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Tuberculosis ( TB), also known colloquially as the " white death", or historically as consumption, is a contagious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the , but it can also affect other parts of the body. Most infections show no symptoms, in which case it is known as inactive or latent tuberculosis. A small proportion of latent infections progress to active disease that, if left untreated, can be fatal. Typical symptoms of active TB are chronic cough with hemoptysis sputum, fever, night sweats, and weight loss. Infection of other organs can cause a wide range of symptoms. (2025). 9780443068393, Churchill Livingstone/Elsevier. ISBN 9780443068393
Tuberculosis is spread from one person to the next Airborne disease when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. A latent infection is more likely to become active in those with weakened Immunodeficiency. There are two principal tests for TB: interferon-gamma release assay (IGRA) of a blood sample, and the Mantoux test.
Prevention of TB involves screening those at high risk, early detection and treatment of cases, and vaccination with the bacillus Calmette-Guérin (BCG) vaccine. (2025). 9780763780470, Jones & Bartlett Learning. ISBN 9780763780470 Those at high risk include household, workplace, and social contacts of people with active TB. Treatment requires the use of multiple over a long period of time.
Tuberculosis has been present in humans since Ancient history. In the 1800s, when it was known as consumption, it was responsible for an estimated quarter of all deaths in Europe. The incidence of TB decreased during the 20th century with improvement in sanitation and the introduction of drug treatments including antibiotics. However, since the 1980s, antibiotic resistance has become a growing problem, with increasing rates of drug-resistant tuberculosis. It is estimated that one quarter of the world's population have latent TB. In 2023, TB is estimated to have newly infected 10.8 million people and caused 1.25 million deaths, making it the leading cause of death from an infectious disease.
Between 1838 and 1845, John Croghan, the owner of Mammoth Cave in Kentucky from 1839 onwards, brought a number of people with tuberculosis into the cave in the hope of curing the disease with the constant temperature and purity of the cave air; each died within a year. Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf (now Sokołowsko) in Silesia. In 1865, Jean Antoine Villemin demonstrated that tuberculosis could be transmitted, via inoculation, from humans to animals and among animals.
(Villemin's findings were confirmed in 1867 and 1868 by John Burdon-Sanderson.Burdon-Sanderson, John Scott. (1870) "Introductory Report on the Intimate Pathology of Contagion." Appendix to: Twelfth Report to the Lords of Her Majesty's Most Honourable Privy Council of the Medical Officer of the Privy Council for, Parliamentary Papers (1870), vol. 38, 229–256.)
Robert Koch identified and described the bacillus causing tuberculosis, M. tuberculosis, on 24 March 1882. (1882). 9783662564547, Springer Spektrum. ISBN 9783662564547 In 1905, he was awarded the Nobel Prize in Physiology or Medicine for this discovery.
After TB was determined to be contagious, in the 1880s, it was put on a notifiable-disease list in Britain. Campaigns started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatorium that resembled prisons. The sanatoria for the middle and upper classes offered excellent care and constant medical attention. What later became known as the Alexandra Hospital for Children with Hip Disease (tuberculous arthritis) was opened in London in 1867. Whatever the benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years ( 1916).
Robert Koch did not believe the cattle and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. During the first half of the 1900s, the risk of transmission from this source was dramatically reduced after the application of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". Although it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. World Tuberculosis Day is marked on 24 March each year, the anniversary of Koch's original scientific announcement. When the Medical Research Council formed in Britain in 1913, it initially focused on tuberculosis research.
Albert Calmette and Camille Guérin achieved the first genuine success in immunization against tuberculosis in 1906, using attenuated bovine-strain tuberculosis. It was called BCG vaccine (BCG). The BCG vaccine was first used on humans in 1921 in France, but achieved widespread acceptance in the US, Great Britain, and Germany only after World War II.
In 1946, the development of the antibiotic streptomycin made effective treatment and cure of TB a reality. Prior to the introduction of this medication, the only treatment was surgical intervention, including the "pneumothorax technique", which involved collapsing an infected lung to "rest" it and to allow tuberculous lesions to heal.
By the 1950s mortality in Europe had decreased about 90%. Improvements in sanitation, vaccination, and other public-health measures began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat.
Treatment of MDR-TB requires treatment with second-line drugs, which in general are less effective, more toxic and more expensive than first-line drugs. Treatment regimes can run for two years, compared to the six months of first-line drug treatment.Kaplan, Jeffrey. 2017. "Tuberculosis" American University. Lecture.
General signs and symptoms include fever, chills, night sweats, loss of appetite, weight loss, and fatigue. In severe cases, nail clubbing may also occur.
Tuberculosis may cause extensive scarring of the lungs, which persists after successful treatment of the disease. Survivors continue to experience chronic respiratory symptoms such as cough, sputum production, and shortness of breath.
Symptoms of extrapulmonary TB usually include the general signs and symptoms as above, with additional symptoms related to the part of the body which is affected. Urogenital tuberculosis, however, typically presents differently, as this manifestation most commonly appears decades after the resolution of pulmonary symptoms. Most patients with chronic urogenital TB do not have pulmonary symptoms at the time of diagnosis. Urogenital tuberculosis most commonly presents with urinary 'storage symptoms' such as increased frequency and/or urgency of urination, flank pain, hematuria, and nonspecific symptoms such as fever and malaise.
The term M. tuberculosis complex describes a genetically related group of Mycobacterium species that can cause tuberculosis in humans or other animals. It includes four other TB-causing mycobacterium: M. bovis, M. africanum, M. canettii, and M. microti. M. bovis causes bovine TB and was once a common cause of human TB, but the introduction of pasteurisation has almost eliminated this as a public health problem in developed countries. (2025). 9781416029731, Elsevier. ISBN 9781416029731 M. africanum is not widespread, but it is a significant cause of human TB in parts of Africa. M. canettii is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants. M. microti appears to have a natural reservoir in small such as mice and voles, but can infect larger mammals. It is rare in humans and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated.
There are other known Mycobacterium which cause lung disease resembling TB. M. avium complex is an environmental microorganism found in soil and water sources worldwide, which tends to present as an opportunistic infection in immunocompromised people. The natural reservoir of M. kansasii is unknown, but it has been found in tap water; it is most likely to infect humans with lung disease or who smoke. These two species are classified as "nontuberculous mycobacteria".
Another important risk factor is use of medications which suppress the immune system; these include, chemotherapy, medication for lupus or rheumatoid arthritis, and medication after an organ transplant. Other risk factors include: alcoholism, diabetes mellitus, silicosis, cigarette, recreational drug use, severe kidney disease, head and neck cancer, low body weight. Children, especially those under age five, have undeveloped immune systems and are at higher risk.
Environmental factors which weaken the body's protective mechanisms and may put a person at additional risk of contracting TB include air pollution, exposure to smoke (including tobacco smoke), and exposure (often occupational) to dust or particulates.
The defence mechanism of the macrophage begins when a foreign body, such as a bacterial cell, binds to Immune receptor on the surface of the macrophage. The macrophage then stretches itself around the bacterium and engulfs it. Once inside this macrophage, the bacterium is trapped in a compartment called a phagosome; the phagosome subsequently merges with a lysosome to form a phagolysosome. The lysosome is an organelle which contains digestive enzymes; these are released into the phagolysosome and kill the invader. (2025). 9781405136037, Blackwell Publishing. ISBN 9781405136037
The M. tuberculosis bacterium is able to subvert the normal process by inhibiting the development of the phagosome and preventing it from fusing with the lysosome. The bacterium is able to survive and replicate within the phagosome; it will eventually destroy its host macrophage, releasing progeny bacteria which spread the infection.
In the next stage of infection, , , T cell and aggregate to form a granuloma, which surrounds and isolates the infected macrophages. This does not destroy the tuberculosis bacilli, but contains them, preventing spread of the infection to other parts of the body. They are nevertheless able to survive within the granuloma. In tuberculosis, the granuloma contains Necrosis tissue at its centre, and appears as a small white nodule, also known as a tubercle, from which the disease derives its name.
Granulomas are most common in the lung, but they can appear anywhere in the body. As long as the infection is contained within granulomas, there are no outward symptoms and the infection is latent. However, if the immune system is unable to control the infection, the disease can progress to active TB, which can cause significant damage to the lungs and other organs.
If TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissues. This severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis. People with this disseminated TB have a high fatality rate even with treatment (about 30%).
In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages (bronchi) and this material can be coughed up. It contains living bacteria and thus can spread the infection. Treatment with appropriate kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.
A diagnosis of TB should be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks. Diagnosis of TB, whether latent or active, starts with medical history and physical examination. Subsequently a number of tests can be performed to refine the diagnosis: A chest X-ray and multiple for acid-fast bacilli are typically part of the initial evaluation.
Blood tests to detect antibodies are not specific or sensitive, so they are not recommended.
PCR testing for Mycobacterium tuberculosis is often required for the diagnosis of urogenital tuberculosis and may also be used to diagnose tuberculosis in other tissues. It is highly sensitive and specific with good turnaround time.
Although latent TB is not infective, it should be treated in order to prevent its development into active pulmonary TB, which is infective. The cascade of person-to-person spread can be circumvented by segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others; however it is important to complete the full course of treatment which is usually six months.
TB was made a notifiable disease in Britain; there were campaigns to stop spitting in public places, and the infected poor were pressured to enter sanatoria that resembled prisons.McCarthy 2001:413-7 In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into .
In 2014, the WHO adopted the "End TB" strategy which aims to reduce TB incidence by 80% and TB deaths by 90% by 2030. The strategy contains a milestone to reduce TB incidence by 20% and TB deaths by 35% by 2020. However, by 2020 only a 9% reduction in incidence per population was achieved globally, with the European region achieving 19% and the African region achieving 16% reductions. Similarly, the number of deaths only fell by 14%, missing the 2020 milestone of a 35% reduction, with some regions making better progress (31% reduction in Europe and 19% in Africa). Correspondingly, also treatment, prevention and funding milestones were missed in 2020, for example only 6.3 million people were started on TB prevention short of the target of 30 million.
The goal of tuberculosis elimination is being hampered by the lack of rapid testing, short and effective treatment courses, and completely effective vaccines.
Public health bodies recommend that patients be given support during the period of treatment. One form of support is directly observed therapy - a healthcare worker watches the TB patient swallow the drugs, either in person or online. Other forms of support include having an assigned case manager, digital monitoring, health education, counseling, and community support.
Drug resistance to TB can come in two forms: primary and secondary. Primary drug resistance is caused by person-to-person transmission of drug-resistant TB bacteria. Secondary drug resistance (also called acquired resistance) develops during TB treatment. A person with fully drug-susceptible TB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality drugs.
Rifampicin resistant TB (RR-TB) is resistant to the drug rifampicin. Multi-drug resistant tuberculosis (MDR-TB) is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant tuberculosis (XDR-TB) is resistant to rifampicin (and may also be resistant to isoniazid), and is also resistant to at least one fluoroquinolone (levofloxacin or moxifloxacin) and to at least one other Group A drug (bedaquiline or linezolid). A further categorization, totally drug resistant tuberculosis, has been used to describe strains with even greater drug resistance. , it has no accepted definition, but it is most commonly described as 'resistance to all first- and second-line drugs used to treat TB'. It was first observed in 2003 in Italy, but not widely reported until 2012, and has also been found in Iran, India, and South Africa.
Treatment for both MDR-TB and XDR-TB involves combinations of several drugs, typically including second-line anti-TB medications like bedaquiline, linezolid, and fluoroquinolones. Treatment regimens are individualized based on drug susceptibility testing and patient-specific factors, and may extend for up to 20 months.
, the WHO estimates that 3.2% of new TB infections globally are RR-TB or MDR-TB; this is a decrease from 4.0% in 2015. Among those who have been previously treated for TB, the proportion of people with RR-TB or MDR-TB has also decreased from 25% in 2015 to an estimated 16% in 2023.
To fully identify drug resistance and guide treatment, drug susceptibility testing (DST) determines which drugs can kill TB bacteria. WHO guidelines recommend a rapid molecular test, Xpert MTB/RIF, to diagnose TB and simultaneously detect rifampicin resistance. Drug susceptibility testing (DST) is crucial for fully identifying drug resistance and guiding treatment.
Treatment of MDR-TB is significantly more costly than treating regular TB. As an example, in the UK in 2013 the cost of standard TB treatment was estimated at £5,000 while the cost of treating MDR-TB was estimated to be more than 10 times greater, ranging from £50,000 to £70,000 per case.
In low income countries, the impact of MDR-TB on the families of its victims is severe, affecting income, mental health, and social well-being. Families may become impoverished due to the financial strain of MDR-TB treatment, with studies reporting that a significant portion of household income can be spent on healthcare.
]]Tuberculosis (TB) is generally curable with prompt and appropriate treatment, but can be fatal if left untreated. The prognosis depends on factors like disease stage, drug resistance, and a person's overall health. While treatment is effective, delays or inadequate treatment can lead to severe illness and death.
Without treatment, about two-thirds of people with TB will die of the disease, on average within 3 years of diagnosis.
Progression from TB infection to overt TB disease occurs when the bacilli overcome the immune system defenses and begin to multiply. In some 1–5% of cases this occurs soon after the initial infection. However, in the majority of cases, a latent infection occurs with no obvious symptoms. Over an individual's lifetime these dormant bacilli produce active tuberculosis in 5–10% of these latent cases, often many years after infection.
The risk of reactivation increases in those whose Immunodeficiency, such as may be caused by certain drug treatments, or by infection with HIV. In people Coinfection with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year.
Tuberculosis (TB) prognosis is significantly worsened by HIV co-infection, leading to higher mortality rates and poorer treatment outcomes. People with HIV are much more susceptible to developing active TB, and even with treatment, they face increased risks of unsuccessful treatment and death compared to those without HIV.
Phylogenetics analysis of DNA lineages indicate that the ancestors of the tuberculosis bacterium adapted to human hosts in Africa around 70,000 years ago, and spread across the globe with migrating humans.
The World Health Organization estimates that roughly one-quarter of the world's population carry infection with M. tuberculosis (prevalence), with new infections occurring in about 11 million people each year (incidence). Most infections with M. tuberculosis do not cause disease, and 90–95% of infections remain asymptomatic.
TB infection disproportionally affects low-income populations and countries. Factors like poverty, inadequate living conditions, and poor nutrition contribute to higher TB prevalence and incidence in these settings. Globally, the highest burden of TB is concentrated in low-income countries; approximately half of all people with TB can be found in 8 countries: Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa.
People living with HIV have a significantly higher risk of developing tuberculosis (TB) compared to those without HIV. HIV weakens the immune system, making individuals more susceptible to TB infection and increasing the likelihood of progression from latent to active TB. TB is also a leading cause of death among people with HIV.
To a certain extent, newly diagnosed TB infections tend to Seasonality; this is attributed in part to lower levels of vitamin D and indoor crowding during the colder seasons, combined with a lag between infection and diagnosis. The strength of seasonality varies with latitude, with stronger patterns observed in regions farther from the equator.
The rate of tuberculosis varies with age. In Africa, it primarily affects adolescents and young adults. However, in countries where incidence rates have declined dramatically (such as the United States), tuberculosis is mainly a disease of the elderly and (risk factors are listed above). Worldwide, 22 "high-burden" states or countries together experience 80% of cases as well as 83% of deaths.
In Canada and Australia, tuberculosis is many times more common among the Indigenous peoples, especially in remote areas. Factors contributing to this include higher prevalence of predisposing health conditions and behaviours, and overcrowding and poverty. In some Canadian Indigenous groups, genetic susceptibility may play a role.
Socioeconomic status (SES) strongly affects TB risk. People of low SES are both more likely to contract TB and to be more severely affected by the disease. Those with low SES are more likely to be affected by risk factors for developing TB (e.g., malnutrition, indoor air pollution, HIV co-infection, etc.), and are additionally more likely to be exposed to crowded and poorly ventilated spaces. Inadequate healthcare also means that people with active disease who facilitate spread are not diagnosed and treated promptly; sick people thus remain in the infectious state and (continue to) spread the infection.
In developed countries, tuberculosis is less common and is found mainly in urban areas. In Europe, deaths from TB fell from 500 out of 100,000 in 1850 to 50 out of 100,000 by 1950. Improvements in public health were reducing tuberculosis even before the arrival of antibiotics, although the disease remained a significant threat to public health, such that when the Medical Research Council was formed in Britain in 1913 its initial focus was tuberculosis research.
In 2010, rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139.
In 2023, tuberculosis overtook COVID-19 as the leading cause of infectious disease-related deaths globally, according to a World Health Organization. Around 8.2 million people were newly diagnosed with TB last year, allowing them access to treatment—a record high since WHO's tracking began in 1995 and an increase from 7.5 million cases in 2022. The report highlights ongoing obstacles in combating TB, including severe funding shortages that hinder efforts toward eradication. Although TB-related deaths decreased slightly to 1.25 million in 2023 from 1.32 million in 2022, the overall number of new cases rose marginally to an estimated 10.8 million.
In South Africa, 54,200 people died in 2022 from TB. The incidence rate was 468 per 100,000 people; in 2015, this was 988 per 100,000. The total incidence was 280,000 in 2022; in 2015, this was 552,000.
As of 2017, India continued to have the largest total incidence, with an estimated 2,740,000 cases. According to the World Health Organization (WHO), in 2000–2015, India's estimated mortality rate dropped from 55 to 36 per 100,000 population per year with estimated 480 thousand people dying of TB in 2015. In India a major proportion of tuberculosis patients are being treated by private partners and private hospitals. Evidence indicates that the tuberculosis national survey does not represent the number of cases that are diagnosed and recorded by private clinics and hospitals in India.
Programs such as the Revised National Tuberculosis Control Program are working to reduce TB levels among people receiving public health care.
In the United States, Native Americans have a fivefold greater mortality from TB, and racial and ethnic minorities accounted for 88% of all reported TB cases. The overall tuberculosis case rate in the United States was 2.9 per 100,000 persons in
2023, representing a 16% increase in cases compared to 2022.
Tuberculosis formed an often-reused theme in literature, as in Thomas Mann's The Magic Mountain, set in a sanatorium; in music, as in Van Morrison's song "T.B. Sheets"; in opera, as in Giacomo Puccini's La bohème and Giuseppe Verdi's La Traviata; in art, as in Edvard Munch's painting of his ill sister; and in film, such as the 1945 The Bells of St. Mary's starring Ingrid Bergman as a nun with tuberculosis.
A 2014 EIU-healthcare report finds there is a need to address apathy and urges for increased funding. The report cites among others Lucica Ditui "TB is like an orphan. It has been neglected even in countries with a high burden and often forgotten by donors and those investing in health interventions."
Slow progress has led to frustration, expressed by the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it." Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government as of 2014, although adherence is often variable. Commercial treatment providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations.
The government of Brazil provides universal TB care, which reduces this problem. Conversely, falling rates of TB infection may not relate to the number of programs directed at reducing infection rates but may be tied to an increased level of education, income, and health of the population. Costs of the disease, as calculated by the World Bank in 2009 may exceed US$150 billion per year in "high burden" countries. Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250 million rural migrants in China.
There is insufficient data to show that active contact tracing helps to improve case detection rates for tuberculosis. Interventions such as house-to-house visits, educational leaflets, mass media strategies, educational sessions may increase tuberculosis detection rates in short-term. There is no study that compares new methods of contact tracing such as social network analysis with existing contact tracing methods.
Stigma towards TB may result in delays in seeking treatment, lower treatment compliance, and family members keeping cause of death secret – allowing the disease to spread further. In contrast, in Russia stigma was associated with increased treatment compliance. TB stigma also affects socially marginalized individuals to a greater degree and varies between regions.
One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling. Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence. Despite this, studies on the relationship between reduced stigma and mortality are lacking , and similar efforts to decrease stigma surrounding AIDS have been minimally effective. Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable. A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.
To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development as of 2006, including prizes, tax incentives, and advance market commitments. A number of groups, including the Stop TB Partnership,
In 2012 a new medication regimen was approved in the US for multidrug-resistant tuberculosis, using bedaquiline as well as existing drugs. There were initial concerns about the safety of this drug, but later research on larger groups found that this regimen improved health outcomes. By 2017 the drug was used in at least 89 countries. Another new drug is delamanid, which was first approved by the European Medicines Agency in 2013 to be used in multidrug-resistant tuberculosis patients, and by 2017 was used in at least 54 countries.
Steroids add-on therapy has not shown any benefits for active pulmonary tuberculosis infection.
, tuberculosis appears to be widespread among captive in the US. It is believed that the animals originally acquired the disease from humans, a process called reverse zoonosis. Because the disease can spread through the air to infect both humans and other animals, it is a public health concern affecting and .
Prognosis
disability-adjusted life years caused by tuberculosis per 100,000 inhabitants, 2004:
Epidemiology
Reports of tuberculosis can be found throughout recorded history. In Europe, Hippocrates, writing around 400 BCE describes phthisis; in India, the Vedas (composed 1500–1200 BCE) refer to yaksma; both of these are generally equated with tuberculosis. Earlier evidence of tuberculosis has been found in prehistoric human remains in Europe, Africa, Asia and the Americas, with the earliest dating to the early Neolithic era (approximately 10,000-11,000 years ago).
At-risk groups
Tuberculosis is closely linked to both overcrowding and malnutrition, making it one of the principal diseases of poverty. Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g., prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health-care providers serving these patients.
Geographical epidemiology
The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many African, Caribbean, South Asian, and eastern European countries test positive in tuberculin tests, while only 5–10% of the U.S. population test positive. Hopes of totally controlling the disease have been dramatically dampened because of many factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.
Russia
Russia has achieved particularly dramatic progress with a decline in its TB mortality rate—from 61.9 per 100,000 in 1965 to 2.7 per 100,000 in 1993; however, mortality rate increased to 24 per 100,000 in 2005 and then recoiled to 11 per 100,000 by 2015.
China
China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010. The number of new cases has declined by 17% between 2004 and 2014.
Africa
In 2007, the country with the highest estimated incidence rate of TB was Eswatini, with 1,200 cases per 100,000 people. In 2017, the country with the highest estimated incidence rate as a % of the population was Lesotho, with 665 cases per 100,000 people.
India
India had the highest total number of TB cases worldwide in 2010, in part due to poor disease management within the private and public health care sector.
North America
In Canada, tuberculosis was endemic in some rural areas as of 1998. The tuberculosis case rate in Canada in 2021 was 4.8 per 100,000 persons. The rates were highest among Inuit (135.1 per 100,000), First Nations (16.1 per 100,000) and people born outside of Canada (12.3 per 100,000).
Western Europe
In 2017, in the United Kingdom, the national average was 9 per 100,000 and the highest incidence rates in Western Europe were 20 per 100,000 in Portugal.
Society and culture
Names
Tuberculosis has been known by many names from the technical to the familiar. Phthisis (φθίσις) in ancient Greek translates to decay or wasting disease, presumed to refer to pulmonary tuberculosis; around 460 BCE, Hippocrates described phthisis as a disease of dry seasons. The abbreviation TB is short for tubercle bacillus. Consumption was the most common nineteenth century English word for the disease, and was also in use well into the twentieth century. The Latin root con meaning 'completely' is linked to sumere meaning 'to take up from under'. In The Life and Death of Mr Badman by John Bunyan, the author calls consumption "the captain of all these men of death." "Great white plague" has also been used.
Art and literature
Tuberculosis was for centuries associated with and qualities among those infected, and was also known as "the romantic disease". (2025). 9781107672802, Cambridge University Press. ISBN 9781107672802 Major artistic figures such as the poets John Keats, Percy Bysshe Shelley, and Edgar Allan Poe, the composer Frédéric Chopin, the playwright Anton Chekhov, the novelists Franz Kafka, Katherine Mansfield, Charlotte Brontë, Fyodor Dostoevsky, Thomas Mann, W. Somerset Maugham, George Orwell, and Robert Louis Stevenson, and the artists Alice Neel, Jean-Antoine Watteau, Elizabeth Siddal, Marie Bashkirtseff, Edvard Munch, Aubrey Beardsley and Amedeo Modigliani either had the disease or were surrounded by people who did. A widespread belief was that tuberculosis assisted artistic talent. Physical mechanisms proposed for this effect included the slight fever and toxaemia that it caused, allegedly helping them to see life more clearly and to act decisively.
Folklore
In 19th century New England, tuberculosis deaths were associated with . When one member of a family died from the disease, the other infected members would lose their health slowly. People believed this was caused by the original person with TB draining the life from the other family members.
Law
Some countries, including Czech Republic, England, Estonia, Germany, Israel, Norway, Russia and Switzerland have legislation to involuntarily detain or examine those suspected to have tuberculosis, or involuntarily treat them if infected.
Public health efforts
In 2012, The World Health Organization (WHO), the Bill and Melinda Gates Foundation, and the U.S. government subsided a fast-acting diagnostic tuberculosis test, Xpert MTB/RIF, for use in low- and middle-income countries. This is a rapid molecular test used to diagnose TB and simultaneously detect rifampicin resistance. It provides results in about two hours, which is much faster than traditional TB culture methods. The test is designed for use with the GeneXpert System.
Stigma
Slow progress in preventing the disease may in part be due to social stigma associated with TB. Stigma may be due to the fear of transmission from affected individuals. This stigma may additionally arise due to links between TB and poverty, and in Africa, AIDS. Such stigmatization may be both real and perceived; for example, in Ghana, individuals with TB are banned from attending public gatherings.
Research
The BCG vaccine has limitations and research to develop new TB vaccines is ongoing. A number of potential candidates are currently in clinical trial. Two main approaches are used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines. MVA85A, an example of a subunit vaccine, is in trials in South Africa as of 2006, is based on a genetically modified vaccinia virus. Vaccines are hoped to play a significant role in treatment of both latent and active disease.
Department of Economic and Social Affairs (2025). 9789211045963, United Nations. . ISBN 9789211045963 the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research. Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280 million (US) from the Bill and Melinda Gates Foundation to develop and license an improved vaccine against tuberculosis for use in high burden countries.
Other animals
Mycobacteria infect many different animals, including birds, fish, rodents, and reptiles. The subspecies Mycobacterium tuberculosis, though, is rarely present in wild animals. An effort to eradicate bovine tuberculosis caused by Mycobacterium bovis from the cattle and deer herds of New Zealand has been relatively successful. Efforts in Great Britain have been less successful.
See also
Sources
Further Reading
External links
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