Tuberculosis — aka, the reason everybody in 19th century literature is always coughing up blood, escaping to the countryside for "better air", or dying tragically young — is back. And this time, it's evolved a resistance to antibiotics. In fact, in a handful of cases, tuberculosis has been resistant to every single antibiotic available to treat it. Tom Levenson explains what's happening and why it matters at The New Yorker.

28 Responses to “Not your great-great-grandfather's consumption”

  1. Snig says:

    So, if I live another thirty years, I will not be surprised to read a whole lot of articles on the history of the second tuberculosis epidemic, with a chapter blaming the shortsightedness of the US politicians who blocked universal healthcare.

    • Boundegar says:

      Well, we have universal faith-based healthcare.  If it was good enough for Samuel Pepys, it’s good enough for me.

    • GregS says:

      How is lack of universal healthcare related to the resistance of tuberculosis to antibiotics? This is also a problem in countries that do have universal healthcare.

      • Nathaniel Green says:

        Somebody didn’t read the article…

      • Snig says:

        Yes, it is a problem in a country where people who get sick can take time off work and get treated for free.  It will be a worse problem in a country when people can’t afford to see a doctor and lose money or get fired for taking off work.    And many in this country have been trained by a system where if they wait until they’re sick enough for the ER, they can  get seen right away,  but if they try to make a regular doctor’s visit when first sick, they can be refused treatment for non-emergency visits if they don’t have money or insurance.  I sincerely hope you’re right and I’m being an alarmist, I would be much happier if the US healthcare system has a sudden uncharacteristic episode of sanity. 
        http://business.time.com/2012/06/07/many-food-industry-workers-barely-getting-by/
        From Here:
        83% of foodworkers with no health insurance, and 35% rely on the ER for healthcare needs.  Bon Apetit!

        • blueelm says:

          Heh… anecdote… when I was at my poorest I worked preparing food for other people. I was not allowed to take of when I was so sick I was vomiting regularly. Yes. I was vomiting, washing my hands, putting my gloves on… and making your food. Because if I didn’t how would I pay for the ER visit that would inevitably come?

          Now… you are lucky people. It turns out in a collective stroke of good fortune, that I have both better income and a couple of auto-immune diseases you never could have caught from me.

          But it isn’t always so. And no one would know the difference… because *that* diagnosis and treatment depends on medical care.

          • FoolishOwl says:

            I was fortunate to be covered by my parents’ health insurance when I was struggling on two part time jobs, one of which was at a bagel shop. I went in for a general physical exam, and I tested positive for exposure to TB; I was on antibiotics for six months.

            There are several things that could have gone wrong in that story: I might not have been tested for TB; I might not have been to take the full course of antibiotics.

            And I haven’t been able to afford health insurance in years.

      • Preston Sturges says:

        Resistance arises and spread unless the state provides health workers to follow up on each patient to make sure they complete their course of medication (taking harsh antibiotics for 6 months can be tough).  There is no other way to insure compliance with the medication, and the state has a huge interest in keeping TB under control. 

        What would it cost to have a prison to handle drug resistant TB?  How would the guards even work?  In moonsuits?  That genie need to stay in the bottle.

  2. Nathaniel Green says:

    Scary Stuff.

  3. Preston Sturges says:

    Various states legislatures have been taken over by the Americans For Prosperity/ALEC  “cargo cult” of austerity that targets programs like public health clinics.

    It’s not clear what benefit is supposed to result from cutting programs like TB prevention because none of the austerity advocates seem to have evolved to the point of speaking in complete sentences. 

    If they were Fascists, you’d actually see them trying to prevent diseases like syphilis and TB (and the new super drug resistant gonorrhea).  These guys seem more like a Maoist peasant rebellion that targets the doctors and teachers.

  4. Preston Sturges says:

    My great grandmother died young in a TB sanitarium.  My aunt described visiting her and being horrified to see her actually cough up a chunk of her lung.

  5. We can always try blaming the factory farms considering 80% of all antibiotics sold go towards livestock.  Add the curious reluctance of Big Pharma to spending time and money on new antibiotics and here we are.

    • Snig says:

      It’s not that curious, it’s just not where the big bucks are calculated to be.  Upper tier antibiotics would hopefully be a drug of last resort, and there’s not a lot of sales involved in a drug used sparingly.  Research suggests that antibiotics have historically been overused for conditions like sinusitis, bronchitis or otitis media, so new drugs wouldn’t have that historic antibiotic application, unless they demonstrated safe improvement and benefit that the preceding antibiotics never did.  Drugs taken routinely or even daily are much more lucrative. You’re definitely right about the factory farms, their antibiotic abuse is criminal.  

      • Barbara Dace says:

        True. Big Pharma is not really interested in cures; it’s interested in something that you have to take every day, preferably for the rest of your life. If a one shot, cheap cure for cancer (or TB) was found, you’d probably never hear about it, and it certainly would be unlikely to receive study funding under the current system. Not enough money in it.

      • digi_owl says:

         One reason for the overuse of antibiotics could be that for-pay health care (family doctor and such) risk loosing a customer if they do not do something. national health care don’t have to do that, as they work for the nation, not the individual patient. Last time there was a noise about a drug resistance bug going round,  Norwegian doctors showed that they had strict requirements for when they could prescribe antibiotics. This then reducing the chance of a resistant strain developing locally.

    • Preston Sturges says:

       It’s not the same antibiotics as used in livestock.

      However, you can get a really awful form of TB from raw milk – it infects and rots the skeleton, especially the spine. That’s one of many reason raw milk is dangerous.

      • Snig says:

        Multidrug resistance can be produced by having a higher selective pressure for genes such as efflux pumps. Efflux pumps are transport proteins that can essentially flush antibiotics out of the bacteria.  They work on more than one drug/class of drug.  Doesn’t matter if the antibiotic used in livestock is not the same as the ones used in animals.  This is just one example of how this could be a problem.  Are you suggesting antibiotics are essential in livestock to prevent transmission of TB?  And not homogenization/pasteurization?

  6. Ian Wood says:

    AD 1928 and AD 2025 marked the narrow boundaries of human domination over the far more numerous microbial species of the planet. The initial resurgence of antibiotic resistant tuberculosis and gonorrhea was soon followed by an onslaught of infectious diseases newly immune to technological intervention, which reduced the human population of the planet to just under two billion people by 2075. This population reduction was a necessary prerequisite for the reestablishment of the fixed-border militarized nation states that endured for the next four centuries.

  7. downwiththesickness says:

    I’ve got latent TB. Basically, I’m being stupid since the risk of developing the real thing is very low, and I’m not at all contagious, while the treatment is nine months of daily antibiotic. Question is, does this issue affect me and people like me much? Are we part of the problem?

    • blueelm says:

      This is interesting. I know some one who had that, but she was compelled by the State to take the treatment because she worked in childcare. So I know if you were in the right state and the right profession you would be considered potentially dangerous, just as if you somehow developed the full disease. But I would be curious to hear from some one who understands pathogens themselves how much of a threat that really poses. 

      It was hard for her. She could literally not work until she finished the full treatment.

    • Preston Sturges says:

       It is fairly common, especially for anyone that has ever worked in a public health facility, and a generation ago it was pretty common in the general population.

      It may come up on extensive health questionnaire about what date you first had a positive skin test and if you took the prophylactic antibiotics.  Partly that is because you will always have a positive skin test, and if they ever have to check the employees, they want to know who was exposed recently and who’s been positive for 20 years. See, for these public health issues this is the kind of information that become IMPORTANT in an outbreak.

  8. Barbara Dace says:

    You can also partly thank all those…persons…who think it’s okay to spit in public places for the rise in TB cases. If a TB carrier spits, as the sputum dries, the bacteria can spread in the air…and TB cases began increasing once public spitting became, inexplicably, more socially acceptible.

    • Preston Sturges says:

      Just say “Chinese.”

      I used to explain this to Chinese students that spitting, spitting, and more spitting was not OK because of American public health taboos based on actual laws going back to the 1920s.

      Todays Chinese students are quite cosmopolitan, but I’ve heard parts of China are practically stuccoed in dried spit.

      • Jonathan Roberts says:

        This is true, and not just outside. It’s not all their fault though, their lungs may have been damaged by the pollution. Even when you leave the country, you’ll probably have to deal with that for a while.

  9. skreader says:

    The BCG shot is a required on the vaccination schedule of Hong Kong.  It doesn’t completely prevent it, but reduces the chances of getting it substantially. Maybe it should be brought into the USA?
    It’s provided for free by the HK Health Dept.
    http://www.info.gov.hk/tb_chest/contents/c1211.htm

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