Acid-fast bacilli (AFB) (shown in red) are tubercle bacilli Mycobacterium tuberculosis.
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Tuberculosis

Tuberculosis (commonly shortened to TB) is an infection caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (Miliary tuberculosis), genitourinary system, bones and joints. more...

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Tuberculosis is the most common major infectious disease today, infecting two billion people or one-third of the world's population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.

Most of those infected (90 percent) have asymptomatic latent TB infection (LTBI). There is a 10 percent lifetime chance that LTBI will progress to active TB disease which, if left untreated, will kill more than 50 percent of its victims. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million, and malaria kills 1 million.

The neglect of TB control programs, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993.

Other names for the disease

  • TB (short for tuberculosis and also for Tubercle Bacillus)
  • Consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor, and long relentless wasting)
  • Wasting disease
  • White plague (TB sufferers appear markedly pale)
  • Phthisis (Greek for consumption) and phthisis pulmonalis
  • Scrofula (swollen neck glands)
  • King's evil (so called because it was believed that a king's touch would heal scrofula)
  • Pott's disease of the spine
  • Miliary TB (x-ray lesions look like millet seeds)
  • Tabes mesenterica (TB of the abdomen)
  • Lupus vulgaris (the common wolf - TB of the skin)
  • Prosector's wart, also a kind of TB of the skin, transmitted by contact with contaminated cadavers to anatomists, pathologists, veterinarians, surgeons, butchers, etc.

The bacterium

The cause of tuberculosis, Mycobacterium tuberculosis (MTB), is a slow-growing aerobic bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria, which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of E. coli that can divide roughly every 20 minutes). It is not classified as either Gram-positive or Gram-negative because it does not have the chemical characteristics of either, although it contains peptidoglycan in their cell wall. If a Gram stain is performed, it stains very weakly Gram-positive or not at all. It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but, spontaneously, can only grow within a host organism (in vitro culture of M. tuberculosis took a long time to be achieved, but is nowadays a normal laboratory procedure).

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Change of IL-12 and TNF-alpha productions measured by whole blood culture in tuberculosis patients after treatment
From CHEST, 10/1/05 by Young S. Kim

PURPOSE: Tuberculosis is one of the leading infectious diseases in adults, causing around 3 million deaths annually. Research on understanding the host defense and immunopathogenesis of tuberculosis is necessary because there is an urgent need for a new vaccine and adjunctive immunotherapy, particularly in patients with drug resistant Mycobacterium tuberculosis infection. Recently, many aspects of cytokine dynamics in patients with active pulmonary tuberculosis have been investigated through ex-vivo studies with specific or crude mycobacterial antigens, or M. tuberculosis.

METHODS: We used whole blood culture method in order to evaluate IL-12 and TNF-alpha productions in active TB patients, tuberculin skin test positive and negative healthy controls. We investigated the productions of IL-12, TNF-alpha in response to nonspecific mitogens and M. tuberculosis specific antigens. We used many tuberculous antigens for stimulation. The tuberculous antigens are culture filtrate proteins (CFP), purified protein derivatives (PPD), antigen 85A M. tuberculosis proteins (Ag85A), early secretory antigen target-6 (ESAT-6), 38k Dalton antigen (38kDa), RNA polymerase [beta] subunit B1 (rpoB1), RNA polymerase [beta] subunits B2 (rpoB1), arabinofuranasyl lipoarabinomannan(araLAM), manosyl-capped lipoarabinomannan(manLAM), and non-specific mitogens are concanavalinA(ConA), lipopolysaccaride(LPS), phytohaemagglutinin(PHA). In addition, we monitored the changes of each cytokine production in TB patients during the course of therapeutic treatment.

RESULTS: In our study, production of IL-12, TNF-alpha to nonmannose-capped lipoarabinomannan(araLAM) increased significantly in active tuberculosis patients compared to healthy controls, After 2 month, production of IL-12, TNF-alpha to araLAM decreased significantly throughout the therapeutic periods.

CONCLUSION: Our study suggest that productions of IL-12, TNF-alpha plays a important role in the pathogenesis and treatment of tuberculosis.

CLINICAL IMPLICATIONS: Whole blood culture method to IL-12, TNF-alpha may be used in the diagnosis of active pulmonary tuberculosis.

DISCLOSURE: Young Kim, None.

Young S. Kim MD * Jin W. Moon MD Chang H. Han MD Shin M. Kang MD Moo S. Park MD Se K. Kim MD Joon Chang MD Sung K. Kim MD Yonsei Univ College of Medicine, Seoul, South Korea

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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