History Of Tuberculosis And Explanation On How Bacteria Become Antibiotic Resistant

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Introduction:

The famous philosopher Charles Darwin once said, ‘It is not the strongest of the species that survive, not the most intelligent that survive. It is the one that is the most adapted to change’. In this research project, I will be discussing the history of Tuberculosis, how it has evolved and more.

Studying evolution is vital for the knowledge of man-kinds on Tuberculosis as well as their health. Rapid evolution coupled with the migration of human populations can endanger the health of many and therefore, understanding how diseases like such evolve are important.

Vaccines are essential for the process of fighting disease-causing bacteria, however, when these types of bacteria evolve new vaccines are at a high demand. For this reason, evolution can help with the development of lifesaving technologies.

Diseases, very often, develop a resistance to these technologies. Therefore, being knowledgeable about how diseases evolve can help scientist understand how to prevent this resistance as well as help in the discovery of new sources of lifesaving drugs. (Source A)

Along with scientists gaining a greater understanding of bacteria so do the rest of the world. Individuals can be taught about bacteria and how they can evolve to help them get a larger understanding and knowledge on how they can prevent themselves from contracting diseases.

The History of Tuberculosis:

Ancient Times

The first physical proof of the existence of Tuberculosis was found in the skeletal abnormalities in the spines of mummified individuals dating back to 2400 BC. This form of Tuberculosis is now best known as Pott’s Disease and has been distinguished in early Egyptian art pieces. However, there is no evidence of diagnostics associated with Tuberculosis reported in the Egyptian scrolls.

The first written documents, bearing data related to Tuberculosis, have been discovered in India and China, which date back from around 3300 years to 2300 years ago.

In Hebraism, the word ‘Schachepheth’ is used to describe Tuberculosis in the biblical books of Deuteronomy and Leviticus. In Greece, ‘Phthisis’ provided evidence of Tuberculous lung lesion. During the same period, Isocrates was the first author claiming Tuberculosis to be an infectious disease. During the Roman period after the decline of the Roman empire, Tuberculosis was widespread in Europe during the 18th and 19th Century. (Source B & C)

Middle Ages and Renaissance Time

During these periods, a new form of Tuberculosis, known as Scrofula, had surfaced and throughout England and France it had earned the name of ‘King’s Evil’. The reasoning behind this unusual name is that many believed that those who have fallen victim to Tuberculosis could be cured by the simple touch of a Royal Family Member. During the 16th Century, the infectious nature of Tuberculosis has been clearly defined by Girolamo Fracastoro, an Italian physician. In 1735, the Health Board of the Republic (HBR) ordered the mandatory notification and isolation of those victimized by Tuberculosis.

In order to achieve this, the HBR had forbidden those suffering from being admitted into public hospitals. As a result, hospitals had been established specifically to begin the treatment process for Tuberculosis without fearing the risk of transmission and widespread across the population. (Source B)

18th and 19th Century

Tuberculosis had reached its peak by the 18th Century in Western Europe. The mortality rates of the countries within this region were estimated to be about 900 deaths among 100 000 individuals.

It was around this time that the International Union Against Tuberculosis (IUAT) had been founded and vaccinations against Tuberculosis had developed.

Multiple global conferences were held where the main focus was on the biological, clinical and social aspects that are associated with Tuberculosis. It is also noted that throughout this period that the global migration of populations ignited the start of the global Tuberculosis outbreak. Consequently, this period was awarded the name of ‘the most important period in history.’ (Source B)

Global Spread of Mycobacterium tuberculosis:

Tuberculosis is generally known to be an airborne disease that is spread or carried in moist air particles in the atmosphere around us, through the actions of speaking, laughing, coughing, sneezing and even singing.

Nevertheless, it is relevant to know that physical contact cannot lead to an individual contracting the Tuberculosis bacteria, whether it be on the surface of an objects or on an individual. No physical contact cannot cause the spread of the disease as it is airborne.

Throughout centuries, the spread of Mycobacterium tuberculosis seems to be associated with the global migration and distribution of mankind. Both populations, Tuberculosis and man-kind, present similarities in regards to their distribution patterns. Ever since the peak of the Tuberculosis outbreak , European countries have presented favorable conditions, in which Tuberculosis has a chance to thrive and continue to spread in. These conditions include poor housing throughout populations, poor sanitation within cities, and malnutrition and overcrowding of populations. With that said, the presence of Tuberculosis has become common in developing countries where the conditions are just as beneficial – it is also noted that within these countries, the Tuberculosis legion tends to spread more rapidly as well. (Source D)

The most common form of Mycobacterium tuberculosis has spread to Asia, Africa, and North and South America by European explorers and colonists. The poorest and socially excluded countries carry the larges amounts of global Tuberculosis cases.

Hence, Africa and Asia account for about two-thirds (2/3) of the worlds Tuberculosis cases, whereas India, Indonesia, and China account for about 43% of the global Tuberculosis cases. (Source E & F)

It is also common for Tubercular co-occurring diseases to exist. It is said that the Human Immunodeficiency Virus (HIV) has become the highest risk factor that could lead to and individual contracting Tuberculosis. The reasoning behind this is because HIV weakens one’s immune system, causing an individual to become more vulnerable to contracting multiple diseases. In cases like this, it is said that Tuberculosis is the first cause of death among those suffering from HIV. With that said, the majority of HIV-associated Tuberculosis cases and deaths tend to occur in the African region of the world. Other co-occurring diseases include those related to Diabetes mellitus, individuals who abuse nicotine and alcohol, and in countries that obtain a middle to low-income rate. As a result, individuals who fall into the above categories are at a greater risk of potentially contracting the Tuberculosis bacteria than those elsewhere. (Source F)

The following information presents the effects migration has on the transmission rates of Tuberculosis in The United States (Source G):

The relationship between Mycobacterium tuberculosis and Humankind:

Bacteria have been used in various ways that have been beneficial to mankind. However, it is still important to remember that bacteria and mankind can portray various types of relationships. This can be a relationship where either one the organisms’ benefit or a relationship where both organisms benefit. In regards to Mycobacterium tuberculosis and mankind, the Tuberculosis bacteria is known to harm the host. This is known as a Parasitic Relationship. In this beneficial relationship, the Tuberculosis bacteria resists the hosts immune defenses and starts grows at rapid rates, all at the expense of the host. The bacteria produces poisonous substances known as endotoxins and exotoxins. Endotoxins consist of lipids that are situated within the host’s body cells, whereas endotoxins are released outside the body cells. (Source H)

Diagram and Explanation on how Bacteria become Antibiotic Resistant:

Key:

Antibiotic-Resistant Bacteria
Normal Non-Antibiotic Resistant Bacteria
Dead Non-Antibiotic Resistant Bacteria

How improved technology has provided an insight into the evolution of Mycobacterium tuberculosis:

Many methods and technologies have been developed throughout history that help establish the dangers of the Tuberculosis bacteria as well as the insight that scientists can use to their advantage when it comes to eliminating this disease.

Radiogram (x-ray)

Radiograms (or better known as x-rays ) are electromagnetic waves of high energy that have the ability to pass through a variety of materials. When observing the changes in one’s lungs, a chest x-ray is usually made use of to determine if those changes could possibly be associated with Tuberculosis. If the Tuberculosis bacteria has attacked the lungs then inflammation occurs, which result in a shadow being formed on the individual’s x-ray. (Nahid, Pai, and Hopewell, 2006)

Tuberculin Skin Test (TST)

The Tuberculin Skin Test (TST) usually takes place with individuals who have not yet been vaccinated for Tuberculosis with the Bacillus Calmette–Guérin (BCG) vaccine. However, it is important to note that those who have been vaccinated with the BCG vaccine must have been positively documented for a prior test. The BCG vaccine is used on foreign-born individuals and in countries with a high prevalence of Tuberculosis. Its purpose is mainly to prevent Tuberculous meningitis (meningitis caused by the Tuberculosis bacteria) and Miliary disease. The Tuberculin Skin Test (TST) takes place in two parts. During the first part, Tuberculin – a protein made from the Tuberculosis bacteria – is injected into the individual’s forearm. Then the second part will take place, where the patient’s injection site is examined after 48 to 72 hours. A raised bump will develop where the individual was injected, indicating that they carry the infectious bacteria. (Source J)

Nucleic Acid Amplification (NAA)

The Nucleic Acid Amplification (NAA) targets the nucleic acid regions, such as DNA or RNA, in an individuals body cells.

The Nucleic Acid Amplification (NAA’s) identify the small amounts of Deoxyribonucleic Acid (DNA) and Ribonucleic Acid (RNA) and uses this information to identify the Tuberculosis bacteria. The nucleic acid sequence within the DNA or RNA must first be identified in order for scientists to make probes which will attach to this sequence. The Nucleic Acid Test (NAT) will then create multiple copies of these probes through chemical reactions, which selectively amplify the signal of the nucleic acid being targeted. (Source K)

Interferon Gamma Release Assays (IGRA)

Interferon Gamma Release Assays (IGRA) are blood tests which are used to determine an individuals immune response to the Tuberculosis bacteria. ICRA detect the Interferon-Gamma Cytokines (molecules produced by the immune system) when mixed with antigens from the M. tuberculosis bacteria. (Source L)

Tuberculosis in the Present and Future:

Presently, Tuberculosis spreads rapidly due to population migration and the living conditions within developing countries. (Refer back to Global Spread of Mycobacterium tuberculosis). It is known that bacteria thrive in moist conditions. Consequently, global warming has a major effect on the rapid growth of Tuberculosis. Due to its constant increase in levels, global warming will continue to allow the rapid increase of Tuberculosis. and, in time, another outbreak will surface..

Climate-related factors, including temperature, precipitation and humidity, impact and have a major effect on the developing process and evolution of Mycobacterium tuberculosis. The quality of the earth’s air is affected by the mass pollution found in our atmosphere, where Carbon Monoxide increases the levels of Tuberculosis growth. (Source M)

The change in ultraviolet (UV) exposure from the sun seems to be another factor that contributes to the growth of Tuberculosis.

This change is brought about as a result of climate change. If an individual does not receive large enough amounts of Vitamin D, which is produced by the sun, they will develop a Vitamin D deficiency. Subsequently, this will weaken their immune system, making them more prone to contracting not only the Tuberculosis bacteria but many more diseases and viruses.

Although supplements can be taken to replace the lack of Vitamin D in an individuals body, it is important to note that there are mass amounts of individuals who are not able to get a hold of these supplements.

Many individuals, who are citizens of developing countries, could potentially not be financially stable enough to afford these costly supplements. It can also be the mere fact that it may happen where a country does not import and supply the supplements necessary to prevent such vitamin deficiencies. It is also important to note that there is a possibility that taking such supplements can interfere with one’s morals (Source N)

Conclusion:

Throughout my research project, I have discussed many aspects associated with the background of Tuberculosis, its relationship between mankind and how it has and still is evolving and aspects that contribute to its evolution.

It is vital to study the evolution of these disease-causing bacteria as they provide scientist with a better understanding on how antibiotics can be improved to prevent antibiotic resistance as well as help in the development of new vaccines against Tuberculosis.

The information obtained from these studies can also be used to educate individual more about the disease and help them gain a better understanding on it and how to prevent themselves from falling victim to the disease. In a summary, Tuberculosis was first found during ancient times, where evidence was present in skeletal abnormalities in Egypt and documents worldwide.

By the 18th Century, Tuberculosis was at its peak when European migrants had colonized to continents worldwide. Other factors that contribute to the worldwide spread of Tuberculosis includes living conditions in cities that create favorable conditions for Tuberculosis to thrive in as well as the co-occurrence of Tuberculosis and many more diseases that causes an individual’s immune system to weaken.

Climate change and global warming can also affect the growth and development of Tuberculosis. In terms of the relationship between the Tuberculosis bacteria and their host, the two organisms present a parasitic relationship where the bacteria benefits and the host is harmed. And finally, the diagnosis of Tuberculosis can be done with the use of many different tests and technologies including, skin tests (Tuberculin Skin Test/ TST), blood tests (Interferon Gamma Release Assay/ IGRA), x-rays and much more.

In the end, although many precautions and technologies such as vaccines and other various tests can be taken, Tuberculosis will continue to spread. That what we have now will soon not be enough to prevent yet another outbreak that will lead to many deaths globally.

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