Talk:Tuberculosis

Cure in a dry climate

In movies about the past, a recent example is "3:10 to Yuma", people talk of moving to a dry climate to treat tuberculosis. Is such a climate helpful? Or is this just a myth? --206.63.95.15 (talk) 18:53, 17 February 2008 (UTC). Another example is the movie "Tombstone" which features the O.K. Corral shootout. In the movie a character by the name of Doc. Holliday is dying of TB. (Edited May,6,2008).

Interferon

The T-cell stimulation tests for latent TB are rather good: http://www.annals.org/cgi/content/abstract/0000605-200808050-00241v1?papetoc JFW | T@lk 22:52, 3 July 2008 (UTC)

People certainly did move to "better climates" - if they could afford to. In many places "better climates" meant warm dry weather. In other places (Switzerland for example) it meant cold weather - patients were stuck outside even during winter (well clothed against the cold) so they could inhale "clean air". Sanitoria were established in these places for TB patients.

However, it doesn't help :) Sanitoria, where people often went (or were sent) on the other hand, did help. Often people got better food and better care than they would otherwise have received. In the worst case, by sending patients to sanitoria, they were unable to infect other people!

Plsmmr (talk) 14:19, 28 January 2009 (UTC) y8uyuyuguy tguguc7tgui —Preceding unsigned comment added by 69.235.26.41 (talk) 01:37, 2 March 2009 (UTC)

Contradiction?

Are these sentences contradictory? "South Africa, the country with the highest prevalence of TB"... "India has the largest number of infections, with over 1.8 million cases." What's the difference between 'prevalence' and 'infections'? delldot talk 22:47, 5 July 2008 (UTC)

They are not contradictory, the terms have different meanings. If a country had ten inhabitants, and all of these inhabitants had TB, then this country would have a very high prevalence (cases per unit of population), but would only have a very small number of cases in total. Webster's is the dictionary I usually use for these things. Tim Vickers (talk) 06:39, 6 July 2008 (UTC)

Ah, that makes sense, sorry. delldot talk 15:06, 6 July 2008 (UTC)

No problem, your question showed me that I need to wikilink that technical term so other people don't have the same problem. Tim Vickers (talk) 15:33, 6 July 2008 (UTC)

Two sentences contradict each other

"One third of the world's current population has been infected by TB,.."

I"n 2005, the country with the highest estimated incidence of TB was Swaziland, with 1262 cases per 100,000 people"

These two sentences contradict each other… How can one sentence claim one third of the world’s current population is infected with TB, and the other that the country with the highest TB incidence is 1262/100,000?

Henkvdm (talk) 03:35, 13 July 2008 (UTC)

I'll check the sources, but I'd think this is probably a difference between one source referring to people with latent TB infections, and the other to people with active TB disease. Tim Vickers (talk) 04:19, 13 July 2008 (UTC)

Correct: the vast majority of people who are infected will never develop full-blown TB, but may remain infected for the rest of their life. This is called latent infection.. Unfortunately, a few percent of them *will* develop TB over their lifetime. Hence you often see statements like "One third of the world's population are infected ..." and so on, which are referring to latent infections, not actual disease. —Preceding unsigned comment added by Plsmmr (talk • contribs) 13:52, 28 January 2009 (UTC)

Incorrect:Somebody clearly was confused when they read the sentence: "The World Health Organization (WHO) estimates that the largest number of new TB cases in 2005 occurred in the South-East Asia Region, which accounted for 34% of incident cases globally."

What this means is that, of all the new cases in 2005, 34% of them came from SE Asia. If you look at the table, it defines prevalence as "the number of cases which exist in the population at a given period of time." Thus, the Global row is the total number of cases in the entire world, which the table lists as 14,052,000. For a world population of 6.7 billion, this means 0.2% of the world is infected with TB.

This source states "Overall, one-third of the world's population is currently infected with the TB bacillus." This is confirmed by PMID 12742798, which gives a global prevalence of MTB infection of 30%. You need to make a distinction between infection with MTB, which is common, and actual TB disease, which is much rarer. Tim Vickers (talk) 19:57, 21 September 2009 (UTC)

Chances of Survival When Left Untreated

What is an estimated life expectancy for someone who has contracted TB and leaves it untreated? —Preceding unsigned comment added by M d'avout (talk • contribs) 06:15, 21 August 2008 (UTC)

Epidemiologic Risk-Factors

The last paragraph in the section on epidemiology talks about risk-factors of tuberculosis. I noticed that no social factors are mentioned, for example I would argue that not co-infection with HIV is the most important risk-factor but simply poverty (see e.g. Paul Farmer, "Infections and Inequalities." UC Press). I believe a discussion on social factors should be included in this section.

That's a good point. Could you suggest some sources that cover this? Tim Vickers (talk) 15:51, 10 September 2008 (UTC)

Check out: Spence, D P et al. “Tuberculosis and poverty.” British Medical Journal 307.6907 (1993): 759–761. It is available at PubMed http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1696420. —Preceding unsigned comment added by 92.193.25.182 (talk) 18:22, 10 September 2008 (UTC)

Added to the epidemiology section. Tim Vickers (talk) 17:55, 7 November 2008 (UTC)

Tuberculin testing results are deceptive

The statement that "80% of the population in many Asian and African countries testing positive in tuberculin tests, while only 5-10% of the US population testing positive" is very deceptive. Many, if not most, third world countries vaccinate against TB, and anyone who has been vaccinated will test positive for Tuberculin. The US does not vaccinate. —Preceding unsigned comment added by 65.31.4.200 (talk) 14:50, 10 October 2008 (UTC)

Tuberculin skin testing is not diagnostic of TB. I vote for this statement to be removed.--Gak (talk) 01:27, 18 October 2008 (UTC)

Suggested Links

I am not sure what section of the links this would fall under but, I stumbled across James Nachtwey an individual who is attempting to spread the word about drug resistant TB. Here are the two links for consideration:

• James Nachtwey
• James Nachtwey on Youtube

--Shane Birley 16:11, 10 October 2008 (UTC)

I don't think these links are appropriate: see WP:ELNO. --Steven Fruitsmaak (Reply) 18:13, 10 October 2008 (UTC)

I agree. Neither of these links is appropriate for this article. It may possibly be appropriate to create an article on James Nachtwey linking back to tuberculosis.--Gak (talk) 01:29, 18 October 2008 (UTC)

I would like to suggest another external link to add as part of the database links:

• Tuberculosis Drug Resistance Mutation Database

The publication on the homepage of the website will officially be released on February 10, 2009.

--Brian Weiner 17:29, 05 February 2009 (EST) —Preceding unsigned comment added by Briankweiner (talk • contribs)

Incidence and carrier rates

I've reverted these two edits by Yeerkkiller1 as factually incorrect per the cited WHO source. -- MarcoTolo (talk) 03:04, 11 October 2008 (UTC)

Vegetarian "Protein deficiency" causing TB?

Yesterday, I've edited a statement that said vegetarians have a 8.5 fold increased risk of being infected with TB because of "protein deficiency". The term "protein deficiency" itself is actually misleading, as the human body digests proteins and does not use them directly. Accordingly, the correct term would "essential amino acid deficiency", which is very unlikely in a vegetarian diet based on legumes and rice, as it is provided with Indian food.http://en.wikipedia.org/wiki/Vegetarian#Protein

The reason I post this here is that the page was edited again within 24 hours with two new references added.

However, none of the cited articles (PMID 15907552, PMID 7570453, PMID 473919) indicate any relation between protein intake and TB.

IMHO, in order to state that a vegetarian diet causes "protein deficiency" we would need to provide better evidence and cite references that really support this theory.

Furthermore I think, if support existed, it should be included on http://en.wikipedia.org/wiki/Vegetarian as well. —Preceding unsigned comment added by There-is-life-on-mars (talk • contribs) 04:51, 7 November 2008 (UTC)

Good point. I've rewritten and expanded the discussion of diet in the section on epidemiology, adding some references that discuss malnutrition as an important global risk factor. The PLoS Medicine article discusses protein malnutrition as a risk factor, but this is in reference to severe malnutrition in the developing world, not alternative dietary choices in affluent countries. Tim Vickers (talk) 16:18, 7 November 2008 (UTC)

It seems that the problem we are scratching on is not directly a matter of what kind of "flavour" your diet is but nutrient deficiencies that affect the immune system in general. The fact that vegetarian Indians in London have a higher risk of getting TB is interesting but not very significant as the study does not cover vegetarian Indians in India. This means the increased TB risk cannot be linked to a traditional Indian diet directly as immigrants naturally change some of their habits and consume food from sources that are different from those in their home countries. (I recall stories of vegetarian immigrants to the US who developed vitamin B-12 deficiency because they changed their traditional way of treating food. The life-style they adopted was simply too clean, as they removed all vitamin-B12-containing bacteria from the vegetables by washing them too well.)

I think if it is worth to keep this part in the article, the following is necessary:
1. provide references that show evidence of the relation between TB and each deficiency
2. link risk groups and deficiencies (e.g. urban vegetarians and vitamin D, vegans and vitamin B12, etc.)
3. emphasise the relation between TB and the human immune system
There-is-life-on-mars (talk) 18:44, 7 November 2008 (UTC)

Let's work on redrafting this paragraph then, please add more references if you find some that would be useful. Tim Vickers (talk) 19:20, 7 November 2008 (UTC)

This is the current text, please edit this draft:

Diet may also modulate risk. For example, among immigrants in London from the Indian subcontinent, lacto vegetarian Hindu Asians were found to have an 8.5 fold increased risk of tuberculosis, compared to Muslims who ate meat and fish daily. Although a causal link is not proved by this data, the authors proposed that this increased risk could be caused by micronutrient deficiencies: possibly iron, vitamin B12 or vitamin D. Further studies have provided more evidence of a link between vitamin D deficiency and an increased risk of contracting tuberculosis. Globally, the severe malnutrition common in parts of the developing world causes a large increase in the risk of developing active tuberculosis, due to its damaging effects on the immune system. Along with overcrowding, poor nutrition may contribute to the strong link observed between tuberculosis and poverty.

I've made a start by attributing the idea of "micronutrient deficiency" directly to Strachan et. al. Tim Vickers (talk) 19:22, 7 November 2008 (UTC)

LOCATING THE SOURCE?

wIs it true that when diagnosed with TB, doctors and / or tests can pin point when it was caught and what part of the Country / orld you were in at the time?

Chris.

Read the article. JFW | T@lk 06:36, 11 March 2009 (UTC)

Updating vaccines info:please update the sentence "Many other strategies are also being used to develop novel vaccines" to the folowing.

{{editsemiprotected}} Many other strategies are also being used to develop novel vaccines, including both subunit vaccines(fusion molecules comprised of two recombinant proteins delivered in an adjuvant) such as Hybrid-1, Hyvac4 or M72and recombinant adenoviruses such as Ad35. Some of these vaccines can be effectively administered without needles, making them preferable for areas where HIV is very common. All of these vaccines have been successfully tested in humans and are now in extended testing in TB-endemic regions.

MarkD100 (talk) 13:59, 27 February 2009 (UTC)

 Done. I've reworked the external links into formatted references as well. haz (talk) 13:58, 1 March 2009 (UTC)

PCR

http://jama.ama-assn.org/cgi/content/full/301/10/1014 - CDC guidelines on the use of PCR. JFW | T@lk 06:36, 11 March 2009 (UTC)

Pathogenesis section edit

Hi, am just a passer by, not sure how to work this whole edit thing, just letting you know this "Within the granuloma, T lymphocytes (CD8+) secrete cytokines such as interferon gamma, which activates macrophages to destroy the bacteria with which they are infected.[31] T lymphocytes (CD4+) can also directly kill infected cells." sentence within the pathogenesis section has a minor but important error, the roles of CD4+ and CD8+ should be swapped with each other.

Reworded. Tim Vickers (talk) 16:15, 11 August 2009 (UTC)

See also section

The see also section needs to be combined into the article. Have started.--Doc James (talk · contribs · email) 16:38, 15 June 2009 (UTC)

Gold-dust treatment?

In Kathryn Hulme's largely fact-based novel The Nun's Story and the film based on it, Sister Luke is cured of tuberculosis by being injected with gold dust. Was this a real treatment? Kostaki mou (talk) 23:55, 3 July 2009 (UTC)

I don't know of any historical treatments such as that, but today we do use gold (albeit not dust) as a treatment for Rheumatoid arthritis. Thus gold should be an immunosuppressant - a very bad idea for someone with TB, it would likely kill them. So perhaps someone did try it, but I very much doubt it would be a good idea. |→ Spaully ^τ 09:24, 4 July 2009 (GMT)

Current:

The Bill and Melinda Gates Foundation has been a strong supporter of new TB vaccine development. Most recently, they announced a $200 million grant to the Aeras Global TB Vaccine Foundation for clinical trials on up to six different TB vaccine candidates currently in the pipeline.

Suggested:

The Bill and Melinda Gates Foundation has been a strong supporter of new TB vaccine development. Most recently, it announced a $200 million grant to the Aeras Global TB Vaccine Foundation for clinical trials on up to six different TB vaccine candidates currently in the pipeline.

Change:

Change "Most recently, they . . ." to "Most recently, it . . " as this refers to the foundation mentioned in the previous sentence. —Preceding unsigned comment added by Sayakurt (talk • contribs) 12:45, 21 July 2009 (UTC)

reference to "cottage country"

I think it might be prudent if someone took another look at the use of the reference to the word "cottage country" in this article. I can corroborate that the phrase "cottage country" is commonly used in Canada, it means many different areas depending on where the person lives, such that it means very different geographic areas depending on whether you live in Montreal, Ottawa, Toronto, Vancouver, Winnepeg etc. This article suggests that Tuberculosis is more common in cottage country, but the reference article refers to only one specific area, i.e. that of one area of rural Manitoba. I think the inference is wrong and should be changed or removed, there is no proof that the incidence of TB is higher in several or all of Canada's cottage countries, as there could possibly be if there was a legitimate confounding factor, such as 'deer are carriers and live in all of Canada's cottage countries'. The paper cited here refers to one area with a high population density of Native Canadians, who also have a higher than normal incidence of TB. Can this reference be corrected or made a bit more specific?

Thanks

Jamaas (talk) 13:20, 11 August 2009 (UTC)

I've removed the phrase, I don't think it added anything. As to making this more detailed, I don't think localised areas of high TB in Canada are particularly important from a global perspective on this disease, so this mention is sufficient. Tim Vickers (talk) 16:08, 11 August 2009 (UTC)

Rifampicin and Pyrazinamide for latent TB

Removed the following paragraph because it falsely gives the impression that RMP and RZA are the main treatments for latent TB and are unsafe. The issues are actually much more complicated and cannot be adequately dealt with in two sentences, but are dealt with in detail in the TB treatment article, which the reader is already referred to at the beginning of the section.

However, treatment using Rifampicin and Pyrazinamide is not risk-free. The Centers for Disease Control and Prevention (CDC) notified healthcare professionals of revised recommendations against the use of rifampin plus pyrazinamide for treatment of latent tuberculosis infection, due to high rates of hospitalization and death from liver injury associated with the combined use of these drugs.

--Gak (talk) 11:27, 3 September 2009 (UTC)

FYI - Quotation

Portions of this article's lead section were quoted by Mr Alistair Coe MLA in the Legislative Assembly of the Australian Capital Territory on 11 November 2009. Just by way of warm (or otherwise) fuzzy to the article's substantial contributors. - DustFormsWords (talk) 06:01, 11 November 2009 (UTC)

M. canetti

... is also part of the TB complex. —Preceding unsigned comment added by 66.159.214.137 (talk) 17:05, 6 December 2009 (UTC)

Added, thank you. Tim Vickers (talk) 18:38, 6 December 2009 (UTC)

Infectious dose

"the inhalation of just a single bacterium can cause a new infection". Surely that's technically (but misleadingly) true of almost anything, and it's the ID50 that really matters? Casual googling suggests the ID50 of TB is 10 organisms. (The page for Coxiella burnetii says that has an ID50 of 1 and is therefore the most infectious organism known to man. This triumph presumably isn't a draw with TB.) 81.131.46.77 (talk) 12:28, 9 December 2009 (UTC)