Persistent shadow-TB

In medicine has developed into quite highly of the 20th century, many difficult disease no longer allow doctors to helpless. But at the same time, some common diseases are due to bacterial evolution and let the doctor headache. -Tuberculosis is one of them.

Tuberculosis is caused by Mycobacterium tuberculosis infectious diseases, including tuberculosis, via droplets; tuberculosis caused by Mycobacterium through not milk spread, resulting in bone tuberculosis. Tuberculosis was once so helpless in the medical sector, until 1882 3/24/Germany · scientists Robert Koch announced the discovery of the Mycobacterium tuberculosis, to worldwide control tuberculosis brought hope. To commemorate this great discoveries, but also for broad public concern on tuberculosis, 1982 at the World Health Organization and international prevention of tuberculosis and lung disease Alliance common initiative, each year, 2 4 day as a "World TB day."

Since the 1990s, had been believed to have effective control and in some areas near-extinct of tuberculosis, in silence for several decades after a comeback, and extremely rapid momentum spread worldwide. According to incomplete statistics, 1993 and 1996, the global TB cases increased 13 per cent. At present there are about 1/3 of the world's population is infected with Mycobacterium tuberculosis, the world has been existing about 20 million TB patients, every year new episode 8 million to 10 million people, died of tuberculosis in about 300 million people, of which 10 million of whom are children. TB has become the number one cause of infectious diseases. If you do not immediately take control measures is expected to be 10 years worldwide will have 90 million cases occurred, 30 million people were killed and 3 million health are affected by tuberculosis.

TB incidence in massive upturn caused by main reasons: first, for a long time TB as the epidemic has been eliminated but is ignored. Many countries lack of unified control scheme to control the spread of the disease, many patients do not receive the complete treatment, resulting in the formation of recurrent and tuberculosis drug resistance. Second, the dual epidemic of tuberculosis and AIDS. Due to the AIDS virus weakens the immune system and AIDS patients infected with TB more likely than average to high 30 5 0 times, and infectious tuberculosis in AIDS patients once they are more likely to develop active, infectious tuberculosis, thereby threatening the health of people around. Third, urban development, environmental destruction, immigrants, refugees and the rapid increase of the global traveller and aggravating the spread of tuberculosis and proliferation.

Prevent the spread of tuberculosis, the need to rely on the State, society and individuals work together. Establish tighter control system, a thorough treatment in patients with supervision, strengthening the development of medicines and vaccines to prevent the spread of tuberculosis, is the essential tool. But more important is that people should learn to regulate their own behavior, enhance awareness of tuberculosis prevention, improve their health.

Awareness of tuberculosis

Tuberculosis is caused by Mycobacterium tuberculosis systemic infections. Is the world's most important communicable diseases, can occur at any age, gender and race. Humanity is not the only cancer patients, cattle, pigs, poultry, fish and amphibians are also vulnerable to infection. Due to Mycobacterium tuberculosis more enter the body through the respiratory tract, the lungs and their growth and reproduction most appropriate conditions, to the most rare pulmonary tuberculosis. In addition, tuberculosis of lymph nodes are also vulnerable to violations, pleural and peritoneal, meningiomas, intestines, kidneys, bones and joints, hoses and other parts of the body. TB early and no obvious symptoms, disease progression can have systemic symptoms such as fatigue, loss of appetite, weight loss, low heat, as well as diseases of organs of local symptoms.

Tuberculosis has lasted for several centuries, as early as 4000 years ago, India writers have described the elephant of tuberculosis. However, due to tuberculosis (TB) is a group raises unique but has not been informed of the Organization and the immune response to infectious, so medical researchers have brought a very challenging problem. Tuberculosis of the basic phenomenon is important because, through its research enables people on all the basic process of infectious diseases have a better understanding.

The history of tuberculosis

Tuberculosis is the risks to human health has a long history of Chronic noncommunicable diseases, scientists from the discover of the early human bones in the spine are found hunched back, this is one of the symptoms of TB. China in 2100 ago buried body--Hunan Changsha Mawangdui Han grave unearthed a woman was also found that the left lung upper left Lung Mun have tuberculosis of calcification. In Egypt have been infected by the TB found mummies. For a description of the tuberculosis can backtrack to 460 years BC. Interestingly, tuberculosis often appear in the description of the urban dwellers live in ancient writings, but in the Bible or the description associated with the works, but residents are very rare.

Now we know that the early records of the various parts of the body is different, and seemingly unrelated sexual disease actually different forms of TB. For example: Lupus Vulgaris is skin tuberculosis, TB is tuberculosis, which Porter-disease is spinal medicine. Lymph node dissection of neck nuclear is the enlargement of the flow of a tuberculosis is common in the past. With microscopic pathology and bacteriology of modern science, we know that all these disease process are different manifestations of tuberculosis. "Tuberculosis" this name does not come from the disease of skin features, such as the depletion of the body, and is the unique node, this is the most basic cell structure, can fully reflect the disease occurs in the characteristic organization changes. Pathologist with nodules can know the pathogenesis of tuberculosis.

The 19th century, tuberculosis in the European and North American big pop, spread to all segments of society, life richer crowd became a hotbed of tuberculosis. And that was the main cause of death, is called the "great white plague." Many of those outstanding character suffering from tuberculosis: Shelley, Schiller, Browning, Thoreau and the Bronte sisters, etc. Tuberculosis epidemic even influenced poets and artists. The ladies have often been described as delicate, silent, very easy to pass out and paroxysmal coughing. Even at that time, the dress is also reflected in the tuberculosis epidemic, such as the men are wearing skivvy seemed to hidden

Reservoirs and neck of tuberculous lymphadenitis.

Research on TB

Lay the foundations for modern medical knowledge of the architecture of the 19th century's greatest medical home la laennec, almost validates the virtue of intuition, that is, whether the concept in which parts of the body, tubercles are the basic anatomy of the disease. La laennec's contribution is unmatched. He is on hundreds of tuberculosis were precise clinical observations and the patient dies of careful autopsy, in 1804, released a report, a comprehensive revolutionized the concept of related lung diseases.

La laennec also invented the stethoscope, laid the foundation of Neo-Confucianism check chest, he introduced the terminology describing physical characterization has been followed ever since. In addition to tuberculosis, La laennec also accurately describe many disease course and anatomical discoveries. In 1819, La laennec published papers is the indirect auscultation in x-rays found nearly 100 years before, on the basis of chest diseases. La laennec in his later years also suffered from chronic tuberculosis, his death was only 45 years old.

In the study of TB, the second is to contribute to France doctors Willman. Willman, born in 1827, is France army surgeons. Is he a through experiments to determine the infectious tuberculosis, thus ending the controversy over the medical profession. In the 17th century, Italy and Spain's physician that tuberculosis infection, but at that time in the entire Nordic are very prestigious Paris University medical scientists but because the disease often sent to the entire family, and suspected tuberculosis is not an infectious disease, but because of genetics.

Willman in the mid 1800 has confirmed the theory of disease bacteria based on the study identified the infectious tuberculosis, easily solved the issue. Willman research results published in 1868, he noted that normal people if swallowed or inhaled the Elimination of tuberculosis, TB is thrown. He also believed that human TB bacteria can make animals such as rabbits, and other infection with TB. Willman's theory has become the leading TB epidemiology. Decades later, confirmed that TB is spread through specific media-related diseases. Last job is Ke hua in 1882. He discovered a special kind of microorganism — Mycobacterium tuberculosis is a bacterial disease of tuberculosis. He also proved that the microorganism is in the culture medium. This discovery allows to TB of becomes a reality. Ke hua 1843 was born in Germany Claus Attar, his father was a local name mining officials. When he was a kid they became interested in natural history. 1862, Ke hua enters the Göttingen University, and in 1866 for medical doctorate. In-school period, his system of learning the chemistry, pathology, Physiology and anatomy. Although that time has not been deemed a bacteriology profession to the Professor, but his anatomy teacher Heng Le back in 1840 by the pathology in the book, you've put in the sixteenth century Italy doctor fracas Toro in infectious diseases of the concept idea, this is the "future Fok Ke Ke hua hypothesis".

After graduation, Ke hua first serve General Hospital in Hamburg, where he witnessed the cholera situation, so make up your mind on the cause of the illness, and found that, in cholera patients of manure has a solid s type, like a whip-like waves. Ke hua only in Hamburg spent several months in 1870 after the outbreak of the Franco-Prussian War, he served as a military medical volunteers. After the war ended, Ke hua first found a comfortable Executive job, 1872, is ordered to serve wahlstam parish doctor. However, he was a very low salary, he was engaged in the research work you like. On the day of the 30-year-old birthday, his wife gave him a microscope, he will own part of the House for renovation, finally has its own simple laboratory. Ke hua select enable local cattle mass mortality of anthrax as a study of object, in 1867, after painstaking research Ke hua thought he had proved anthrax is a production of Bacillus bacteria. Curtis Hawthorne wrote to the Chief roslau bacteriological top experts Cohen, briefed him on this discovery, and requested his release before audits. Cohen look after very appreciated, and in your own journals published by Ke hua papers about anthrax, became an Fok. Since then, the Ke hua turn our attention to surgical infections, bacterial staining and are micro-photography.

1880, Joel began in Berlin Health Department, and to continue to improve the methodology of bacteriology. He has been using animal glue as bacteria of coagulant, later, he's a colleague's wife & suggestions he used agar place of animal glue, this approach has been followed ever since.

Ke hua's most important achievement is 1882 announced discovery of tuberculosis causes, he found that tuberculosis is caused by a ratio of anthrax Bacillus anthracis in smaller and more difficult to dye, more difficult to culture of Mycobacterium tuberculosis. 1884, Ke hua also amended certain views hang Le, now known as the "Ke hua hypothesis". In order to confirm a specific disease is caused by microorganisms, Joel assumes that: 1) a disease organisms should exist for each patient, and may in the medium in the purification; 2) will this inoculant to have feelings of animals you will produce this disease; 3) the animals can produce the same purification of microorganisms.

1890, Ke hua also announced the discovery of a regardless of in vitro or in vivo can inhibit the growth of the TB bacteria. However, when he was being treated for tuberculosis patients, the results were disappointing. This mysterious substance called nodules, although eventually it did not become the treatment of TB drugs, but become a diagnosis of tuberculosis. A study of Ke hua covers cholera, plague, dysentery, typhoid, tuberculosis and pneumonia. From 1900 onwards, Ke hua also gradually attention on tropical diseases, including leprosy, rinderpest, livestock of pernicious anemia, cattle urine disease, malaria and sleeping disorders research.

Ke hua 1941

Awarded the Nobel Prize in Physiology or medicine, the rest of my dedication to tuberculosis and tropical disease research. He is searching suppress disease etiology and has made great achievements are unparalleled.

Tuberculosis infection

TB bacteria invade the human body caused by infection, since the human body produces cell immunity, innate immunity, with only 5 per cent of infections occurred tuberculosis, the remaining 5% is only manifested tuberculin Yang go without.

Invasion of the body's way of Mycobacterium tuberculosis are:

(1) the most common is a respiratory infection. By bacteria patients cough spray into the air of "droplet nuclei" infectious, bacteria of tuberculosis patients in loud talking, coughing or sneezing when sprayed out of droplets, and patients in 1 m distance to direct inhalation droplet size droplets section beyond the respiratory tract of alveolar mucociliary defense go, through the pulmonary infection.

(2) gastrointestinal infection. Drinking unsterilized Mycobacterium bovis-containing milk occurs on the mesenteric lymph nodes.

(3) tonsil infection. Tubercle Bacillus enters the tonsil, submandibular lymph.

(4) contacts. For pathological anatomy workers work part of the injury, so that the infected parts correspond to the lymph nodes.

Once you reach the alveolar Mycobacterium tuberculosis, gut mucosal epithelium, tonsil, etc, will remain in these parts, and to 15 hours of proliferation once slow proliferation. After 3-7 weeks, in the human body cell immune response, TB bacteria can enter through the lymphatic nodes belong. And then after thoracic duct into the blood circulation. TB bacteria in the human body caused by specific reactions of T lymphocytes number has not been sufficient to control the spread of infection progress has already been in an infected person-body, and for subsequent intrapulmonary lung outside collection it laid the Foundation. If you do not have adequate immune reaction, blood flow to the dissemination will cause Hematogenous spread of TB. The infection process ultimately by special reactions sensitized lymphocytes will macrophages to infection and under control. Macrophages engulf the bacteria, but TB bacteria in macrophages in vitro and in vivo remains alive and continue proliferation. Most infected people's defense capabilities to control the further spread of infection so that infected with TB bacteria are in equilibrium. Some tubercle Bacillus in focus in the healing process of gradually been eliminated, but most of the tuberculosis still survive in a latent state.

Treatment of tuberculosis

Application in chemical therapy no TB treatment before it is health nutrition therapy, namely, the use of sunlight, air nutrition, quiet rest to recover the patient's resistance. Living in nursing homes in on tuberculosis has also played to the quarantine, the role of prevention. Since the discovery of the chemical drug treatment of tuberculosis, on tuberculosis and extrapulmonary tuberculosis treatment played a decisive role. Now commonly used chemical substances with rifampicin (be), isoniazid, streptomycin, ETHAMBUTOL, sodium, and so on ammonia willow. Chemical treatment is divided into two phases, intensive treatment stage is for a large number are reproduction of tuberculosis, be quick to kill, to reduce the bacteria and eliminate the root causes of resistant bacteria. Consolidation of the treatment phase is to control tuberculosis dormant, during which a metabolic activities in order to prevent the recurrence of Mycobacterium tuberculosis.

BCG vaccination is commonly used to prevent tuberculosis BCG vaccination, for cellular immune dysfunction occurring in infants and children Hematogenous Miliary Tuberculosis – tuberculosis tuberculous meningitis and has an obvious role.

World tuberculosis prevention

In 1993 and 1996, the world's TB cases increased 13 per cent. The number of people died of tuberculosis than die from malaria and AIDS combined. The world last year, more than 700 million TB patients, nearly 3 million people died of TB, including 10 million children.

According to the United Nations World Health Organization 1997 statistics, world existing 17.22 million people infected with TB bacteria, every year, 9 million new TB patients, about 3 million people died of tuberculosis, this figure exceeds the tuberculosis epidemic in 1900, the year the world about 210 million people died of tuberculosis. At present, the TB has become the first in infectious diseases. Now many countries tuberculosis cases skyrocket, 20 years will increase by 10 million tuberculosis patients.

Tuberculosis is a serious threat to human life, in its serious epidemic at the beginning of the century, the world each year by the number of deaths from tuberculosis for more than 200 million. Only medical developed today, the early detection and prompt treatment of tuberculosis will no longer be an incurable disease, the cure rate is almost reached 100%. However, the concern that in recent years, the world's TB infection, and therefore the number of people who lost their lives to skyrocket in the history of the "top level".

The dual epidemic of tuberculosis and AIDS are to be ignored in a big reason. Now the TB has become one of the major killers of mankind, is also a major killer of AIDS. TB is the only major AIDS opportunistic infection "," easy to mass communication. Like the common cold, TB spread through the air, anyone can become infected. United Nations programme on HIV/AIDS, TB, said to the spread of HIV, TB cases will continue to increase. Infected people infected with tuberculosis is not infected person of 30 times. TB and HIV while dissemination has become the world's most serious public health threat.

The world die each year from the number of tuberculosis has more than 300 million people, equivalent to every 10 seconds a people died of tuberculosis. Experts forecast this year 100 million women and 10 million children die from TB, but if the control measures in a timely manner, the vast majority of them can be cured.

In April 1993, who have warned that the world is tuberculosis emergency, requires Governments to take urgent measures and the fight against tuberculosis crisis, but not sufficient for the international community. Tuberculosis germs can spread through the air. Due to the

The current global speed and number of population movement than before, thus the risk of suffering from tuberculosis (TB) than any other period of history.

Worldwide each year nearly 1 million people infected, with one-tenth of the illness. Because of the publicity is not enough, some people lack knowledge of tuberculosis, can not be timely medical treatment and delay treatment; and some patients have a better adherence by not taking a course, resulting in their resistance to the treatment of difficult, or even life threatening. Experts say that the emergence of drug-resistant tuberculosis treatment a person fee is the cost of ordinary TB 100 times. This to some patients in developing countries, would be sentenced to death. At present, such patients worldwide has nearly 50 million people.

Tuberculosis is a young one of the major killers, of which 95% of tuberculosis cases and 98 per cent of deaths in developing countries. Poverty, population, nutrition and the prevention of the spread of tuberculosis is ineffective.

In addition to the poverty, malnutrition and other factors, the reason for the decades of social unrest in some areas, the entire international community to relax on the prevention and treatment of infectious diseases is the current resurgence of tuberculosis, an important cause of rampant global first countries do not have a national control programme, economic investment negligible; on the other hand, mass media, medical institutions on tuberculosis prevention and control measures for hazards, resulting in a lot of publicity in this area development lag, shortage of medicines, the patient is unable to receive timely treatment. Tuberculosis patients to receive treatment in a timely manner, this will not only effect is good, but cost is low. General early treatment only needs about $ 70, but once the delay treatment costs at least increased 3 times, the cure rate is only almost to zero. But TB is also a kind of speed and space-borne diseases, fairly quickly to strengthen propaganda to make people aware of the importance of prevention and treatment of TB is imminent.

Prospect

Statistics show that the world population has at least one-third of people with Mycobacterium tuberculosis, an average of 3 million people being took lives of tuberculosis. At present, although there are many antibiotics against tuberculosis, TB bacteria resistance is increasing, and therapeutic drugs remains high costs, long treatment period. Therefore, global tuberculosis control situation remains dire.

Tuberculosis is mainly caused by Mycobacterium tuberculosis infection. There have been generalized tuberculosis vaccine (BCG) spoke in full on the basis of Mycobacterium tuberculosis and, in application limitations. Scientists around the world are assiduously sought to find new ways to fight tuberculosis, there have been some new results.

By the United Kingdom, Brazil and Switzerland and other countries, scientists in a research group said that they use experimental study on mice, a novel DNA vaccine can be effective in killing mice of Mycobacterium tuberculosis. And BCG, newly developed out of DNA vaccines only selected Mycobacterium tuberculosis gene fragments, better stimulate the immune system activity and, therefore, be quite a significant treatment effects.

The scientists found that infected with Mycobacterium tuberculosis "sick rats" to accept the DNA vaccine, in her original soft invalid immune response would be greatly enhanced, and will stimulate T cells through effective and gain the ability to kill the TB bacteria. In another experiment, the researchers first "disease drug treatment in rats", subsequently to a DNA Vaccine injection, as a result many "disease in mice" in vivo drug treatment residues of germs are subjected to further vaccines. This experiment also found that DNA vaccine may eliminate some resistant Mycobacterium tuberculosis.

Scientists believe that through the new DNA vaccines and antibiotics, may be more quickly and effectively treating tuberculosis opens up a new way. Scientists have also noted that the DNA vaccine safety requires further study, the one closest to the actual application there is a considerable distance. Scientists say that if progress smoothly, DNA vaccine is possible within a few years into human clinical trials. Wales scientist in Mycobacterium tuberculosis in new discovery may play the role of protein signaling, this outcome is likely to open up new avenues of tuberculosis prevention and control.

Wales Michael · Yang group led by Professor at a small cocci found that similar information hormones R Ⅶ protein not only can play the role of the "alarm" chemistry "wakeup" dormant Micrococcus, but also can act as a growth factor in its growth. As a result of such harmless Micrococcus is Mycobacterium tuberculosis "close relatives", in the gene is present on many similarities, scientists then on Mycobacterium tuberculosis genome research in detail.

According to Professor Michael · Yang, they found that at least five Mycobacterium tuberculosis gene, they can produce and R Ⅶ characteristics similar proteins. Previously United Kingdom Sanger Center and other research institutions have guessed contains 4000 genes full of Mycobacterium tuberculosis genome, as their research offers great convenience.

The scientists noted that the newly discovered this Mycobacterium tuberculosis growth factor protein has a wealth of potential uses. Statistics show that one third of the world's population may have tuberculosis bacteria. But these germs lurk in hibernation in the human body. Existing anti-TB drugs only if the virus is activated before you can play a role. Professor Michael · Yang said, due to newly discovered protein "wakeup" germs that drug coordination will likely remove dormant bacteria

Whereas the development of scientists in the Nordic vaccine has also made new breakthroughs.　 Sweden-manufacture of scientific research personnel are a novel vaccine against tuberculosis, nasal-spray vaccine are available through, the cost is lower than the existing vaccines. Responsible for the manufacture of Sweden State University Professor of Svensson, Sweden agricultural University and prevent infectious diseases Research Institute of scientific research cooperation, already in mice test this new tuberculosis vaccines. Now they are ready for human testing. If successful, the vaccine five years will be to market.

Svensson Professor told me that the new vaccine through the nostrils blasting for human vaccination, use than existing methods for TB vaccine injection to much more convenient, but better, at lower cost. But he also pointed out that the new vaccine is not meant to replace the currently used vaccines in children, but only up to a supplementary role. New vaccines will be primarily used to enhance the ability of the immune adults.