Talk:Tuberculosis

First skim of the page "look"

Layout looks a little scatter shot and some of the images seem poor as well. Has a big effect on someone seeing page for first time.

Image on top needs an explanation of the white and black marks on X-ray. More debatable, but perhaps w-linking x-ray not needed in this day and age and for an article not on imaging itself. The other thing is it's actually a hard image to quickly look at and grok the disease for general public. I'm a smart guy, but don't know what to look for. Think putting it lower in article and then explaining it (under diagnosis or whatever) would be better. The picture of the evil looking B&W bacterium would work well as an iconic lead image, that does not need a lot of clunky caption analytical explanation.

The list of external links seems clunky in it;s blueness and letter-number inexplicabillity, for a general reader. Would be better in a table towards the end or just in External links, formally. Doing that, would also allow junking the info box and just having a lead image.

Symptoms is way to small. Would display it centered and larger. Also seems a little confusing. That said, it is kind of cool looking visually and the method of using a body to point out various symptom areas is helpful visual summary.

I can't understand the genus organization. (are there X-Y axes? Is it some sort of PCA representation of differentness?). That and it's also very blurry and should be drawn in SVG (image help desk is great at Wiki). But maybe just a basic branching tree would work well. Would this fit better in the article on the bacterium?

The red and yellow photo is pretty. Would like to add a scale though. And probably a little more in caption or section text to get a "so what". Is it just an optical version of the SEM picture?

High burden map should be bigger. Could use it centered to start the section, but no push.

Age standardized death is painful with how 80% of the image space is for the KEY. There are ways to clean that up with a coloured bar or other tricks. Would up size it a bit too.

Do we need a prevalance AND death map? They roughly correlate. Plus given the map before we have 3 similar maps now. And if it is important to show this, we should use the SAME colour scale as the map before (yellow is good on one and bad on the other). If you have same rough scale, at least then we can see where the two aspect are not correlated. If this compare and contrast is really important, maybe a side by side would be good also (will also help with the text wrapping issues because you're not going down the gutter as much then).

I like the X-Y line graph for diversity of a visual. And it is simple clear content. But is too small to read the fonts of the axes, needs a redraw or an up size. Also, this content seems similar to the high burden--time dimension as opposed to geo dimension of new cases--should they be near each other?

Mummy, public health and Kochs pictures look great and are nice variety.

Haven't looked at the article text itself to think about what aspects need illustration. FWIW, may be some other helpful images easily available (just on Commons, not doing Flickr or donations or any of that): [1]

Haven't looked at licencing.

TCO (talk) 05:38, 6 July 2011 (UTC)

As with many frequently edited articles, editors chunk in random unnecessary images over time. Here is the version that passed FAR. SandyGeorgia (Talk) 13:53, 6 July 2011 (UTC)

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World Health Organization Recommends Ban on TB Blood Test

It is reported today on the BBC that the TB blood test commonly used in much of the world should be banned entirely, on the grounds that it fails to provide the correct diagnosis 50% of the time (in both directions), and that it is unethically marketed to the Third World, as this error is known to be the case.

The test kits are manufactured by eighteen companies in Europe and North America.

I am not sufficiently skilled to make edits to Wikipedia articles, so I leave the information here for those more capable. http://www.bbc.co.uk/news/health-14234575 James K. 71.50.19.103 (talk) 23:44, 21 July 2011 (UTC) 71.50.19.103 (talk) 23:46, 21 July 2011 (UTC)

Still working?

Are editors still working on this article in response to the comments at the featured article review? If so, could you please place an update there? There have been several comments on the review page regarding comprehensiveness, organizations, contradictory material, sourcing, etc., that as far as I can tell have not been addressed. This article is in danger of being delisted from featured status unless interested editors reappear and more work is completed in the near future. Dana boomer (talk) 15:02, 24 August 2011 (UTC)

Update: Article de-listed 9/26/11. Discussion here: F.A.R/archive -Anon98 98.92.184.116 (talk) 07:18, 11 November 2011 (UTC)

Vampires

I am removing the following text:

"Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits. People with TB often have symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin and coughing blood, suggesting the idea that the only way for the afflicted to replenish this loss of blood was by sucking blood."

This is not supported by the reference it is attached to and also seems to be describing the modern vampire with its pale skin and aversion to sunlight.

The folkloric vampire is the exact opposite of someone with tuberculosis.

"These vampires were corpses, who went out of their graves at night to suck the blood of the living, either at their throats or stomachs, after which they returned to their cemeteries. The persons so sucked waned, grew pale, and fell into consumption; while the sucking corpses grew fat, got rosy, and enjoyed an excellent appetite. It was in Poland, Hungary, Silesia, Moravia, Austria, and Lorraine, that the dead made this good cheer." - Voltaire http://en.wikipedia.org/wiki/Vampire#Medieval_and_later_European_folklore

--69.169.137.62 (talk) 06:16, 27 January 2012 (UTC)

PVN Acharya's and Dexter Goldman's TB Article on Chemical COmposition of the cell wall.

I would like to re -add this article form 1970

It is from a respectable, reliable journal. Although it is more than 3-5 years old, there are numerous articles on this page far older than that. Further, I put this article on here years ago and have only recently encountered this opposition. (RaghuVAcharya (talk) 19:00, 7 February 2012 (UTC))

The citation is unnecessary (WP:CITEKILL), is old (against WP:MEDRS) and per your own statements here and on other pages, is being used to promote your family member's research. This is not appropriate for Wikipedia. Yobol (talk) 18:13, 8 February 2012 (UTC)

I agree with Yobol. Graham Colm (talk) 18:38, 8 February 2012 (UTC)

Ok. This article in particular has been cited so many times anyway that the world probably knows about it. Thanks and have a jolly good show. (RaghuVAcharya (talk) 18:17, 9 February 2012 (UTC))

I have noticed that Reference 81 is a one page article by Schoenlein, about impetiginous lesions, but does not mention Tuberculosis. The information about him being the first to name the disease can be found in <Arnholdt, Robert, Johann Lukas Schönlein als Tuberkulosearzt,[Johann Lukas Schönlein, the Tuberculosis Doctor]In: Bayerisches Ärzteblatt 1978, S. 702-707> PaullTas (talk) 04:23, 2 March 2012 (UTC)

precaution

which precaution should be take by patient after cure?Bhavinkundaliya (talk) 17:46, 28 March 2012 (UTC)

Fix

That such an important article has fallen into disarray is unfortunate. Will see if I can fix it.--Doc James (talk · contribs · email) 12:23, 29 December 2011 (UTC)

We have a great 2011 Lancet review here

• Lawn, SD (2011 Jul 2). "Tuberculosis". Lancet. 378 (9785): 57–72. PMID 21420161. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Escalante, P (2009 Jun 2). "In the clinic. Tuberculosis". Annals of internal medicine. 150 (11): ITC61-614, quiz ITV616. PMID 19487708. {{cite journal}}: Check date values in: |date= (help)Doc James (talk · contribs · email) 04:53, 5 January 2012 (UTC)

2011 US data

[2] Doc James (talk · contribs · email) 16:40, 23 March 2012 (UTC)

Seminar

The Lancet have a seminar in print (doi:10.1016/S0140-6736(10)62173-3) that might be useful for updating the article.JFW | T@lk 07:31, 27 June 2011 (UTC)

And here is the 2011 WHO report [3]--Doc James (talk · contribs · email) 22:16, 31 March 2012 (UTC)

1. Lienhardt, C (2011 Nov). "What research is needed to stop TB? Introducing the TB Research Movement". PLoS medicine. 8 (11): e1001135. PMID 22140369. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
2. Marais, BJ (2011). "What do we know about how to treat tuberculosis?". Advances in experimental medicine and biology. 719: 171–84. PMID 22125044.
3. Lessells, RJ (2011 Nov 15). "Evaluation of tuberculosis diagnostics: establishing an evidence base around the public health impact". The Journal of infectious diseases. 204 Suppl 4: S1187-95. PMID 21996701. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
4. McShane, H (2011 Oct 12). "Tuberculosis vaccines: beyond bacille Calmette-Guerin". Philosophical transactions of the Royal Society of London. Series B, Biological sciences. 366 (1579): 2782–9. PMID 21893541. {{cite journal}}: Check date values in: |date= (help)-Doc James (talk · contribs · email) 11:15, 1 April 2012 (UTC)

GA Review

This review is transcluded from Talk:Tuberculosis/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Axl (talk · contribs) 20:30, 20 April 2012 (UTC)

Okay, I'll review it. Axl ¤ [Talk] 20:30, 20 April 2012 (UTC)

Thanks --Doc James (talk · contribs · email) 03:42, 21 April 2012 (UTC)

From the lead section, paragraph 2: "Diagnosis relies on ... blood tests." Diagnosis does not rely on blood tests. Axl ¤ [Talk] 20:31, 20 April 2012 (UTC)

The ref says "Tuberculin skin test has been the only screen avliable for the diagnosis of latent infection with TB. Its major failing is its inability to reliably distinguish individuals infects from individuals immunized with BCG. IGRAs were developed whereby interferon-gama titres were measured after in vitro stimulation of peripheral blood mononuclear cells... These have now become the gold standard for identifying individuals whose immune system has previously encountered MTB" It is a blood test. 90% of the population has been immunized with BCG.

IGRAs can be used as rule out but not rule in tests for diagnosis of active tuberculosis.Page 64 of the Lancet.--Doc James (talk · contribs · email) 04:07, 21 April 2012 (UTC)

Okay thanks the Mantoux and IGRA are for latent TB not for active TB will fix/clarify Doc James (talk · contribs · email) 04:14, 21 April 2012 (UTC)

On a related note, from "Diagnosis", subsection "Active tuberculosis", paragraph 1: "a tuberculin skin test (Mantoux test) or a interferon gamma release assay are typically part of the initial evaluation." An IGRA is not typically part of the initial evaluation. Axl ¤ [Talk] 20:37, 20 April 2012 (UTC)

Yes sorry that section was originally about both latent and active TB before I split them into separate sections. Thanks for picking it up.Doc James (talk · contribs · email) 04:26, 21 April 2012 (UTC)

From the lead section, paragraph 2: "Antibiotic resistance is a growing problem in (extensively) multiple drug-resistant tuberculosis." I don't think that "extensively" needs to included in parentheses here in the lead section. XDR is mentioned in the "Management" section. Axl ¤ [Talk] 20:49, 20 April 2012 (UTC)

Agree Doc James (talk · contribs · email) 04:26, 21 April 2012 (UTC)

From "Signs and symptoms": "General symptoms such as: fever, chills, night sweats, appetite loss, weight loss, fatigue, and finger clubbing may also occur." Finger clubbing is not a symptom. (Fever and weight loss may be both signs and symptoms.) Axl ¤ [Talk] 20:59, 20 April 2012 (UTC)

fixed Doc James (talk · contribs · email) 04:37, 21 April 2012 (UTC)

From "Signs and symptoms", subsection "Pulmonary": "Spitting up stones known as lithoptysis has been described due to bronchial lymph nodes communicated with the airways." I wasn't aware of that symptom. A PubMed search for "lithoptysis" revealed only 23 results. Most of these describe broncholithiasis, often in association with bronchiectasis. Admittedly TB can cause bronchiectasis and broncholithiasis. However I believe that this symptom is exceedingly rare, in my opinion not worth mentioning in this article. Axl ¤ [Talk] 21:25, 20 April 2012 (UTC)

It is mentioned in "Dolin, [edited by] Gerald L. Mandell, John E. Bennett, Raphael (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. pp. Chapter 250" But yes I assume it is very uncommon. Doc James (talk · contribs · email) 05:50, 21 April 2012 (UTC)

Okay, it is mentioned as a complication of calcified nodes. (It should be "coughing", not "spitting".) I'm still not convinced that it should be in Wikipedia's article. Axl ¤ [Talk] 12:01, 23 April 2012 (UTC)

Sure removed :-) Doc James (talk · contribs · email) 12:16, 23 April 2012 (UTC)

Thanks. Axl ¤ [Talk] 12:55, 23 April 2012 (UTC)

From "Signs and symptoms", subsection "Extrapulmonary": "In the other 25% of active cases, the infection moves from the lungs." The first 75% haven't been explicitly noted. Axl ¤ [Talk] 21:30, 20 April 2012 (UTC)

Done --Doc James (talk · contribs · email) 23:46, 3 May 2012 (UTC)

From "Causes", subsection "Mycobacteria", paragraph 1: "The main cause of TB is Mycobacterium tuberculosis, a small, aerobic nonmotile bacillus or less commonly, the closely related Mycobacterium bovis." The third paragraph goes on to discuss MTB complex, including M. bovis. Perhaps remove the mention of M. bovis from the first paragraph? Axl ¤ [Talk] 09:56, 21 April 2012 (UTC)

Done --Doc James (talk · contribs · email) 23:48, 3 May 2012 (UTC)

From "Causes", subsection "Mycobacteria", paragraph 1: "Mycobacteria have an outer membrane lipid bilayer, yet microbiology textbooks continue to classify them as a Gram-positive bacteria." This sentence implies that the reader should know that the presence of an outer membrane lipid bilayer precludes the label of Gram-positive bacteria. The sentence needs to be refactored, in conjunction with the subsequent sentence. Axl ¤ [Talk] 10:03, 21 April 2012 (UTC)

Probably best in within a subpage.--Doc James (talk · contribs · email) 23:52, 3 May 2012 (UTC)

From "Causes", subsection "Mycobacteria", paragraph 2: "The most common acid-fast staining technique, the Ziehl-Neelsen stain, dyes AFBs a bright red that stands out clearly against a blue background. Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy." These sentences do not have a reference. In the UK, I believe that auramine-rhodamine is more commonly used, although I have been unable to find a reference. Interestingly, Mandell, Douglas & Bennett states: "Fluorescent stains [such as auramine-rhodamine] are more sensitive for the detection of mycobacteria, particularly in direct specimens, because the organisms stain brightly and can be clearly distinguished from background material." Axl ¤ [Talk] 18:02, 23 April 2012 (UTC)

Okay found a couple of refs that state these two are the most commonly used.--Doc James (talk · contribs · email) 00:11, 4 May 2012 (UTC)

The latter sentence: "Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy." seems to imply that auramine-rhodamine is a distinct technique separate from fluorescence microscopy. Axl ¤ [Talk] 18:05, 23 April 2012 (UTC)

Fixed--Doc James (talk · contribs · email) 00:11, 4 May 2012 (UTC)

From "Causes", subsection "Risk factors": "Worldwide, the most important of these is HIV, with coinfection present in about 13% of cases." Can this sentence be simplified to make it easier for lay readers to understand? Actually, I think that the "Risk factors" subsection should be in "Epidemiology", not "Causes". Axl ¤ [Talk] 18:34, 23 April 2012 (UTC)

I usually put my comments on risk factors in the section on causes rather than epidemiology. I think it usually fits better their. In epidemiology I than discuss how common the condition is in which parts of the world and how the rate is changing over time. Doc James (talk · contribs · email) 12:48, 24 April 2012 (UTC)

Simplified the wording.--Doc James (talk · contribs · email) 00:19, 4 May 2012 (UTC)

I meant simplification of "coinfection". What is coinfection? 13% of people with HIV have TB, or 13% of people with TB have HIV? Axl ¤ [Talk] 10:26, 4 May 2012 (UTC)

How about "The most important risk factor globally is HIV; 13% of all TB cases are also infected with HIV."? Axl ¤ [Talk] 17:47, 4 May 2012 (UTC)

Sure Doc James (talk · contribs · email) 20:02, 4 May 2012 (UTC)

From "Mechanism", subsection "Transmission", paragraph 2: "Others at risk include people in areas where TB is common, people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (eg. prisons, homeless shelters), medically underprivileged and resource-poor populations, high-risk racial or ethnic minorities, children in close contact with high-risk category patients, those who are immunocompromised by conditions such as HIV infection, people who take immunosuppressant drugs, and health care providers serving these clients." This list should be in the "Epidemiology" section, along with the other risk factors. Axl ¤ [Talk] 11:00, 24 April 2012 (UTC)

Combined into section on risk factors.--Doc James (talk · contribs · email) 00:19, 4 May 2012 (UTC)

From "Mechanism", subsection "Transmission", paragraph 3: "The cascade of person-to-person spread can be circumvented by effective segregation of those with active (overt) TB, and putting them on recommended anti-TB drug regimens." Is the word "recommended" required here? Axl ¤ [Talk] 09:55, 26 April 2012 (UTC)

Good point and will remove.Doc James (talk · contribs · email) 10:12, 26 April 2012 (UTC)

From "Pathogenesis", paragraph 1: "About 90% of those infected with M. tuberculosis have asymptomatic, latent TB infections (sometimes called LTBI), with only a 10% lifetime chance that a latent infection will progress to TB disease." This is referenced to Robbins Basic Pathology. I found the following text in Robbins Basic Pathology: "About 5% of those newly infected develop significant disease [primary tuberculosis].... In approximately 95% of cases, development of cell-mediated immunity controls the infection." Regarding the development of secondary TB (i.e. reactivation of LTBI), Robbins states: "Whatever the source of the organism, only a few individuals (less than 5%) with primary disease subsequently develop secondary tuberculosis." Axl ¤ [Talk] 09:52, 27 April 2012 (UTC)

The WHO reference states: "People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%." However primary TB isn't distinguished from LTBI reactivation in this figure. Axl ¤ [Talk] 18:04, 27 April 2012 (UTC)

Do you not think the WHO ref supports this? Never the less I have found a better ref which I think does.--Doc James (talk · contribs · email) 00:53, 4 May 2012 (UTC)

The new reference only supports the second half of the sentence. Axl ¤ [Talk] 18:17, 4 May 2012 (UTC)

Added a second ref. Doc James (talk · contribs · email) 21:53, 8 May 2012 (UTC)

I am not able to view that reference, but I'll assume good faith. Axl ¤ [Talk] 10:08, 9 May 2012 (UTC)

From "Signs and symptoms", subsection "Pulmonary": "The upper lungs are believed to be more frequently affected due to their poor lymph supply rather than more air flow." This is referenced to Mandell, Douglas & Bennett. The reference supports the statement. However Robbins Basic Pathology states: "Secondary pulmonary tuberculosis is classically localized to the apex of one or both upper lobes. The reason is obscure but may relate to high oxygen tension in the apices." Axl ¤ [Talk] 09:56, 27 April 2012 (UTC)

I do not have access to a Robbins Basic Pathology. Will balance.--Doc James (talk · contribs · email) 00:53, 4 May 2012 (UTC)

I have adjusted the text. Axl ¤ [Talk] 18:22, 4 May 2012 (UTC)

From "Mechanism", subsection "Pathogenesis", paragraph 1: "However, if effective treatment is not rendered, the death rate for active TB cases is more than 50%." The reference (WHO) states: "Without proper treatment up to two thirds of people ill with TB will die." Axl ¤ [Talk] 19:47, 30 April 2012 (UTC)

I think I see the problem. This text was written based on a 2004 WHO statement which has subsequently been updated. Fixed --Doc James (talk · contribs · email) 01:04, 4 May 2012 (UTC)

I have changed "rendered" to "given". Axl ¤ [Talk] 18:35, 4 May 2012 (UTC)

"Mechanism", subsection "Pathogenesis", paragraph 2 has duplicate text describing Simon foci. Axl ¤ [Talk] 20:00, 30 April 2012 (UTC)

Done --Doc James (talk · contribs · email) 01:16, 4 May 2012 (UTC)

I have adjusted the text. Axl ¤ [Talk] 18:37, 4 May 2012 (UTC)

From "Mechanism", subsection "Pathogenesis", paragraph 3: "Tuberculosis is classified as one of the granulomatous inflammatory conditions." How about "diseases" instead of "conditions"? Axl ¤ [Talk] 20:07, 30 April 2012 (UTC)

Done --Doc James (talk · contribs · email) 01:16, 4 May 2012 (UTC)

From "Mechanism", subsection "Pathogenesis", paragraph 3: "Another feature of the granulomas of human tuberculosis is the development of abnormal cell death (necrosis) in the center of tubercles." Why is this called out as "human tuberculosis"? Is this specific to humans? The reference states: "The caseous necrosis is the basic process of tuberculosis disease in humans." Axl ¤ [Talk] 20:14, 30 April 2012 (UTC)

Agree and removed human. --Doc James (talk · contribs · email) 01:20, 4 May 2012 (UTC)

From "Mechanism", subsection "Pathogenesis", paragraph 4: "This severe form of TB disease, most common in infants and the elderly, is called miliary tuberculosis." I am surprised that HIV/AIDS isn't mentioned. This reference states: "In North America, miliary TB is most common in elderly people and in HIV-infected patients." Axl ¤ [Talk] 20:44, 30 April 2012 (UTC)

Yes and fixed --Doc James (talk · contribs · email) 01:39, 4 May 2012 (UTC)

Given that the new reference is Textbook of Pediatric HIV care, I'm not convinced that it supports the statement indicating high incidence: "This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis." Axl ¤ [Talk] 19:18, 4 May 2012 (UTC)

The ref is/was [4] --Doc James (talk · contribs · email) 20:01, 4 May 2012 (UTC)

You have missed my point. The textbook is about paediatric HIV disease. We cannot infer that miliary TB is common in young children, or even that it is more common than in adults. Axl ¤ [Talk] 21:37, 4 May 2012 (UTC)

Hum. Okay added a couple of different refs and than there is this one http://books.google.ca/books?id=8dfhwKaCSxkC&pg=PA75 --Doc James (talk · contribs · email) 22:11, 4 May 2012 (UTC)

The new reference, "A practical guide to pediatric emergency medicine : caring for children in the emergency department", has the same problem. It is implicitly about the paediatric group. "TB/HIV: A Clinical Manual" is a better reference. Axl ¤ [Talk] 12:44, 6 May 2012 (UTC)

Done Doc James (talk · contribs · email) 20:23, 6 May 2012 (UTC)

From "Mechanism", subsection "Pathogenesis", paragraph 4: "People with this disseminated TB have a fatality rate near 100% if left untreated. However, if treated early, the fatality rate is reduced to about 10%." The reference is Kim, "Miliary tuberculosis and acute respiratory distress syndrome". I don't have access to the paper. However it looks like a primary source. The paper seems to be about miliary TB with ARDS, not miliary TB alone. What exactly does the source say about mortality rate? I am struggling to find a source that gives mortality rates for miliary TB, untreated & treated. Axl ¤ [Talk] 17:36, 1 May 2012 (UTC)

reworded --Doc James (talk · contribs · email) 01:40, 4 May 2012 (UTC)

I have adjusted the text. Axl ¤ [Talk] 12:56, 6 May 2012 (UTC)

From "Diagnosis", subsection "Active tuberculosis", paragraph 2: "However, the difficult culture process for this slow-growing organism can take four to 12 weeks for blood or sputum culture." The reference is the NICE guideline. Culture really shouldn't take more than six weeks – and even that is usually in cases where mycobacteria are not actually TB. In any case, I can't find the statement in the reference. The reference has 307 pages and it is unhelpful to quote the whole document as the source for a single statement. The main purpose of referencing is for verifiability. Axl ¤ [Talk] 18:13, 1 May 2012 (UTC)

Ref was just for the very last sentence. Have corrected the statement in question and provided a ref.Doc James (talk · contribs · email) 09:18, 4 May 2012 (UTC)

From "Diagnosis", subsection "Latent tuberculosis": "These are not affected by immunization or environmental mycobacteria, so they generate fewer false-positive results." There are some mycobacteria that create false positives: notably M. szulgai, M. marinum and M. kansasii. "Clinical evaluation of the QuantiFERON-TB Gold test in patients with non-tuberculous mycobacterial disease". Axl ¤ [Talk] 19:02, 1 May 2012 (UTC)

Yes and added. Doc James (talk · contribs · email) 09:28, 4 May 2012 (UTC)

From "Diagnosis", subsection "Latent tuberculosis": "There is also evidence IGRAs are more sensitive than the skin test." This is referenced to Lalvani. This looks like a letter, not a secondary source. Also, Lalvani is the guy who invented T-SPOT.TB. Axl ¤ [Talk] 10:40, 3 May 2012 (UTC)

Thanks for picking that up. Replaced with review. Doc James (talk · contribs · email) 01:50, 4 May 2012 (UTC)

From "Causes", subsection "Risk factors": "Chronic lung disease is another significant risk factor - smoking more than 20 cigarettes a day seems to increase the risk of TB by two to four times." Smoking isn't a chronic lung disease. Axl ¤ [Talk] 18:04, 4 May 2012 (UTC)

Yes and separated.Doc James (talk · contribs · email) 19:04, 4 May 2012 (UTC)

In "Causes", subsection "Risk factors", can I recommend this 2010 review article from the European Respiratory Journal over the existing 2006 article from Transactions of the Royal Society of Tropical Medicine and Hygiene? Axl ¤ [Talk] 19:38, 6 May 2012 (UTC)

Updated. Doc James (talk · contribs · email) 19:53, 6 May 2012 (UTC)

From "Prognosis", paragraph 1: "These dormant bacilli can produce tuberculosis in 2% to 23% of these latent cases, often many years after infection." It's odd that this range is quoted; earlier in the article, 10% lifetime risk of re-activation of LTBI is quoted. Axl ¤ [Talk] 19:51, 6 May 2012 (UTC)

Updated with newer ref. Doc James (talk · contribs · email) 22:44, 6 May 2012 (UTC)

From "Epidemiology", paragraph 1: "However, not all infections with M. tuberculosis cause TB disease, and many infections are asymptomatic." 90–95% are asymptomatic at the time of infection. Axl ¤ [Talk] 09:18, 7 May 2012 (UTC)

Added with ref. Doc James (talk · contribs · email) 22:02, 8 May 2012 (UTC)

I have adjusted the text. Axl ¤ [Talk] 10:15, 9 May 2012 (UTC)

From "Epidemiology", paragraph 2: "China has achieved particularly dramatic progress, with an approximate 80% decline in its TB mortality rate." Over what period of time? Axl ¤ [Talk] 10:05, 7 May 2012 (UTC)

Fixed Doc James (talk · contribs · email) 22:06, 8 May 2012 (UTC)

From "Epidemiology", paragraph 2: "Hopes of totally controlling the disease have been dramatically dampened because of a number of factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, and the emergence of drug-resistant cases in the 1980s." What about HIV? Axl ¤ [Talk] 21:32, 8 May 2012 (UTC)

You are correct. I missed that one and have now added. --Doc James (talk · contribs · email) 22:12, 8 May 2012 (UTC)

From "Epidemiology", paragraph 3: "These rates contrast with 98 per 100,000 in China and 48 per 100,000 in Brazil." Why are China and Brazil singled out for comparison with Western Europe? Axl ¤ [Talk] 10:32, 9 May 2012 (UTC)

Both are very large countries. I guess I could add India aswell... --Doc James (talk · contribs · email) 00:43, 12 May 2012 (UTC)

Okay removed most country specific data and replaced it with region specific data. --Doc James (talk · contribs · email) 00:57, 12 May 2012 (UTC)

I think that the region-specific information would be better displayed as a table. Also, I'm not sure why the Canadian aboriginal peoples are singled out. [Conflict of interest perhaps? ;-) ] Axl ¤ [Talk] 10:55, 12 May 2012 (UTC)

Okay will do and see what it looks like. Will look for content regarding aboriginal populations in general. Only a little COI... --Doc James (talk · contribs · email) 21:41, 12 May 2012 (UTC)

In "Epidemiology", I wonder if the last paragraph should be in the "History" section? Axl ¤ [Talk] 10:39, 9 May 2012 (UTC)

Agree --Doc James (talk · contribs · email) 00:37, 12 May 2012 (UTC)

From "History", paragraph 1: "A genomic approach comparing M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests that humans did not acquire MTBC from animals during animal domestication, as was previously believed." For the benefit of lay readers, what is a "genomic approach"? Axl ¤ [Talk] 10:53, 9 May 2012 (UTC)

Good point and simplified. --Doc James (talk · contribs · email) 01:23, 12 May 2012 (UTC)

From "History", paragraph 1: ""Phthisis" is a Greek term for consumption." Again, for the benefit of lay readers, what is "consumption" in this context? Axl ¤ [Talk] 11:04, 9 May 2012 (UTC)

Clarified what it means --Doc James (talk · contribs · email) 01:33, 12 May 2012 (UTC)

From "History", last paragraph: "This technique [artificial pneumothorax] was of little or no benefit and was largely abandoned by the 1950s." Was it really of little/no benefit? I can only view the abstract of the reference. The full article is in German so I won't understand it anyway. Axl ¤ [Talk] 18:11, 9 May 2012 (UTC)

Found a better ref --Doc James (talk · contribs · email) 01:47, 12 May 2012 (UTC)

Break

From "Society and culture": "One molecular diagnostics test which gives results in 100 minutes is currently being offered to 116 low- and middle-income countries at a discount with support from the World Health Organization and the Bill and Melinda Gates Foundation." The merits of the test are being emphasized rather than the cultural impact and charitable work. The position of this test in a formal screening or diagnostic protocol is still being evaluated. The reference is Reuters, which shouldn't be used to describe the merits of the test itself when peer-reviewed medical sources are available. Axl ¤ [Talk] 18:34, 9 May 2012 (UTC)

Have added a second ref supporting the science part of it.--Doc James (talk · contribs · email) 02:01, 12 May 2012 (UTC)

The problem here is that the section is "Society and culture". Currently, the text emphasizes the significance of the test, not the societal impact of the WHO and Bill & Melinda Gates Foundation. The short time to a result is not relevant in this section. The text needs to be re-factored to make the societal impact more prominent. Something like: "The World Health Organization and the Bill and Melinda Gates Foundation are subsidizing a new fast-acting diagnostic test for use in low- and middle-income countries." Axl ¤ [Talk] 10:43, 13 May 2012 (UTC)

Okay that would be good. Must catch another plane. Doc James (talk · contribs · email) 23:35, 13 May 2012 (UTC)

I have changed the text. Axl ¤ [Talk] 10:35, 14 May 2012 (UTC)

From "Society and culture", paragraph 1: "It is useful for diagnosis MDR-TB or HIV-associated TB." Again, this isn't really relevant in "Society and culture". Axl ¤ [Talk] 10:56, 13 May 2012 (UTC)

I have deleted the sentence. Axl ¤ [Talk] 10:36, 14 May 2012 (UTC)

From "Society and culture": "Implementation is pending for programs similar to the Revised National Tuberculosis Control Program that has helped reduce TB levels amongst people receiving public health care." This statement implies that RNTCP is now defunct. Is that correct? The reference is from "Hypothesis" Journal. This journal doesn't appear to be listed on PubMed. Although there does seem to be a degree of peer review, they state: "We aim to establish an interdisciplinary journal that swiftly publishes new, provocative, and sometimes currently untestable ideas". I am not convinced that this journal is a suitable secondary source for referencing Wikipedia's articles. Axl ¤ [Talk] 18:49, 9 May 2012 (UTC)

Added ref and adjusted wording. I usually give a little more leyway with respect to refs in the "society and culture" section Doc James (talk · contribs · email) 02:03, 12 May 2012 (UTC)

Regarding the x-ray in the Infobox, it would be helpful if the caption stated the significance of the arrows. Axl ¤ [Talk] 20:13, 11 May 2012 (UTC)

Add info. Doc James (talk · contribs · email) 02:03, 12 May 2012 (UTC)

I have adjusted the caption. Axl ¤ [Talk] 11:02, 13 May 2012 (UTC)

Summary

I am just waiting on Doc James to address a few more points above. Otherwise, the article looks very good.

1. The article is well-written.
2. It is accurate and appropriately referenced.
3. The article covers the whole topic without undue detail.
4. It is neutral in tone.
5. The content is stable, without any edit warring.
6. The pictures are all freely available from Wikimedia Commons. They help to illustrate the article.

Axl ¤ [Talk] 20:21, 11 May 2012 (UTC)

Okay, the article meets the GA criteria. I am awarding GA status. My thanks and congratulations to Doc James (Jmh649).

There are some areas that can be improved:-

• From "Epidemiology", paragraph 3, the regional incidence values could be better displayed as a table.

Not really room for a table.Doc James (talk · contribs · email) 22:04, 25 May 2012 (UTC)

• From "Epidemiology", paragraph 3, the information about Canadian aboriginals seems to give undue weight to that population and should be removed.

Added balancing details. Doc James (talk · contribs · email) 22:04, 25 May 2012 (UTC)

• The "History" section should include information about thoracoplasty and plombage as well as artificial pneumothorax.

Will consider putting in the sub article of history. Doc James (talk · contribs · email) 22:04, 25 May 2012 (UTC)

• The references need to be standardized to a single format. Some journal names use abbreviations while others do not; some use capital letters, while others don't.

Do you know if there is a bot that can do this? Doc James (talk · contribs · email) 07:04, 18 May 2012 (UTC)

• Reference 59 (NICE) has several formats, of different length and with different text. The full document is 307 pages long, while the abbreviated document is 63 pages long. In the interest of verifiability, the reference should specify which format is being used, and which page.

Axl ¤ [Talk] 10:53, 14 May 2012 (UTC)

To add

• http://www.ncbi.nlm.nih.gov/pubmed/17943789

--Doc James (talk · contribs · email) 21:52, 12 May 2012 (UTC)

Done --Doc James (talk · contribs · email) 22:26, 25 May 2012 (UTC)

The White Death

I've heard that TB was called 'The White Death' at some point in the past. I can find no mention of the term in the article. Isn't it worthy of a mention? Perhaps in the history section? VenomousConcept (talk) 10:39, 16 May 2012 (UTC)

It is mentioned in "History of tuberculosis". Axl ¤ [Talk] 21:04, 16 May 2012 (UTC)

Post-GA improvement

" Not really room for a table [of regional incidence values]. "

— Doc James

What do you mean "Not really room"? Space is not an issue in Wikipedia articles. Adding a table isn't going to make the article impractically large.

While we have two images in that section on epidemiology right now. Adding a table will make formatting worse.Doc James (talk · contribs · email) 23:05, 26 May 2012 (UTC)

" Added balancing details [about aboriginals]. "

— Doc James

I'm still not convinced that this focus on aboriginal peoples is appropriate for this general article. Anyway, I am prepared to ignore it for the time being. The FAC reviewers will consider it when the time comes and we can get a consensus.

" Will consider putting [thoracoplasty and plombage] in the sub article of history. "

— Doc James

These used to be important and common treatments for TB. This article should at least mention them in the "History" section. I could add this.

" Do you know if there is a bot that can do this [standardize references]? "

— Doc James

I don't know. I can go through the reference list and fix these issues.

Axl ¤ [Talk] 10:24, 26 May 2012 (UTC)

The bacteria in granulomas are not dormant. The granuloma is helpful to the host, but dow not prevent dissemination of the disease. See articles by L. Ramakrishnan at U. Washington in the journal,Cell. — Preceding unsigned comment added by Chemtr (talk • contribs) 09:05, 14 October 2012 (UTC)

2013 review in the NEJM

Zumla, A (2013 Feb 21). "Tuberculosis". The New England journal of medicine. 368 (8): 745–55. PMID 23425167. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:57, 28 February 2013 (UTC)

Pending needed edit.

The very second citation does not support the assertion that TB spreads through"saliva". How do you know it does not spread through mucous, or free baccilli suspended in air. This is wrong, and needs to be changed promptly: It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit their saliva through the air.[2]Go scan the citation - it has nothing whatsoever to do with the issue of transmission, it is an article about diagnostics. I can't perform this edit from this account and won't, from my primary account, due to WP-policy compliant reasons of my own.Agent128 (talk) 01:02, 7 March 2013 (UTC)

Yes "The infection is transmitted by respirable droplets generated during forceful expiratory manoeuvres such as coughing." Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:04, 7 March 2013 (UTC)

But we know that is not a comprehensive description in that the infection can in some cases be transmitted by events other than "expiratory manoeuvres". In any case I am glad you supported my edit as it is not "saliva" but rather the baccilli which transmit, via pulmonary and perhaps other material originating in the sinuses, the oral mucosa. I don't know that the baccillus has been isolated from saliva, or from sinoidal fluid, or from mucous, but I imagine that a late stage patient does indeed have swarms of MTD everywhere. Agent128 (talk) 01:45, 7 March 2013 (UTC)

Vaccine

I was just going to add that the vaccine is "no longer" used routinely in the UK, because it was up until like 2006. I think i may have been in the last year to get it. Just saying it's not routinely given suggests that it never was, when there a good couple of generations of people with the scars to prove otherwise! — Preceding unsigned comment added by 129.215.149.97 (talk) 22:13, 8 April 2013 (UTC)

Yes good point. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:09, 19 May 2013 (UTC)

Reduction of cost for test to detect drug-resistant strain(s)

Public-Private Partnership Announces Immediate 40 Percent Cost Reduction for Rapid TB Test, press release reprinted by WHO, Aug. 6, 2012.

"PEPFAR, USAID, UNITAID and Bill & Melinda Gates Foundation have finalized an agreement to expand access to GeneXpert®, a molecular diagnostic system that provides a two-hour rapid diagnosis of TB, TB/HIV co-infection and drug-resistant TB. . . "

" . . . can detect TB disease in patients co-infected with HIV and resistance to the antibiotic rifampicin – a widely accepted indicator of the presence of multi-drug resistant TB . . . "

The Stop TB Partnership, which operates through a secretariat hosted by the World Health Organization (WHO) in Geneva, Switzerland, with WHO also as a leading partner. Published evidence and commentary on the Xpert MTB/RIF assay, a PDF file containing 11 pages of published studies and commentary, updated April 5, 2013.

I added these two references to our Diagnosis . . . Active tuberculosis subsection. I AM NOT A DOCTOR. However, I am interested in issues of public health, and am willing to do the work (time permitting of course) of getting good references. Cool Nerd (talk) 22:27, 17 May 2013 (UTC)

Have moved to were this discussion already was in the society and culture section. Refs need further formatting. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:45, 18 May 2013 (UTC)

Hi Doc James, good to here from you!  :>) In the Extrapulmonary subsection our article states "In those with HIV, this occurs in more than 50% of cases." And I'm assuming that's why microscopic examination of morning sputum is less helpful . . . but I'd still ask if the patient co-infected with HIV might tend to have extrapulmonary in addition to pulmonary? Now, on the question of drug resistance, I'm surprised there's not the best bet approach used, say like what a seasoned poker player might do. I mean, if a certain type of resistance is present in 30% of TB strains in a region, why don't doctors treat all cases in that region as if such resistance is present? I know WHO has gone from DOTS to DOTSPlus and I think two further levels as well. And I know there's been a debate, with some people saying, Hey, DOTS has saved a whole bunch of lives over the years, and other people saying, Yes, and we can do better.

On the issue of formatting the references, I'm against it! I mean, just straight up. Please remember, I'm one of the people who think we pay dearly for the (over-) formality of wikipedia, often at the expense of the accuracy of the information itself, and certainly at the expense of breadth of coverage. To me, the formatted reference is more complicated to do and more complicated to correct and improve. For example, we might loss the part from above "a PDF file containing 11 pages of published studies and commentary," which is what it is and is useful information to share with our readers. Cool Nerd (talk) 18:16, 18 May 2013 (UTC)

"In those with HIV, this occurs in more than 50% of cases" simply refers to extrapulmonary Tb and yes they likely also have pulmonary Tb. With respect to "I mean, if a certain type of resistance is present in 30% of TB strains in a region, why don't doctors treat all cases in that region as if such resistance is present?". They might be I am not sure. Every other ref in this article is formatted in a certain fashion. I have formatted these two. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:53, 18 May 2013 (UTC)

Familial disseminated atypical mycobacterial infection

Or Mendelian Susceptibility to Mycobacterial Disease can expand on this? Jpogi (talk) 07:23, 16 May 2013 (UTC)

Evidence

• Weiand, D (2012 Sep). "Assessing and improving adherence with multidrug therapy". Leprosy review. 83 (3): 282–91. PMID 23356029. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Sumpter, C (2013 Jan). "Systematic review and meta-analysis of the associations between indoor air pollution and tuberculosis". Tropical medicine & international health : TM & IH. 18 (1): 101–8. PMID 23130953. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:45, 18 May 2013 (UTC)

History, first sanatorium

In the article, it is written

Hermann Brehmer opened the first TB sanatorium in 1859 in Sokołowsko, Poland.[104]

I read from this sentence, that the sanatorium was opened in Poland. This is not true. In 1859, this town was called Görbersdorf and it was part of the Lower Silecian Province in Prussia. — Preceding unsigned comment added by 139.20.118.102 (talk) 08:09, 21 May 2013 (UTC)

Inaccurate information

From the article,"One third of the world's population is thought to have been infected with M. tuberculosis,[3] with new infections occurring at a rate of about one per second." I went to the source http://www.who.int/mediacentre/factsheets/fs104/en/index.html and found that "At least one-third of the 34 million people living with HIV worldwide are infected with TB bacteria, although not yet ill with active TB. " was the only mention of the 1/3 statistics and this clearly represents a skewed class in which the people infected with HIV is non-representative of the global population. Secondly, through their information of ~9 million people falling ill per year--> this leads to only 0.3 per sec not 1 per second. I request either removable or change unless someone can find sources on this sentence. Andy Jiang (talk) 00:44, 22 May 2013 (UTC)

What do you think about this line "About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease."[5] Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:04, 22 May 2013 (UTC)

As far as I can tell, the original source does not indicate that the one-third of the world's population has TB but rather one-third of the HIV population "About one-third of the world's HIV population has latent TB." would be more appropriate. Also, the second half of the one case per second is false.Andy Jiang (talk) 05:07, 22 May 2013 (UTC)

That however is not what the WHO site states. Have you tried writing to the WHO to ask them to correct / clarify this? There site very clearly states "one-third of the world's population" Do you have a counter ref saying this is incorrect? Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:43, 22 May 2013 (UTC)

And if WHO is wrong so are dozens of review articles such as this one [6] and [7] plus many textbooks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:47, 22 May 2013 (UTC)

I agree with James. Flyer22 (talk) 08:29, 22 May 2013 (UTC)

Can you point to me which line in the WHO site has that information of 1/3 of the world? Also that would imply ~2.3 billion people which is much more than 10 times of 8.7 million. I simply wish to see an estimate of the total that is approximately 1/3 of the world's population.Andy Jiang (talk) 14:17, 22 May 2013 (UTC)

Linked above twice and two additional links provided. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:45, 22 May 2013 (UTC)

I apologize,I just found it in the article. It should be kept. It just seemed a little out of proportions. The one per second statistics I assume is also based on the total cases--latent and active? I think it should be made more clear that this is the case.71.197.67.191 (talk) 00:44, 23 May 2013 (UTC)