Tuberculosis is an infectious disease caused by acid-fast mycobacteria from the Mycobacterium tuberculosis complex group – M. tuberculosis , M. bovis, and M. africanum , known as Koch’s bacilli after the discoverer. In Poland, anti-tuberculosis vaccination (BCG) is obligatory only in newborns, this vaccination protects against severe forms of the disease, especially against meningitis.

What is tuberculosis? Infection withMycobacterium tuberculosis,bovisorafrcianum

It is caused by several species of mycobacteria (Mycobacterium tuberculosis(see Figure 1),Mycobacterium bovisandMycobacterium africanum).Mycobacteriosisis a group of diseases with symptoms similar to tuberculosis, caused by infection with the so-called non-tuberculous bacilli.

Dig. 1.Mycobacterium tuberculosiscolonies , Public Health Image Library

In the past, tuberculosis in Poland was a very common disease and was a huge social problem. Currently, thanks to the efforts of many generations of doctors, its incidence has significantly decreased, in 2019 5321 people fell ill with tuberculosis, 166 less than in 2018. Unfortunately, this disease is still much more common in Poland than in Western Europe.

Tuberculosis symptoms

Tuberculosis is an insidious disease. In most patients, the symptoms are mild and in many cases the disease is diagnosed too late. Particularly extrapulmonary tuberculosis, now very rare, is often difficult to diagnose.

Some patients develop systemic symptoms:

• low-grade fever
• night sweats
• bad mood
• weight loss, and in the advanced stage of the disease – cachexia.

These symptoms do not appear in all patients and are not very characteristic.

Pulmonary tuberculosis – symptoms

Lung involvement also does not always cause symptoms. Most often, patients complain of a chronic (lasting longer than 8 weeks)cough. It is of various severity, initially usually slight, and becomes more troublesome with time. In the early stages of the disease, the cough is usually dry (no sputum production). In more advanced tuberculosis, patients often expectorate mucous (whitish) or purulent (yellow) sputum.

Some patients have blood in their sputum, and in advanced pulmonary tuberculosis,hemoptysismay be profuse. Patients with extensive lung lesions may experienceshortnessof breath . Patients with significantly weakened immunity may develop miliary tuberculosis – the bacteria spread through the bloodstream, causing small changes (with the appearance of millet grain, hence the name) in the entire lungs and in other organs. The disease manifests itself with highfeverand shortness of breath.

Extrapulmonary tuberculosis – symptoms

Symptoms of extrapulmonary tuberculosis are not usually characteristic of this disease. They depend on the location of the lesions. The most common forms of extrapulmonary tuberculosis today are:

Dig. 2.Pleural tuberculosis

• Pleural tuberculosis. The pleura is the membrane that covers the surface of the lung and lines the inside of the chest. The pleural cavity is the space between the lungs and the chest wall. Normally, it contains a trace of fluid which helps the lungs to move more easily while breathing. The involvement of the pleura by the disease causes the accumulation of various amounts of fluid in the pleural cavity, sometimes up to several liters. Unlike many other forms of tuberculosis, pleural involvement often causes acute symptoms – fever, shortness of breath, cough, andchest painthat increases with breathing. This form of tuberculosis is relatively common among young people.
• Tuberculosis of the lymph nodes. The disease most often affects the lymph nodes in the neck, less often the lymph nodes above the collarbone. The knots increase in size, but they are not painful. After some time of the disease, the nodes become soft and fistulas may form (the contents of the affected node breaks through the skin and a hole is created through which the pus is released).
• Tuberculosis of bones and joints. The spine is most often affected. Initially, the symptoms are very mild, pain in the affected joints and limitation of their mobility dominate. Tuberculosis of the spine can lead to spinefractures.
• Tuberculous meningitis. Fortunately, a serious disease that occurs in Poland rarely, mainly in children. Initially, it manifests itself as drowsiness and fatigue, which may be accompanied by a low-grade fever.Consciousness disordersprogress, there isheadache, nausea, vomiting, and sometimes symptoms of cranial nerve paralysis.
• Tuberculosis can also affect the genitourinary system(e.g., causeinfertility)and the digestive system.

Diagnosis of tuberculosis – smear

The doctor suspects the disease on the basis of the symptoms of the disease or the result of a radiological examination of the lungs. It is always necessary to perform additional tests to confirm the disease. A certain diagnosis of tuberculosis can only be established on the basis of the presence of mycobacteria in the material tested by means of a smear or culture method. In special cases, the diagnosis (understood as the decision to start treatment) is made despite the lack of bacteriological confirmation of tuberculosis.

In patients with suspected pulmonary tuberculosis, the basic material for examination is sputum. When coughing up sputum for examination, make sure that it is actually coughing up bronchial fluid and not saliva.

If the patient is unable to cough up the sputum, expectoration may be induced by inhalation with sodiumchloridesolution (induced sputum). In patients with strong suspicion of the disease,bronchoscopyis also performed , collecting bronchial lavage for examination. The material is examined using the smear and culture method. Also, bronchial specimens taken from lesions visualized during bronchoscopy or material collected during surgery (tissue fragment) can be sent for examination. Since tuberculosis can affect various organs, in some situations practically any biological material collected from the patient can be sent for examination (except for faeces, which contain so many other bacteria that it prevents reliable diagnosis).

The smear consists in staining a thin layer of the test material smeared on a glass slide using special methods allowing for the selective staining of tuberculosis mycobacteria. The slide is then viewed under a microscope. The presence of mycobacteria in the sputum smear proves not only the diagnosis of tuberculosis, but also confirms that the patient is contagious to the environment.

Mycobacteria are grown on special media. For this purpose, a solid substrate is used – it is the Löwenstein-Jensen method, or a liquid one (in Poland, the Bactec method is most often used). Since the mycobacterium tuberculosis grows very slowly, it takes time to obtain a result. In the case of cultivation on a solid medium, colony growth can be observed at the earliest after about 4–6 weeks, and the final negative result in the laboratory is reported when no mycobacterial growth is observed after 3 months. Cultivation in a liquid medium allows for faster obtaining of test results. In the Bactec method, radioisotope-labeled fatty acids are added to the medium. Mycobacteria growing in the medium metabolize them to carbon dioxide containing the radioisotope. In the case of the presence of mycobacteria in the tested sample, the gas above the sample becomes radioactive. This trace amount of radiation is detected by a sensitive device. In the case of a positive breeding result, it allows to confirm the presence of mycobacteria after about a week, and the final result is obtained after about 6 weeks. In some cases, it is also advisable to test the sensitivity of mycobacteria to anti-tuberculosis drugs.

In recent years, genetic methods have also been introduced into the diagnosis of tuberculosis, which consist in detecting the genetic material of mycobacteria in a tested sample. They are slightly less sensitive than mycobacterial culture, but the test is short and the result is obtained in 1-2 days.

Tuberculosis diagnosis – chest X-ray

It is the basic test for determining the presence of tuberculous lesions in the lungs and assessing their severity. In times of high prevalence of tuberculosis in Poland, the so-called 35mm photos. This examination is no longer performed because it is not very precise and, paradoxically, it involves a higher dose of ionizing radiation than a conventionalchest radiograph.

Lesions suspected of tuberculous etiology have a characteristic appearance on a chest X-ray. Unfortunately, they are not completely specific for this disease, so their identification requires additional research. Due to the high prevalence of tuberculosis in the past in Poland, many people have lung lesions of various sizes caused by tuberculosis bacilli. For some it is called primary syndrome, left over after the organism’s first contact with mycobacteria, and in some cases more severe changes are visible. On the basis of their appearance, the doctor can sometimes make a preliminary assessment whether they are old (after an infection or disease) or related to active tuberculosis. It is rare that patient-reported symptoms and changes in the chest radiograph are so typical that despite negative test results for mycobacteria, the doctor decides to start anti-mycobacterial treatment. However, a normal chest radiograph does not rule out the presence of clinically active pulmonary tuberculosis.

Summing up, it can be said that the chest radiograph is the basic examination in the imaging diagnostics of pulmonary tuberculosis, the result of which often directs further medical treatment. In rare cases, it is necessary to performcomputed tomographyof the chest, most often in the high-frequency algorithm (HRCT), which allows for accurate visualization of the lung parenchyma.

Diagnosis of tuberculosis – tuberculin test

This test is often called the RT23 test, from the name of the tuberculin preparation used in Poland and in Europe. It consists in injecting a standard amount of a highly purified tuberculosis culture filtrate into the skin of the forearm. The preparation is administered intradermally, therefore the injection is not painful. The body of a person who has been in contact with mycobacteria before (that is, infected or vaccinated with BCG) reacts with an immune response to mycobacterial antigens. There is an erythema on the skin at the injection site, and a thickening is felt under the fingers. In people with a high immune response, tiny blisters may form on the skin. The size of the reaction does not exceed 2-3 cm. The reading is based on measuring the diameter of the infiltrate you can feel in the skin (not erythema) and is performed approximately 48–72 hours after insertion.

The test is safe and there are no contraindications to its performance. Even the most severe reaction disappears after a while, leaving no traces on the skin. A positive result indicates:

• Mycobacterial infection or active tuberculosis (it does not differentiate between a previous infection and an active disease)
• BCG vaccination (and successfully induce an immune response by this vaccination). If the majority of people in a given population were vaccinated with BCG (as is the case in Poland), it reduces the diagnostic usefulness of the test
• exposure to contact with non-tuberculous mycobacteria (these are bacteria common in the environment that very rarely cause diseases called mycobacteriosis [see below]).

Unfortunately, in a large percentage (up to 40%) of people infected with mycobacteria, the tuberculin test is negative. The reasons for this are most often factors that weaken or modify the body’s immunity, such as some viral infections (e.g. smallpox,measles, mumps, especially HIV infection), chronic diseases (e.g. diabetes, renal failure), drugs (e.g. glucocorticosteroids), malnutrition and many other factors. Due to these factors, a negative tuberculin test result does not exclude infection with mycobacterium in any case. The test can be safely repeated many times. If the staining size has increased by 10 mm in 12 months, this indicates a recent mycobacterial infection.

Diagnosis of tuberculosis – tests based on the secretion of interferon

The test is performed with blood drawn from a vein. Mycobacterial tuberculosis proteins are added to the blood. Lymphocytes (a type of white blood cell) in our blood react to the presence of these proteins if our body has previously been in contact with tuberculosis. The immune reaction leads to the secretion of a special protein, interferon gamma, which is important in the fight of the immune system against tuberculosis. These tests detect the secretion of gamma interferon, allow for the quantification of its production intensity, and have several advantages over the tuberculin test. Contrary to tuberculin (used in the tuberculin test), the proteins used in the IGRA tests are more specific for mycobacteria tuberculosis (they are not present in the BCG mycobacteria used for vaccination). As a result, previous TB vaccination does not affect the outcome.

Treatment of tuberculosis

Due to the specific properties of Mycobacterium tuberculosis, treatment of infection with these bacteria is different from treatment of ‘typical’ bacterial infections (egpneumonia). The special structural properties of mycobacteria make these bacteria insensitive to many known antibiotics. As mycobacteria divide very slowly and can go into a “dormant” state, treatment must be long enough. Each population of mycobacteria contains bacteria that are resistant to some of the commonly used drugs. Therefore, effective treatment should include several drugs. If treatment is stopped, treatment is too short, or not enough drugs are used, the bacteria that are most resistant to the drugs survive.

Symptoms may resolve initially, but if the patient discontinues treatment too early, tuberculosis will recur because these selected, refractory mycobacteria will proliferate. In such a situation, therapy may be much more difficult. Treatment is divided into two phases – intensive (shorter duration, involving more drugs) and follow-up, which lasts longer but contains fewer drugs. The intensive phase serves to kill as many mycobacteria as possible rapidly to prevent the development of drug resistance. The continuation phase, on the other hand, serves to kill the remaining mycobacteria that survived the intense phase due to the inhibition of metabolism and division.

For the reasons mentioned above, remember never to stop your treatment without consulting your doctor! This can lead to a health risk not only for the patient, but also for those who come into contact with him (people from the patient’s environment may become infected with a resistant strain of tuberculosis, which may develop as a consequence of discontinuation of treatment).

Additional tests are often performed before starting treatment:

• laboratory tests to assess kidney and liver function,
• ophthalmological consultation, indicated for patients who will be taking ethambutol.

Antituberculosis drugs for tuberculosis

The basic and most commonly used antituberculosis drugs are:

• rifampicin
• isoniazid
• pyrazinamide
• streptomycin
• ethambutol

In most cases of tuberculosis, several of these drugs are used (see treatment regimens below). In selected patients, most often with treatment-resistant tuberculosis, various regimens containing alternative drugs are used (e.g. ethionamide, fluoroquinolone, capreomycin, para-aminosalicylic acid, amikacin, rifabutin, rifapentine, clarithromycin and others). Treatment-naïve patients with tuberculosis are treated with the following treatment regimen.

Rifampicin, isoniazid, pyrazinamide and ethambutol are used for 2 months (this is the intensive phase), and for the next 4 months – rifampicin and isoniazid (the continuation phase). Treatment usually lasts 6 months. In patients who were treated previously without improvement, discontinued treatment, other regimens, usually longer and / or containing more drugs, are used. Drugs are taken once a day in the morning, 30 minutes before meals.

The most common side effects of antituberculosis drugs are:

• rash
• impaired liver function (occurs in a few percent of patients, most often does not give clinical symptoms and is detected accidentally during control tests, which show an increase in the activity of liver enzymes, i.e. ALT and AST. Asymptomatic elevation of ALT and ASP concentration exceeding the norm <3 times no is an indication for discontinuation of treatment, and only follow-up tests).

Side effects of antituberculosis drugs

The side effects of the individual antituberculosis drugs are listed below. When familiarizing yourself with them, it is worth remembering that most drugs (including those sold over the counter) have numerous side effects (you can find out about it by reading the leaflet carefully attached to any drug).

• isoniazid: rash, liver damage,jaundice, fever, anemia, disturbances in peripheral nerves, decrease in white blood cells (white blood cells) or platelets (thrombocytopenia), increase in eosinophils (eosinophilia), lupus-like syndrome (symptoms similar to those in a disease called lupus systemic – includingjointpain, chest pain, skin changes). To reduce the risk of peripheral nerve dysfunction while taking this medication, prophylactic vitamin B6 intake at a dose of 10 mg / day is usually recommended.
• rifampicin: abdominal pain, nausea, vomiting,gas , rash, liver damage,flu-like syndrome (malaise, fever, chills, muscle aches), severe reduction in platelets (thrombocytopenia), which may be manifested as an excessive bleeding tendency (diathesis haemorrhagic), severe reduction in the number of red blood cells (anemia) due to their toxic breakdown (haemolysis), very rarely severe drop in blood pressure, anaphylactic shock (rapid onset and life-threatening hypersensitivity reaction),acute kidney failuredeveloping within hours of taking the medicine. Shock, anemia, thrombocytopenia, and renal failure are likely to be immune-related. Upon their occurrence, rifampicin should be discontinued immediately. Rifampicin affects the rate at which your liver metabolizes other medications you are taking (this is one reason why you should tell your doctor who prescribes medications to treat tuberculosis if you are taking any medications chronically.
• pyrazinamide: facial flushing, nausea, vomiting, abdominal pain, liver damage, hyperuricaemia, coagulation disorders, rarely fever, rash, red discoloration of parts of the body exposed to sunlight
• ethambutol: retrobulbar inflammation of the optic nerve, the first symptom of which is impaired green and red perception, followed by a deterioration in visual acuity, and reduced visual field. If you experience visual disturbances while taking the drug, stop taking the drug immediately and contact your doctor. Before starting treatment, the patient should be examined by an ophthalmologist
• streptomycin:dizziness, tinnitus and tingling around the mouth (require contact a doctor as it may be the result of damage to the nervous system), kidney damage (periodic monitoring of kidney function is recommended), fever, rash, headache, blocking neuromuscular connections worsening muscle function in patients withmyasthenia gravis. Before starting treatment, laboratory tests are performed to assess kidney function andblood counts.

Prevention of tuberculosis

Patients with tuberculosis who are contagious to those around them should not be treated at home, but in a hospital ward. At home, patients who do not have mycobacteria in their sputum are treated at home, so they do not pose a threat to the environment. However, it is worth following a few simple rules during treatment (especially during the first 2 months). Mycobacteria are sensitive to ultraviolet radiation, so it is advisable to open windows wide and air them frequently. Patients should avoid close contact with young children.

Vaccinating infants against tuberculosis

In Poland, there is a one-time vaccination of infants with the BCG vaccine. It reduces the risk of severe forms of tuberculosis (meningitis, disseminated tuberculosis). However, it probably does not significantly reduce the risk of tuberculosis. Vaccine side effects are seen in about 1 in 1,000 children vaccinated. Most often it is too large (> 20 mm or> 10 mm in newborns) or too long ulceration at the vaccination site. The lymph nodes in the armpit may become enlarged and even rarely become suppurated. Other complications are extremely rare.

Prophylactic treatment of tuberculosis

In special cases, most often after contact with a tuberculosis patient, the doctor recommends the patient prophylactic treatment. Such management reduces the risk of contracting tuberculosis. Most often, isoniazid administered alone for 9 months. It is used after contact with a tuberculosis patient, if the tests performed do not show signs of an active disease, i.e. there are no changes in the chest radiograph, but there are signs of infection, i.e. RT23 test or an interferon test is positive, and in all children aged < 5. In addition, prophylactic treatment is used in people infected with Mycobacterium (with a positive RT23 result or an interferon-based test) who are to be treated with some biological drugs (e.g. antibodies against TNF in patients withrheumatoid arthritis).

Mycobacteriosis

It is a group of diseases caused by infection with non-tuberculous bacilli. These bacteria are very widespread in the environment, they are present e.g. in water or soil. They also often colonize our system without causing disease symptoms. You can’t catch it from another patient. Infections with non-tuberculous bacilli are rare and most often affect people with impaired immunity.

Mycobacteriosis occurs mainly in:

1. people with AIDS
2. people who have had tuberculosis
3. patients with pneumoconiosis
4. patients with cystic fibrosis
5. COPD patients
6. alcoholics.

These bacteria divide very slowly and therefore the symptoms of mycobacteriosis are usually scant (or absent at all) and the disease progresses very slowly. The lesions most often occur in the lungs, lymph nodes or skin. Lung involvement is manifested by coughing, weakness, sweating and increased body temperature. Less commonly, there is shortness of breath or chest pain. The basic examination is a chest radiograph and in some cases an HRCT examination. The changes often resemble those found in tuberculosis. The diagnostics described on the tuberculosis pages are also similar. The confirmation of the diagnosis is the cultivation of mycobacteria. Since mycobacteria frequently colonize the organism, diagnosis requires both clinical and

Unfortunately, mycobacteria are very resistant to treatment. You need to take at least a few medications for a long time, which is usually more than a year, since the tests no longer show mycobacteria.For the inquisitive

History

Tuberculosis has accompanied our species from the beginning of its history. The preserved human remains from the times of ancient civilizations (e.g. Egyptian mummies, skeletons from China and Ancient Rome) bear typical traces of advanced tuberculosis (e.g. characteristic deformations of some bones). Descriptions of the advanced forms of tuberculosis can be found in the writings of the great doctors of antiquity (including Hippocrates and Galen). In addition to accurate observations of the clinical forms of tuberculosis, some descriptions suggest a significant prevalence of the disease – eg Hippocrates described phtysis as one of the most common diseases.

Mycobacterial DNA was also identified in ancient human remains using modern molecular biology methods. With the advent of the early industrial age, tuberculosis became a social problem. Large numbers of the population moved from the countryside to the cities, where most of them lived in conditions conducive to the spread of the disease. The risk of mycobacterial infection increased due to high population density, poor housing conditions and malnutrition. Mycobacteria of tuberculosis are sensitive to ultraviolet radiation, therefore they die quickly in the open, in the sun. In dark, poorly ventilated rooms, on the contrary, mycobacteria can survive for a long time.

In the 18th and 19th centuries, tuberculosis took a heavy toll in Europe, being one of the most common causes of death. No effective drugs were known, and many of the treatments at the time had tragic consequences. In addition, the cause of tuberculosis has still not been discovered. Tuberculosis tuberculosis (tuberculosis) in the lungs was described in the 17th century, but over the following centuries it was not realized that different clinical forms of tuberculosis (e.g. pulmonary tuberculosis and lymph node tuberculosis) were manifestations of the same disease. In the nineteenth century, the Latin name of the disease (tuberculosis) began to be used, emphasizing the importance of the presence of tuberculous granulation tissue in the affected organs. It was then that some medical authorities gradually began to combine different forms of tuberculosis into one disease.

Discovery of Mycobacterium tuberculosis by Robert Koch (1882)

The breakthrough in knowledge about the disease came with the discovery of tuberculosis bacilli by Robert Koch. In the mid-nineteenth century, it was shown that tuberculosis can be transmitted from humans to cattle, which was one of the incentives to look for the microbe responsible for the disease. The first report on the role of mycobacteria in the etiology of tuberculosis dates back to 1882. Koch showed that it is possible to infect animals by transferring biological material collected from sick people. He also developed a method of growing mycobacteria on a special medium. A few years later, he presented four demands for the recognition of a disease as transmitted by a microorganism:

1. the bacterium should be present in all sick animals and absent in healthy animals,
2. bacteria collected from a sick animal can be grown in a laboratory,
3. infection of a healthy animal with cultured bacteria will cause disease,
4. bacteria can be found in material collected from an infected animal.

Development of a method for staining mycobacteria (Ziehl and Neelsen, 1883)

Dig. 3.Mycobacterial staining by the Ziehl-Neelsen method is used in the diagnosis of tuberculosis until today, Public Health Image Library

Koch’s groundbreaking work led to tuberculosis being widely recognized as a contagious disease. In 1883, Ziehl and Neelsen developed a method of staining mycobacteria that allowed them to be easily visualized under a microscope and distinguished from other bacteria. Mycobacterial staining by the method of Ziehl and Neelsen is used in the diagnosis of tuberculosis to this day.

The world learns of a new contagious disease (Paris, 1887)

In 1887, at an international scientific conference in Paris, the world learned about new discoveries. Soon, methods of growing mycobacteria on a special medium were also developed. After some time, these discoveries allowed for the implementation of methods to diagnose the disease. Sputum examination by means of Ziehl and Neelsen staining allowed the identification of mycobacteria and a reliable diagnosis of tuberculosis. In 1890, Koch developed a method of obtaining a bacterial-free solution containing numerous mycobacterial antigens, or tuberculin. In 1910, the method of detecting the infection by means of intradermal administration of tuberculin was introduced, i.e. the tuberculin test, which is still used in the diagnosis of tuberculosis. Unfortunately, there was still no effective treatment.

At the beginning of the 20th century, the work of Wilhelm von Röntgen led to the development of medical radiology, and chest radiographs became over time the most important method for assessing the presence and advancement of tuberculous lesions in the lungs. At that time, work on a vaccine against tuberculosis also began.

Tuberculosis vaccine

After many years of research, Calmette and Guérin developed a vaccine later called BCG (fromBacillus Calmette-Guerin bacillusstrain ). For 13 years, they grew a strain of bovine mycobacterium, eventually obtaining bacteria that did not cause disease, and possibly induced resistance to mycobacterial infection. Initially, great hopes were attached to the vaccine, so its use spread to many countries around the world. In Poland, the obligation to vaccinate all children was introduced in 1955.

Unfortunately, in the course of later studies it turned out that the vaccine is not as effective as expected. There is no certain evidence that it reduces the risk of infection, but it does lower the incidence of severe forms of tuberculosis in children, and therefore it is still used.

In the 19th century, sanatorium treatment became popular. Proper nutrition, medical care, being in the open air and in the sun improved the health of some patients, but, as you can guess, it was not a very effective method, and besides, it was only available to a few. One of the benefits, however, was – at least temporarily – the isolation of patients from the rest of the population.

Dig. 4.Doctor examining the patient in a sanatorium for tuberculosis patients in the USA, Public Health Image Library

At the beginning of the 20th century, it was observed that compression of a part of the lung with tuberculous lesions had a beneficial effect on the course of the disease. Thus, surgical methods were introduced to treat tuberculosis. Apneumothoraxwas used , i.e. the introduction of air into the pleural cavity between the lung and the chest wall. This caused one lung to collapse. There were also so-called thoracoplasty involving the removal of a part of the ribs above the affected part of the lung. These methods were still used after World War II. Even today, although very rarely, we see lung diseases in the departments of lung diseases who were once treated in this way.

Increasing knowledge of the etiology of tuberculosis and methods of disease prevention was one of the reasons for the establishment of the Central Tuberculosis Bureau in Berlin in 1902. The fight against tuberculosis was compared to a crusade, and its symbol became a sign from the times of the Crusades – a cross with a double arm. We find it today, e.g. in the emblem of the Institute of Tuberculosis and Lung Diseases, the most important center for tuberculosis research and treatment in Poland. The Central Tuberculosis Prevention Office later changed its name to the International Union for Combating Tuberculosis and Lung Diseases. Unfortunately, after more than 100 years, its activity seems to be as important for human health as it was in the 19th century.

Streptomycin and para-aminosalicylic acid in the treatment of tuberculosis

The first effective drugs against tuberculosis were introduced only after World War II. Shortly after the war, doctors became the weapon of streptomycin and para-aminosalicylic acid (PAS for short). Streptomycin is widely used today. The two drugs together were soon shown to be more effective than just one of them.

Unfortunately, many patients still could not be cured and the therapy was burdened with numerous side effects. After the introduction of the first effective drugs, the phenomenon of mycobacterial drug resistance was also observed.

Isoniazid and rifampicin – modern drugs against tuberculosis

Other modern anti-tuberculosis drugs are isoniazid, followed by rifampicin. After their introduction, multi-drug treatment regimens were developed that allowed virtually all patients to be cured. The risk of developing mycobacterial drug resistance and efforts to combat tuberculosis at the population level have led to the development of supervised treatment methods based on the patient taking the drug in the presence of a healthcare professional. This method of tuberculosis treatment has been recommended by the WHO for over 20 years. Treatment of tuberculosis is compulsory in many countries. This has resulted in a gradual reduction in the incidence of tuberculosis in developed countries. Unfortunately, in many regions of the world the situation is still dire and tuberculosis is still a huge health problem, killing around 1.5 million people each year.

The 20th century challenge: treating tuberculosis in AIDS patients

With the emergence of the AIDS epidemic in some developed countries and in many African countries, treatment of tuberculosis in AIDS patients has become a problem. Another problem in many regions of the world (fortunately still to a small extent related to Poland) are tuberculosis strains resistant to many antituberculosis drugs.

In Poland, after World War II, more than 1/1000 people contracted tuberculosis annually. In a society devastated by war, disease was one of the most important health problems.