Eradication of Mycobacterium tuberculosis
Introduction to Mycobacterium Tuberculosis:
Mycobacterium tuberculosis is a bacterial species also known as acid-fast bacilli (AFB). Mycobacterium tuberculosis can be gram-positive or gram-negative. Mycobacterium tuberculosis is a pathogenic organism that commonly causes Tuberculosis. It measurably affects the lungs or lower respiratory tract but may also cause infection in the brain, bones, glands, and other body parts.
Robert Koch first discovered Mycobacterium tuberculosis in 1882. Mycobacterium tuberculosis has a unique character; it contains a waxy layer on its cell wall made up of mycolic acid and teichoic acid. Because of mycolic acid and teichoic acid, gram stain cannot penetrate inside the cell wall of Mycobacterium tuberculosis. Therefore, M. tuberculosis is stained with Ziehl-Neelsen stain or acid-fast stain, as ZN stain can penetrate the cell wall of acid-fast bacteria. M. tuberculosis is a highly aerobic strain, and this is the reason it causes diseases primarily in the lungs.
History of Mycobacterium tuberculosis:
In ancient times, Mycobacterium tuberculosis was known as tubercle bacillus. Three million years ago, M. tuberculosis originated in East Africa. In 1993, WHO declared tuberculosis a world emergency.
Robert Koch first discovered tubercle bacillus on March 24, 1882. Therefore, this bacterium is also known as Koch’s bacillus.
Structure of Mycobacterium tuberculosis: M. tuberculosis is a rod-shaped bacterium, nearly 2-4 mm in length and 0.2–0.5 mm in width. Tubercle Bacillus is an obligate aerobe.
And these bacteria are facultative intracellular parasites.
Their generation time is 15-20 hours. They can quickly be grown on Lowenstein Jensen Medium. LJ Medium is a unique medium for M. tuberculosis.
Pathogenicity of M. tuberculosis:
Tubercle bacilli can only cause infection in human beings. This disease or illness can only spread infection from one person to another through air droplets during coughing, sneezing, and speaking. They cannot be spread by handshaking or sharing food.
Mycobacterium tuberculosis first enters the respiratory tract through the medium of air droplets and reaches the lungs. After reaching the lungs, alveolar macrophages engulf the bacteria for phagocytosis. But due to the unique characteristics of the bacterial cell wall, macrophages cannot lyse the bacteria. Because of the aerobic conditions of the lungs, tuberculin bacilli start multiplying inside the macrophages. And are released from alveolar macrophages after the cell dies, lyses, or bursts. Granulomatous lesions formed in the lungs and caused infection in the lungs. Tubercle bacilli can also cause infection in other body parts other than the lungs by moving through lymphatic vessels to other sites known as extrapulmonary tuberculosis.
Lymph node TB is commonly seen in HIV-infected patients. Tubercle bacilli may also penetrate the pleural fluid and cause pleural TB. It is very common after primary tuberculosis. Mycobacterium tuberculosis may cause:
- Skeletal TB
- Genitourinary TB
- Gastrointestinal TB
- TB meningitis
- TB pericarditis
- Miliary TB or disseminated TB
When a person is infected with tuberculosis for the first time in life, the condition is known as primary tuberculosis. If a person has an infection after a primary infection, that condition is known as a secondary infection, a reinfection, or a chronic infection. A person may also develop latent tuberculosis; that is, one may carry the infection but not develop symptoms of tuberculosis. Such a kind of infection is called latent tuberculosis. Latent tuberculosis patients are capable of infecting other people.
People at risk:
As per the study, all age groups are at risk because of tuberculosis, but adults are mostly affected by tuberculosis for a few years.
People suffering from HIV are 18 times at higher risk in comparison to healthy people. However, people whose immunity is compromised because of any other disease, or, we can say, a patient suffering from an immunocompromised condition, are also at high risk.
Malnutrition is also a major cause of tuberculosis. As we all know, the immunity or immune system of malnourished people is very compromised; they are more susceptible to the disease tuberculosis caused by Mycobacterium tuberculosis.
As per the study, if a person is in a starvation state, their energy will get low, which will automatically lead to a lower immunity level. And one will become susceptible to tuberculosis. As per earlier studies, all age groups are at equal risk of getting infected with tuberculosis, but adults are affected mainly by tuberculosis infection.
People who have HIV are 18 times at higher risk in comparison to healthy people. However, people whose immunity is compromised because of any other disease or a patient suffering from an immunocompromised condition are also at high risk.
Malnutrition is also a significant cause of tuberculosis; as we all know, people’s immunity or immune system is very compromised; they are more susceptible to the disease tuberculosis caused by Mycobacterium tuberculosis.
As per a study, if a person is in a starvation state, the patient’s energy will get low, automatically leading to a lower immunity level. And one will become susceptible to tuberculosis disease. Overall, we may consider that starvation regularly will increase the chance of a disease occurring because of weakness or compromising immunity. So, it is said, one should always have their meal on time. Must have a healthy meal at the start of the day.
disease. Overall conditions we may consider starvation on a regular basis will increase the chance of occurring disease because of weakness or compromising immunity. So, it is said, one should always have their meal on time. Must have a healthy meal at the start of the day.
Facts about tuberculosis:
In 2020, 43% of new tuberculosis cases were registered in the southeast Asian region, 25% of new cases in the African region, and 18% of new cases in the Pacific region.
Tuberculosis is the 13th leading cause of death worldwide. 1.5 million people died in 2020 due to tuberculosis disease. 86% of new tuberculosis diseases were registered in 2020 within the 30 most infected countries. Tuberculosis is a curable and preventable disease. Society is suffering greatly from tuberculosis because of multi-resistant TB (MDR-TB).
The primary symptom of lung tuberculosis is a cough with sputum, and sometimes patients may have sputum with blood, weakness, weight loss, fever, night sweat, and chest pain.
Coughing is a significant symptom of tuberculosis. People should go for a checkup for tuberculosis if they have been suffering from a cough for more than two or three weeks. A person will suffer from fever, as body temperature increases during bacterial infection as a symptom of inflammation. One may also suffer from chest pain or have breathing difficulties.
Diagnosis of tuberculosis:
A physical examination of tuberculosis involves the diagnosis of lymph nodes or listening to the sound of breathing from the lungs with a stethoscope. We may also go for a skin test, a tuberculin test, or a Mantoux test. 1 mL of tuberculin is injected into the subcutaneous layer of skin at the forearm. Then it is observed after 48 to 72 hours for a reaction. Tuberculosis may also be diagnosed with the TB-Gold test (ELISA test). TB-Gold is a qualitative as well as quantitative test.
Tuberculosis may also be diagnosed with a ZN stain. Mycobacterium tuberculosis is an acid-fast bacillus. Therefore, it is stained with an acid-fast stain.
Mycobacterium tuberculosis is cultured on a specialized medium known as Lowenstein Jensen Medium (LJ). The incubation period of tubercle bacilli in LJ medium is 7 to 14 days.
A chest X-ray is performed for the diagnosis of tuberculosis. Ghon’s complex forms a lesion in the lungs, and it is observed in a chest X-ray.
Treatment of Tuberculosis:
Tuberculosis is a treatable disease; multiple types of treatment are available to treat it.
Commonly used medicines for tuberculosis are isoniazid, rifampin, ethambutol, and pyrazinamide.
If a person is suffering from multiple-resistant tuberculosis, a combination of antibiotics called fluoroquinolones and injectable medicines, such as amikacin or capreomycin, is generally used for 20 to 30 months.
There are multiple side effects of medications, like nausea, loss of appetite, yellow color to your skin, dark urine, easy bruising or bleeding, and blurred vision.
Complete treatment of tuberculosis is very much necessary. If an individual does not complete their treatment, the disease will develop resistance against it, leading to multi-resistance TB.
will develop resistance against the. Leading to multi-resistance TB.
The best way to prevent tuberculosis is by being vaccinated. Bacillus calmette guerin (BCG) is a live vaccine against tuberculosis. BCG has been used worldwide for the prevention of tuberculosis since 1921. This vaccine is 80% effective in preventing tuberculosis after 15 years of vaccination.
Tuberculosis is spread in droplets; therefore, good ventilation is very much necessary to prevent the spread of the disease.
UV light is a method of sterilization for the prevention of disease; therefore, UV light is used for the sterilization of M. tuberculosis.
Because tuberculosis is spread with droplets, it is very necessary to cover the mouth and nose while sneezing to prevent tuberculosis. It is also prevented with the use of protective masks, ventilation systems, and regular screening of healthcare workers for tuberculosis.
As per the study, 60% of adults can prevent disease with a healthy immune system.
Eradication of Tuberculosis:
Eradication of Tuberculosis:
The United Nations Sustainable Development Goals (SDGs) are trying to eradicate the tuberculosis epidemic worldwide by 2030. 13 billion is needed to treat, prevent, and cure tuberculosis disease. On September 26, 2018, the United Nations arranged a meeting for discussion of the prevention and eradication of tuberculosis.
After that, in 2017, the first global ministerial conference on TB was held by the WHO and the Russian government. After the conference, it was mutually decided, and UN members made a political declaration to eradicate tuberculosis.
The political declaration of the UN high-level meeting included four new global targets:
- treat 40 million people for TB disease in the five years 2018–2022;
- reach at least 30 million people with TB preventive treatment for a latent TB infection in the five years 2018–2022;
- mobilize at least US$13 billion annually for universal access to TB diagnosis, treatment, and care by 2022;
- mobilize at least US$2 billion annually for TB research.
As requested in the political declaration:
- WHO finalized and published a Multisectoral Accountability Framework for TB (MAF-TB) in 2019. WHO is supporting countries to adapt and use the framework to translate commitments into actions and monitor, report, and review progress with high-level leadership, all relevant sectors, civil society, and other stakeholders.
- In 2020, a progress report from the UN Secretary-General to the General Assembly was developed. It was released with the support of the WHO.
- Examples of high-level leadership on multisectoral accountability include presidential or Head of State End TB initiatives, formalized mechanisms for the engagement and accountability of stakeholders in India, Indonesia, Pakistan, the Philippines, and Vietnam, and national campaigns to drive progress in the Race to End TB.
WHO is working closely with countries, partners, and civil society to scale up the TB response. Six core functions are being pursued by WHO to contribute to achieving the targets of the UN high-level meeting political declaration, the SDGs, the End TB Strategy, and WHO strategic priorities:
- Providing global leadership to end TB through strategy development, political and multisectoral engagement, strengthening review and accountability, advocacy, and partnerships, including with civil society;
- Shaping the TB research and innovation agenda and stimulating the generation, translation, and dissemination of knowledge;
- Setting norms and standards on TB prevention and care and promoting and facilitating their implementation;
- Developing and promoting ethical and evidence-based policy options for TB prevention and care;
- Ensuring the provision of specialized technical support to the Member States and partners jointly with WHO regional and country offices, catalyzing change, and building sustainable capacity;
- Monitoring and reporting on the status of the TB epidemic. And reporting progress in financing and implementing the response at global, regional, and country levels.
This blog has been submitted by the faculty of the IMPACT PARAMEDICAL & HEALTH INSTITUTE (IPHI).
Impact Paramedical & Health Institute (IPHI) is one of the top paramedical institutions in Delhi. It offers its students an opportunity to learn from an industry-leading faculty of doctors.
