Overview
Tuberculosis is thought of by many in developed countries as a disease of the past, but this could not be further from the truth. Tuberculosis is currently the 8th leading cause of death in low income countries. Before Covid-19, TB was the top leading cause of death due to a single infectious agent, now ranking second. It is also the leading cause of death in patients with HIV.
Statistics
What does TB look like t0day?
In 2021,10.6 million people fell ill with tuberculosis world wide, an increase of 4.5% from 2020. Approximately 1.5 million people die from TB every year, 167,000 of which are HIV positive. Individuals with HIV are 20-30 times more likely to develop active TB and it's almost 100% fatal. In the US alone, 8331 cases of TB were diagnosed and up to 13 million individuals in the US are currently living with a TB infection. The burden of drug-resistant TB (DR-TB) also increased by 3% between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB (RR-TB) in 2021.
13 billion USD are needed annually for TB prevention, diagnosis, treatment and care to achieve global targets agreed on at the UN high level-TB meeting. The US provides the largest funding for the global fund of aids, tuberculosis, and malaria, close to 50% of international donor funding for TB. A decline in global spending on essential TB services went from US$ 6 billion in 2019 to US $5.4 billion in 2021, which is less than half of the global target of US $13 billion annually by 2022.
6.3 million people were treated for TB between 2018 and 2021, still far short of the 40 million targets set for 2018–2022.
Diagnostics, Treatment, and Vaccination
How is tuberculosis identified and treated?
A tuberculin skin test (TST) or interferongamma release assay (IGRA) can be used to identify people with infection. In addition, rapid diagnostic tests recommended by WHO include the Xpert MTB/RIF Ultra and Truenat assays. It is very important to get tested regularly if you are at high risk for contracting TB.
Typically treated with a standard 6 month course of 4 different antibiotics.TB prevention treatment for only the latent stage is around 1-3 months. Some commonly used antibiotics include rifampin, pyrazinamide, ethambutol, streptomycin, and isoniazid. If drug resistant and persistent others will be used.
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin.Antibiotic resistant forms of TB can take upwards of 9-12 months to treat and on rare occasions even longer. In 2016 about 600,000 cases were resistant to at least one drug and 500,000 were resistant to multiple. Second Line treatments are often extremely expensive as well as toxic
Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease, however, it is not commonly used in the US and is not always the most effective. The vaccine is largely given to small infants and children in areas where TB is common.
Prevalance and Risk Factors
What areas and people are most at risk of contracting TB?
About half of TB cases can be found in India, Indonesia, Nigeria, Pakistan, The Philippines, and South Africa. The 30 countries carry the highest burden include: Angola, Bangladesh, Brazil, Central African Republic, China, Congo, Democratic People’s Republic of Korea, Democratic Republic of Congo, Ethiopia, Gabon, India, Indonesia, Kenya, Lesotho, Liberia, Mongolia, Mozambique, Myanmar, Namibia, Nigeria, Pakistan, Papua New Guinea, Philippines, Sierra Leone, South Africa, Thailand, Uganda, United Republic of Tanzania, Vietnam and Zambia.
HIV infection is the strongest risk factor of developing active TB. Other risk factors of developing TB include, recent infection with the tuberculosis bacterium, diabetes, substance abuse, silicosis, severe kidney disease, low body weight, organ transplants, head and neck cancers, medical treatments such as corticosteroids, and specialized treatment for rheumatoid arthritis or Crohn’s disease.