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Should I be worried about tuberculosis? It wasn't that disease wiped out long ago. Tuberculosis is ancient, a foe humans have been battling since the dawn of civilization. But it is definitely not a disease of the past. In fact, it is one of the deadliest infectious diseases in the world today. Controlling and eventually eliminating this disease will require a worldwide effort. So what is tuberculosis and how does it make people sick? Tuberculosis is an airborne disease caused by a tiny mycobacterium. It is so small we need a microscope to get a good look at it. There it is. When it's host, a person with tuberculosis of the lungs, speaks, coughs or sings. Mycobacterium tuberculosis launches from the lungs, out the mouth or nose and spreads through the air in small droplets, which can linger. What happens next determines its fate. If other human beings are nearby, M tuberculosis is in luck. Anyone within range, especially if they're indoors. Will breathe in the TB bacteria, which works its way down the respiratory tract and settles deep in the lungs. In the many tiny air sacs known as alveoli, where oxygen is absorbed into the bloodstream. Special white blood cells called macrophages stand guard over the alveoli, waiting for just such an attack by a foreign invader. These immune defense cells will devour TB bacteria, keeping the numbers of infecting. Organism small and walling off the infection. 9 out of 10 people have immune system strong enough to contain or kill the TB bacteria. They do not develop symptoms or become sick. They have what is known as a latent TB infection. Latent TB can hang on for years, lying in wait for the immune system to weaken, as happens when an individual ages or develops a serious disease such as cancer. Now TB bacteria, which survived the assault by the macrophages, will begin to multiply, causing inflammation in the lung. The human host at this point has pulmonary tuberculosis. They experience chest pain, develop a bad cough, bringing forth sputum, yuck and sometimes even blood. This unlucky soul can now spread the deadly disease to others. Usually, the lungs are an ideal home for TB, and that is where it stays. But some TB bacteria travel through the blood to other parts of the body, such as the kidneys, spine, and brain, with truly unpleasant results. If the sick person develops TB disease, it is important to seek treatment. Fortunately, excellent ones are available. Thanks to the success of public health measures and antibiotics, TB has become. Rare in the United States, but not too long ago, this airborne killer was widespread and largely unchecked. In the 19th and early 20th centuries, the disease, then known as consumption, killed one in every seven people. Thought it was a staple of popular culture. Doctors did not know what caused TB and they had no effective treatments. The best they could do for patients was keep them well fed and isolate them in large dormitory like buildings called sanatoriums. So many major artists suffered from it in the 1700s and 1800s. That many believe that TB somehow enhanced artistic talent and it was known as the romantic disease. Finally, on March 24th, 1882, Doctor Robert Koch announces the discovery of Mycobacterium tuberculosis and humankind can see its tiny airborne enemy for the first time. In 1921, Doctors Comet and Gueron 2 French scientists. The Pasteur Institute in France develop a vaccine called BCG or Bacille Comet Gueron. BCG proves to be safe and effective in young children and is soon shipped to countries around the world for use in the 1940's. The discovery of antibiotics provides another breakthrough, the very first effective treatment against TB. What really stops the Mycobacterium in its tracks though, are robust public health measures. Improved sanitation and less crowded housing. Eventually the disease is very nearly wiped out in many high income countries. However, in nations with crowding, poverty and limited access to medical care, TB continues to kill millions. Unfortunately, the misuse and mismanagement of antibiotics has led to the rise of new strains of tuberculosis that resist most antibiotic treatments. This is called multidrug resistant tuberculosis, or MDR TB for short. MDRTB is on the rise even in wealthy countries like the United States, whose populations may think that TB has been vanquished. Alas, TB, despite being demoted to the number 2 airborne disease, has not been idle during the coronavirus pandemic, which led to hospital services being diverted from treating TB and many patients being unwilling or unable to seek medical care. We are likely to see an increased infection rate and spread of TB throughout much of the world. We can do better. The BCG vaccine is not standardized in how it is manufactured throughout the world. We could optimize BCG to make it more effective. Scientists are also hard at work developing new vaccines against TB. Current anti TB antibiotics, while effective, are expensive, have side effects, and take weeks or months. Secure a patient. New treatments need to be cheaper and faster acting to reach populations still at risk. TB provides us with an excellent example of how a disease that remains active in large parts of the world is a danger to us all. The challenge for wealthy nations is clear. We must develop new and improved vaccines, do more testing, and deploy new treatments to finally Vanquish this tiny but ancient adversary of humankind.