Human disease is front and center on the world stage. New diseases increase uncertainty and questions for the medical community. However, researchers have a long history of diseases to pull knowledge from. One of the world’s deadliest diseases was first recorded in ancient Israel, Greece, and Rome. This disease, tuberculosis, has been called the “White Death,” “consumption,” and eventually became known, simply, as TB. By the time it was identified in 1882, Mycobacterium tuberculosis – the pathogen behind tuberculosis – was killing one out of every seven Americans.
TB Statistics Worldwide
Dr. Robert Koch’s discovery of Mycobacterium tuberculosis paved the way for screening tools, prevention methods, and even a cure. However, it still remains one of the deadliest diseases in recorded history. In fact, the WHO publishes TB surveillance data every two years – revealing that in 2018, a total of 1.5 million people died from tuberculosis out of a total of 10 million who contracted the infection.
Thirty countries with an excessively high TB burden accounted for 87% of these cases, with two-thirds of these coming from remote populations in India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. As one might expect, identifying and treating TB cases in these areas is exceedingly difficult. It has led to these abnormally high numbers – so how can we improve screening and treatment in remote areas? Recently, researchers have identified three key tactics:
- TB Case Finding Campaigns. Officials in many affected countries have begun surveying remote populations via active case finding campaigns. Researchers ask people about symptoms common to TB, including severe cough, chest pain, and coughing up blood and sputum. Often, many people with these symptoms were unaware of their severity and would not have pursued treatment otherwise.
- Triage Potential Patients. Testing all members of a remote population for TB can prove to be labor-intensive and unnecessarily expensive. Instead, researchers recommend utilizing a triage system like TB+TRIAGE, which aims to analyze a large number of chest x-rays and blood samples for TB markers using high-throughput screening. This early identification of potential TB cases can reduce diagnostic costs and improve access to eventual TB testing and treatment.
- Molecular Sputum Testing. People demonstrating multiple TB symptoms identified by a TB case finding campaign and showing TB markers via a triage system like TB+TRIAGE must then undergo molecular sputum testing. Molecular sputum testing involves using the currently developed test – Xpert MTB/RIF – to analyze swabs of sputum or phlegm retrieved from the lungs. A lab technician applies a special stain to aid in identifying the presence of any strain of Mycobacterium tuberculosis within the sputum.
The Future of TB
The TB+TRIAGE project is currently underway in heavily-affected communities in remote South Africa. Over 35,000 people identified through the TB campaign will receive screening via high-throughput methods, and many of those will undergo molecular sputum testing. As the project continues, researchers hope to identify TB cases in underserved populations before they become severe, allowing for more effective treatment to take place.
In addition, researchers hope to keep costs low by offering TB sputum testing only to those who are triaged and identified via high-throughput screening first. This way, research groups can serve larger portions of the world’s remote populations with necessary prevention and treatment methods. As the project progresses, we remain hopeful that one day, the remote areas can move forward without the threat of TB.
Resources:
https://www.cdc.gov/tb/worldtbday/history.htm
https://www.who.int/news-room/fact-sheets/detail/tuberculosis
https://www.nationaljewish.org/conditions/tuberculosis-tb/diagnosis/sputum-test
https://medicalxpress.com/news/2019-12-tuberculosis-screening-remote-areas.html
