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“ Medical education does not exist to provide students with a way of making a living but to ensure

“ Medical education does not exist to provide students with a way of making a living but to ensure the health of the community ” Rudolf Virchow Mid 1800s. Tuberculosis has been killing millions for centuries. Symptoms of untreated active TB. Persistent cough and Low grade-fever.

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“ Medical education does not exist to provide students with a way of making a living but to ensure

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  1. “Medical education does not exist to provide students with a way of making a living but to ensure the health of the community” Rudolf Virchow Mid 1800s

  2. Tuberculosis has been killing millions for centuries

  3. Symptoms of untreated active TB Persistent cough and Low grade-fever Difficultyin breathing Night sweats Blood in sputum Cambodian TB patient Severe weight loss Picture: World Lung Foundation

  4. TB is an ancient human disease! Recent evidence supports a diagnosis of TB in this 500,000 year old Homo erectus Bone lesions indicative of TB Credit: Marsha Miller, the University of Texas at Austin

  5. TB is an ancient human disease! TB spinal lesions have also been found in Egyptian mummies

  6. It is estimated that from 1700-1900, TB killed 1 billion people. The annual death rate in the late 1800s was 7 million. TB Ward, Ellis Island Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 "Forgotten Ellis Island,” photographer Stephen Wilkes

  7. After urbanization up to 25% of all European deaths in the 1800s may have resulted from TB TB Ward, Ellis Island http://www.birdchildsandgoldsmith.com/acatalog/slums.gif

  8. The famous and the infamous died of TB Anton Chekhov John Keats Frederic Chopin Emily Bronte Simon Bolivar Henry Thoreau

  9. The famous and the infamous died of TB along with countless millions known only to their families George Orwell Eleanor Roosevelt DH Lawrence Franz Kafka Eugene O’Neill

  10. In 1900 TB was still the second leading cause of death in the US CDC

  11. Now infectious diseases are much less prominent as causes of death and TB has dropped off the list CDC

  12. In the early to mid 1900s TB remained a major public health challenge in the US "Prevent Disease: Careless Spitting, Coughing, Sneezing, Spread Influenza and Tuberculosis." Rensselaer County Tuberculosis Association (Troy, N.Y.), [ca. 1925] "'Stamp' Out Tuberculosis: Buy Christmas Seals." National Tuberculosis Association, 1924. American Red Cross. "The Next to Go: Fight Tuberculosis." [American Red Cross], 1919.

  13. In the US TB is now an almost forgotten disease US TB deaths in 2010: 569 CDC

  14. In the US TB is now an almost forgotten disease US TB deaths in 2010: 569 US Influenza deaths: 2125 (90% age >60 years) US deaths due to dog bites: 30 CDC

  15. But not in the developing world! TB KILLS 1.3 MILLION PEOPLE EVERY YEAR OVER 3500 EVERY DAY ONE PERSON EVERY 27 SECONDS Stats from WHO, 2012

  16. TB is present world-wide but Incidence rates differ dramatically CDC

  17. For this Peruvian family mourning a child dead to TB the disease is certainly not forgotten Partners in Health and Harvard Medical School Dept. of Social Medicine Program in Infectious Disease and Social Change http://www.hms.harvard.edu/news/releases/family_cemetery.html

  18. Two billion people --one third of the world’s population-- are infected with the bacteria that causes TB World Lung Foundation (2008)

  19. Worldwide TB causes: 5% of all deaths ~10% of all adult deaths Morocco India China South Africa Stats:NIAID/NIH Pix: World Lung Foundation

  20. Left untreated, a person with active TB will infect 10-15 other people per year World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html

  21. Left untreated, a person with active TB will infect 10-15 other people per year new infections occur at a rate of one per second! World Lung Foundation (2008) and http://pathport.vbi.vt.edu/pathinfo/pathogens/Tuberculosis_2.html

  22. In most cases TB starts as an infection of the lungs = pulmonary TB http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html

  23. X-rays used to be the primary means of diagnosis http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html

  24. Now TB exposure is diagnosed by a skin test

  25. What is an antigen? What does this test measure?

  26. Tubersol =a cell-free purified protein fraction obtained from a human strain of Mycobacterium tuberculosis grown on a protein-free synthetic medium, and inactivated

  27. A positive test result simply means you have been exposed to TB* at some point and have developed antibodies to it *=Active case Previously “cured” Inactive case Vaccinated with BCG

  28. The next step is a Chest X-ray and a sputum culture

  29. The next frontier: DNA testing to identify different strains of TB and assess drug resistance Dbtechno.com

  30. The next frontier: DNA testing to identify different strains of TB and assess drug resistance July 2008: WHO unveils $26 million program to create labs in poor nations that can do DNA tests Cost: $5 per test Time frame: 24 hours Rather than weeks to months!

  31. However, the TB bacterium can also Infect many other organs, causing distinct “diseases http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG022.html

  32. However, the TB bacterium can also Infect many other organs, causing distinct “diseases Renal TB www.vetmed.wsu.edu

  33. However, the TB bacterium can also Infect many other organs, causing distinct “diseases” Lupus vulgaris Renal TB http://www.ecureme.com/atlas/data/Tuberculosis_of_Skin550_ab.htm

  34. TB infecting the spine Pott’s disease = tuberculous spondylitis Credit: Dr Laughlin Dawes www3.shropshire-cc.gov.uk/. ../med/med_i03.htm

  35. “Miliary TB” is disseminated throughout the body Here it is presenting in the eye www.aippg.net/forum/ viewtopic.php?t=11673

  36. Scrofula: TB of the lymph nodes of neck King Henry IV of France touching sufferers of scrofula. André de Laurens, 1609

  37. As late as the 1800s, causes and cures of TB remained mysterious www.nlm.nih.gov

  38. TB sanitoria were built all around the US www.umdnj.edu/librweb

  39. This may seem like ancient history to you Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 housed over 400 patients, from infants to adults. Waverly Hills closed in 1961 library.louisville.edu

  40. But they remained in operation until After Professor Peifer was born Waverly Hills Tuberculosis Sanatorium. Louisville KT 1926 housed over 400 patients, from infants to adults. Waverly Hills closed in 1961 library.louisville.edu

  41. Gravely Building, now the site of the UNC Cancer Hospital and only torn down in 2010, was a TB sanitorium www.med.unc.edu

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