the emergence of multidrug resistant TB, which requires additional drugs and more than nine months of treatment.
All TB drugs are toxic; the quality of life for TB patients deteriorates during treatment and remains so throughout their lives. Finding cases and treating TB illness early, before symptoms begin, is important because it not only reduces the spread of disease but also greatly reduces drug toxicity.
What should people be aware of?
People should be aware that TB is still a public health problem across the globe. Education on the transmission, treatment and need for active work to eradicate TB is the best defense.
One of the reasons why education and awareness about TB are so important is that a person with latent TB may be unknowingly harboring the microorganism for years. In the absence of symptoms, these people are unlikely to seek care and will not be diagnosed and treated unless identified as part of an outbreak, as was the case for more than half of the patients in Kansas.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Fight Against TB Was Frozen In Time, Until Now. See Its Future
Consumption, phthisis, the white plague – a killer by any other name, tuberculosis (TB) has stalked humanity since at least the ice age. Today, the disease – passed from those who are actively sick to others through airborne droplets – is the leading infectious disease globally, killing 1.25 million in 2023.
Still, for decades, the fight against TB has been frozen in time, even as the bacteria that causes it has become more resistant. The world's only TB vaccine protects young infants and children but dates back to Prohibition.
National Institutes of Health (NIH) support has enabled scientists from UC San Francisco and others from around the country to chart a new course. Three UCSF experts break down some of the biggest developments in the field and the promise that lies ahead.
The ultimate ambition is to get to regimens that are weeks, not months, long, and offer patients more treatment options so that medicines work for their lives."
Payam Nahid, MD, MPH, Executive Director of the UCSF's Institute for Global Health Sciences
Treatment The Goldilocks era? Shorter, kinder and more efficient
For decades, TB treatment was long and painful. Roughly 1 in 8 cases of TB globally are resistant to standard medicine. Until just a few years ago, treating these cases involved handfuls of daily pills for two years or longer, including months of regular injections. Medicines left many nauseous and vomiting, and some with permanent hearing loss and kidney damage. Even then, cure was not assured. Today, the worst forms of TB can be cured with just three or four drugs taken orally in six months.
Similarly, the treatment time for drug-susceptible TB has nearly halved, dropping to just four – thanks to a landmark 2021 study co-led by UCSF scientists. The work followed in the footsteps of School of Pharmacy professor Rada Savic, PhD. A co-director of the UCSF Center for Tuberculosis, Savic pioneered pharmacology studies that were among the first to suggest it was possible to shave months off treatment without compromising care.
And a quicker cure is a more effective cure, explains UCSF's Institute for Global Health Sciences Executive Director Payam Nahid, MD, MPH.
"People are more likely to finish shorter treatment courses, which makes them more effective and guards against the development of drug resistance," he says. "Symptoms improve more quickly and people become less infectious sooner, reducing new infections."
Earlier this year, Nahid helped develop new American TB guidelines to make shorter treatment available to more people. These guidelines are now being used to fight the current Kansas TB outbreak.
And even better cures are on the horizon, Nahid says. The pipeline for experimental drugs is larger than ever and features entirely new types of medicines.
"The ultimate ambition is to get to regimens that are weeks, not months, long, and offer patients more treatment options so that medicines work for their lives."
Part of this, Nahid predicts, will be a shift towards a Goldilocks, or just right approach to treatment.
"An enormous amount of work at UCSF has shown that the world is currently treating many patients with tuberculosis with regimens and durations that are needed to cure the minority 20% who have severe forms of the disease," he continues. "Eighty percent could actually be treated with much shorter regimen and possibly even fewer drugs. I think more of that differentiation will emerge in the next five years."
Previous treatment: Previous TB treatment involved handfuls of daily pills for two or more years, alongside regular injections. Medicines caused nausea, and sometimes permanent hearing loss and kidney damage.
Treatment today: Today, the most severe cases of TB can be cured with an updated regimen of just three or four drugs taken orally in six months. Images by John-Michael Maas, TB Alliance
Diagnosis Leveraging advances made during COVID-19 pandemic
Imagine a room full of rows of technicians perched at lab benches and hunched over microscopes. For hours on end, these microscopists peer through their lenses looking for TB's tell-tale rod shaped bacteria on tiny blue-stained test samples to diagnose TB.
In more than half of TB diagnostic units in high-burden countries, this is what TB testing looks like. It's not too different from how TB was first discovered more than a century ago, explains UCSF Center for TB's Adithya Cattamanchi, MD. Cattamanchi is also UC Irvine's division chief of pulmonary diseases and critical care medicine.
TB can be a debilitating illness: The longer it goes undiagnosed, the more delays there are in treatment, the more damage it causes to the lungs."
Adithya Cattamanchi, MD
Other forms of testing need sophisticated laboratories or expensive molecular diagnostics not always available. All of them require patients to cough up phlegm from deep within their lungs for sampling, which is nearly impossible for children and the very sick. It's why millions of people go undiagnosed each year.
"TB can be a debilitating illness: The longer it goes undiagnosed, the more delays there are in treatment, the more damage it causes to the lungs," he tells UCSF News. "Many TB survivors live with chronic lung disease even after being cured."
Cattamanchi is working with scientists at UCSF and partners around the world to revolutionize TB testing to, one day, put fast reliable TB testing within communities' reach.
"We're leveraging the diagnostic advances made during COVID for TB, in particular, easy-to-use and low-cost swab-based molecular testing," he explains. "We've identified best practice methods for collecting and processing swabs. Now, we're working with product developers to adapt those for their testing platforms."
UCSF researchers, including Cattamanchi, are also investigating how to improve existing experimental urine-based tests and, eventually, develop TB blood tests.
TB's Great Mystery Why some people get sick and not others
TB illness may seem like a game of chance. Although many people are exposed to the bacteria that cause TB each year, only about 1 in 10 get sick. No one really knows why.
Assistant Professor of Medicine Sara Suliman, PhD, MPH, is working to solve this mystery. The answer lies partly in what scientists call biomarkers – or measurable, biological changes in our bodies that can be used to diagnose illness, predict disease progression or gauge a vaccine response.
... There are different types of TB patients who would benefit from different types of treatment."
Sara Suliman, PhD, MPH
"The question that my lab is trying to answer is twofold: One, can we find biomarkers markers that could act almost like a crystal ball to tell us who among the people exposed to TB is at high risk of developing the disease," Suliman explains. "The second is, we can use that to develop an intervention to reduce that risk?"
Currently, medicine cures TB with antibiotics that kill the bacteria itself. The discovery of a TB biomarker could pave the way for treatments focused not on the germs but instead us, so that our immune system can better control the infection. And it will help usher in a new era in stratified care.
"Stratified medicine, which groups similar patients, is one step before precision medicine, or care based on the individual," she says. "My dream is to move away from this one-size-fits-all approach and towards an understanding that there are different types of TB patients who would benefit from different types of treatment."
Trump Is Ceding Ground To Tuberculosis - The Atlantic
Mycobacterium tuberculosis is a near-perfect predator. In 1882, Robert Koch, the physician who discovered the microbe, told a room full of scientists that it caused one in seven of all deaths. In 2023, after a brief hiatus, tuberculosis regained from COVID its status as the world's deadliest infectious disease—a title it has held for most of what we know of human history.
Some people die of TB when their lungs collapse or fill with fluid. For others, scarring leaves so little healthy lung tissue that breathing becomes impossible. Or the infection spreads to the brain or the spinal column, or they suffer a sudden, uncontrollable hemorrhage. Lack of appetite and extreme abdominal pain can fuel weight loss so severe that it whittles away muscle and bone. This is why TB was widely known as "consumption" until the 20th century—it seemed to be a disease that consumed the very body, shrinking and shriveling it. On a trip to Sierra Leone in 2019, I met a boy named Henry Reider, whose mix of shyness and enthusiasm for connection reminded me of my own son. I thought he was perhaps 9 years old. His doctors later told me that he was in fact 17, his body stunted by a combination of malnutrition and tuberculosis.
The cure for TB—roughly half a year on antibiotics—has existed since the 1950s, and works for most patients. Yet, in the decades since, more than 100 million people have died of tuberculosis because the drugs are not widely available in many parts of the world. The most proximate cause of contemporary tuberculosis deaths is not M. Tuberculosis, but Homo sapiens. Now, as the Trump administration decimates foreign-aid programs, the U.S. Is both making survival less likely for people with TB and risking the disease becoming far more treatment-resistant. After decades of improvement, we could return to something more like the world before the cure.
Read: The danger of ignoring tuberculosis
Anyone can get tuberculosis—in fact, a quarter of all humans living now, including an estimated 13 million Americans, have been infected with the bacterium, which spreads through coughs, sneezes, and breaths. Most will only ever have a latent form of the infection, in which infection-fighting white blood cells envelop the bacteria so it cannot wreak havoc on the body. But in 5 to 10 percent of infections, the immune system can't produce enough white blood cells to surround the invader. M. Tuberculosis explodes outward, and active disease begins.
Certain triggers make the disease more likely to go from latent to active, including air pollution and an immune system weakened by malnutrition, stress, or diabetes. The disease spreads especially well along the trails that poverty has blazed for it: in crowded living and working conditions such as slums and poorly ventilated factories. Left untreated, most people who develop active TB will die of the disease.
In the early 1980s, physicians and activists in Africa and Asia began sounding the alarm about an explosion of young patients dying within weeks of being infected instead of years. Hours after entering the hospital, they were choking to death on their own blood. In 1985, physicians in Zaire and Zambia noted high rates of active tuberculosis among patients who had the emerging disease now known as HIV/AIDS. TB surged globally, including in the U.S. Deaths skyrocketed. From 1985 to 2005, roughly as many people died of tuberculosis as in World War I, and many of them also had HIV. In 2000, nearly a third of the 2.3 million people who died of tuberculosis were co-infected with HIV.
Read: Tragedy would unfold if Trump cancels Bush's AIDS program
By the mid-1990s, antiretroviral cocktails made HIV a treatable and survivable disease in rich communities. While a person is taking these medications, their viral levels generally become so low as to be undetectable and untransmittable; if a person with HIV becomes sick with tuberculosis, the drugs increase their odds of survival dramatically. But rich countries largely refused to spend money on HIV and TB meds in low- and middle-income countries. They cited many reasons, including that patients couldn't be trusted to take their medication on time, and that resources would be better spent on prevention and control. In 2001, the head of the U.S. Agency for International Development had this to say when explaining to Congress why many Africans would not benefit from access to HIV medications: "People do not know what watches and clocks are. They do not use Western means for telling time. They use the sun. These drugs have to be administered during a certain sequence of time during the day and when you say take it at 10:00, people will say, 'What do you mean by 10:00?'" A 2007 review of 58 studies on patient habits found that Africans were more likely to adhere to HIV treatment regimens than North Americans.
In the mid-2000s, programs such as PEPFAR and the Global Fund finally began distributing antiretroviral therapy to millions of people living with HIV in poor countries. PEPFAR, a U.S.-funded initiative, was especially successful, saving more than 25 million lives and preventing 7 million children from being born with HIV. These projects lowered deaths and infections while also strengthening health-care systems, allowing low-income countries to better respond to diseases as varied as malaria and diabetes. Millions of lives have been saved—and tuberculosis deaths among those living with HIV have declined dramatically in the decades since.
Still, tuberculosis is great at exploiting any advantage that humans hand it. During the coronavirus pandemic, disruptions to supply chains and TB-prevention programs led to an uptick in infections worldwide. Last year, the U.S. Logged more cases of tuberculosis than it has in any year since the CDC began keeping count in the 1950s. Two people died. But in some ways, at the beginning of this year, the fight against tuberculosis had never looked more promising. High-quality vaccine candidates were in late-stage trials. In December, the World Health Organization made its first endorsement of a TB diagnostic test, and global health workers readied to deploy it.
Read: America can't just unpause USAID
Now that progress is on the verge of being erased. Since Donald Trump has taken office, his administration has dismantled USAID, massively eliminating foreign-aid funding and programs. According to The New York Times, hundreds of thousands of sick patients have seen their access to medication and testing suddenly cut off. A memo released by a USAID official earlier this month estimated that cases of multidrug-resistant tuberculosis will rise by about 30 percent in the next few years, an unprecedented regression in the history of humankind's fight against the disease. (The official was subsequently placed on administrative leave.) Research on tuberculosis tests and treatments has been terminated. Although the secretary of state and Elon Musk have assured the public that the new administration's actions have not disrupted the distribution of life-saving medicine, that just isn't true. A colleague in central Africa sent me a picture of TB drugs that the U.S. Has already paid for sitting unused in a warehouse because of stop-work orders. (Neither the State Department nor DOGE employees responded to requests for comment.)
Last year, roughly half of all international donor funding for tuberculosis treatment came from the U.S. Now many programs are disappearing. In a recent survey on the impact of lost funding in 31 countries, one in four organizations providing TB care reported they have shut down entirely. About half have stopped screening for new cases of tuberculosis. The average untreated case of active tuberculosis will spread the infection to 10 to 15 people a year. Without treatment, or even a diagnosis, hundreds of thousands more people will die—and each of those deaths will be needless.
By revoking money from global-health efforts, the U.S. Has created the conditions for the health of people around the world to deteriorate, which will give tuberculosis even more opportunities to kill. HIV clinics in many countries have started rationing pills as drug supplies run dangerously low, raising the specter of co-infection. Like HIV, insufficient nutrition weakens the immune system. It is the leading risk factor for tuberculosis. An estimated 1 million children with severe acute malnutrition will lose access to treatment because of the USAID cuts, and refugee camps across the world are slashing already meager food rations.
For billions of people, TB is already a nightmare disease, both because the bacterium is unusually powerful and because world leaders have done a poor job of distributing cures. And yet, to the extent that one hears about TB at all in the rich world, it's usually in the context of a looming crisis: Given enough time, a strain of tuberculosis may evolve that is resistant to all available antibiotics, a superbug that is perhaps even more aggressive and deadly than previous iterations of the disease.
Read: Resistance to the antibiotic of last resort is silently spreading
The Trump administration's current policies are making such a future more plausible. Even pausing TB treatment for a couple of weeks can give the bacterium a chance to evolve resistance. The world is ill-prepared to respond to drug-resistant TB, because we have shockingly few treatments for the world's deadliest infectious disease. Between 1963 and 2012, scientists approved no new drugs to treat tuberculosis. Doing so stopped being profitable once the disease ceased to be a crisis in rich countries. Many strains of tuberculosis are already resistant to the 60-year-old drugs that are still the first line of treatment for nearly all TB patients. If a person is unlucky enough to have drug-resistant TB, the next step is costly testing to determine if their body can withstand harsh, alternative treatments. The United States helped pay for those tests in many countries, which means that now fewer people with drug-resistant TB are being diagnosed or treated. Instead, they are almost certainly getting sicker and spreading the infection.
Drug-resistant TB is harder to cure in individual patients, and so the aid freeze will directly lead to many deaths. But giving the bacteria so many new opportunities to develop drug resistance is also a threat to all of humanity. We now risk the emergence of TB strains that can't be cured with our existing tools. The millennia-long history of humans' fight against TB has seen many vicious cycles. I fear we are watching the dawn of another.
This article has been adapted from John Green's forthcoming book, Everything Is Tuberculosis.
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