(commonly shortened to '''TB''') is an
Infection caused by the
Bacterium ''
Mycobacterium Tuberculosis '', which most commonly affects the
Lung s (
Pulmonary TB) but can also affect the
Central Nervous System (
Meningitis ),
Lymphatic System ,
Circulatory System (
Miliary Tuberculosis ),
Genitourinary System ,
Bone s and
Joint s.
Tuberculosis is one of the most deadly and common major
Infectious Disease s today, infecting two billion people, or approximately one-third (
1) of the world's population. Nine million new cases of the disease, resulting in two million deaths, occur annually, mostly in
Developing Countries . However,
Developed Countries are not spared the burden of tuberculosis. There is a rising number of people in the developed world who contract tuberculosis because they have
Compromised Immune Systems , typically as a result of
Immunosupressive Drugs or
HIV/AIDS . These people are at particular risk of tuberculosis infection and active tuberculosis disease.
Most of those infected (90%) have kills 2-3 million.
The neglect of TB control programs, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) and Extreme Drug-Resistance in Tuberculosis (XDR-TB) are emerging. The which aims to save an additional 14 million lives between 2006 and 2015.
- (short for ''t''u''b''erculosis and also for '''T'''ubercle '''B'''acillus)
- (TB seemed to consume people from within with its symptoms of bloody cough, fever, Pallor , and long relentless wasting)
-
- (TB sufferers appear markedly pale)
- (Greek for consumption) and '''phthisis pulmonalis'''
- (swollen neck glands)
- (so called because it was believed that a king's touch would heal scrofula)
- of the spine
- (x-ray lesions look like millet seeds)
- (TB of the abdomen)
- (the common wolf - TB of the skin)
- , also a kind of TB of the skin, transmitted by contact with contaminated cadavers to Anatomist s, Pathologist s, Veterinarian s, Surgeon s, Butcher s, etc.
- named after Robert Koch who discovered the Tuberculosis Bacilli .
''
Mycobacterium Tuberculosis ''.]]
The cause of tuberculosis, ''
Mycobacterium Tuberculosis '' (MTB), is a slow-growing
Aerobic Bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria (although not the slowest), which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of ''
E. Coli '' that can divide roughly every 20 minutes; by contrast,
Mycobacterium Leprae divides every 20 days). MTB is not classified as either
Gram-positive or
Gram-negative because it does not have the chemical characteristics of either. If a Gram stain is performed, it stains very weakly Gram-positive or not at all (ghost cells). It is a small rod-like
Bacillus which can withstand weak
Disinfectant s and can survive in a
Dry State for weeks but, spontaneously, can only grow within a host organism (
in vitro culture of
M. tuberculosis took a long time to be achieved, but is nowadays a routine laboratory procedure).
MTB is identified microscopically by its staining characteristics: it retains certain stains after being treated with acidic solution, and is thus classified as an "
Acid-fast Bacillus " or "AFB". In the most common staining technique, the
Ziehl-Neelsen Stain , AFB are stained a bright red which stands out clearly against a blue background. Acid-fast bacilli can also be visualized by fluorescent microscopy, and by an
Auramine-rhodamine Stain .
The ''M. tuberculosis'' complex includes 3 other , M. africanum, and
''M. microti''. The first two are very rare causes of disease and the last one does not cause human disease.
:
Nontuberculous Mycobacteria (NTM) are other mycobacteria (besides
M. Leprae which causes
Leprosy ) which may cause pulmonary disease resembling TB, lymphadenitis, skin disease, or disseminated disease. These include ''Mycobacterium avium, M. kansasii'', and others.
TB infects around 2 billion people in the world. The prevalence varies enormously throughout the world, from 356 per 100,000 in
Africa to 41 per 100,000 in the
Americas . In the UK, incidence is 90 per 100,000 in areas like the centre of
Birmingham to less than 5 per 100,000 in rural
Hertfordshire .
TB is spread by aerosol droplets expelled by people with active TB disease of the lungs when they cough, sneeze, speak, or spit. Each droplet is 5
Micrometre in diameter and contains 1 to 3
Bacilli . Close contacts (people with prolonged, frequent, or intense contact) are at highest risk of becoming infected (typically a 22% infection rate). A person with untreated, active tuberculosis can infect an estimated 20 other people per year. Others at risk include foreign-born from areas where TB is common,
Immunocompromised patients (eg.
HIV /
AIDS ), residents and employees of high-risk congregate settings, health care workers who serve high-risk clients, medically underserved, low-income populations, high-risk racial or ethnic minority populations, children exposed to adults in high-risk categories, and people who inject illicit drugs.
Transmission can only occur from people with active TB disease (not latent TB infection).
The probability of transmission depends upon
Infectious ness of the person with TB (quantity expelled), environment of exposure, duration of exposure, and
Virulence of the organism.
The chain of transmission can be stopped by isolating patients with active disease and starting effective anti-tuberculous therapy.
While only 10% of TB infection progresses to TB disease, if untreated the death rate is 51%.
TB infection begins when MTB bacilli reach the
Pulmonary Alveoli , infecting alveolar macrophages, where the mycobacteria replicate exponentially. The primary site of infection in the lungs is called the
Ghon Focus . Bacteria are picked up by
Dendritic Cells , which can transport the bacilli to local (mediastinal)
Lymph Node s, and then through the bloodstream to the more distant tissues and organs where TB disease could potentially develop: lung apices, peripheral lymph nodes, kidneys, brain, and bone.
Tuberculosis is classed as one of the granulomatous inflammatory conditions.
Macrophages ,
T Lymphocytes ,
B Lymphocytes and
Fibroblasts are among the cells that aggregate to form a
Granuloma , with lymphocytes surrounding infected macrophages. The granuloma functions not only to prevent dissemination of the mycobacteria, but also provides a local environment for communication of cells of the immune system. Within the granuloma, T lymphocytes (CD4+) secrete a
Cytokine such as
Interferon Gamma , which activates macrophages to destroy the bacteria with which they are infected, making them better able to fight infection. T lymphocytes (CD8+) can also directly kill infected cells.
Importantly, bacteria are not eliminated with the granuloma, but can become dormant, resulting in a latent infection. Latent infection can be diagnosed only by tuberculin skin test, which yields a delayed hypersensitivity type response to purified protein derivatives of M. tuberculosis in an infected person.
Another feature of the
Granuloma s of human tuberculosis is the development of cell death, also called necrosis, in the center of tubercles. To the naked eye this has the texture of soft white cheese and was termed
Caseous Necrosis .
If TB bacteria gain entry to the blood stream from an area of tissue damage they spread through the body and set up myriad foci of infection, all appearing as tiny white tubercles in the tissues. This is called
Miliary Tuberculosis and has a high case fatality.
In many patients the infection waxes and wanes. Tissue destruction and necrosis are balanced by healing and
Fibrosis . Affected tissue is replaced by scarring and cavities filled with cheese-like white necrotic material. During active disease, some of these cavities are in continuity with the air passages
Bronchi . This material may therefore be coughed up. It contains living bacteria and can pass on infection.
Treatment with appropriate
Antibiotic s kills bacteria and allows healing to take place. Affected areas are eventually replaced by scar tissue.
In those people in whom TB bacilli overcome the immune system defenses and begin to multiply, there is progression from TB infection to TB disease. This may occur soon after infection (primary TB disease – 1 to 5%) or many years after infection (post primary TB, secondary TB, reactivation TB disease of dormant bacilli – 5 to 9%). The risk of reactivation increases with immune compromise, such as that caused by infection with HIV. In patients co-infected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year, while in immune competent individuals, the risk is between 5 and 10% in a lifetime.
About five percent of infected persons will develop TB disease in the first two years, and another five percent will develop disease later in life. In other words, about 10% of infected persons with normal immune systems will develop TB disease in their lifetime.
Some medical conditions increase the risk of progression to TB disease. In
HIV infected persons with TB infection, the risk increases to 10% each year instead of 10% over a lifetime. Other such conditions include drug injection (mainly because of the life style of IV Drug users), substance abuse, recent TB infection (within two years) or history of inadequately treated TB, chest X-ray suggestive of previous TB (fibrotic lesions and nodules), diabetes mellitus, silicosis, prolonged corticosteroid therapy and other immunosuppressive therapy, head and neck cancers, hematologic and reticuloendothelial diseases (leukemia and Hodgkin's disease), end-stage renal disease, intestinal bypass or gastrectomy, chronic malabsorption syndromes, or low body weight (10% or more below the ideal).
Some drugs, including rheumatoid arthritis drugs that work by blocking
Tumor Necrosis Factor-alpha (an inflammation-causing cytokine), raise the risk of causing a latent infection to become active due to the importance of this cytokine in the immune defense against TB.
TB disease most commonly affects the lungs (75% or more), where it is called pulmonary TB. Symptoms may include a productive, prolonged cough of more than three weeks duration, chest pain, and
Hemoptysis . Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, and easy fatigability. The term consumption arose because sufferers appeared as if they were "consumed" from within by the disease. People from Asian and African descent may have lymph node TB more often than Caucasians.
Only 10 percent of TB infection progress to active TB disease; 90 percent have latent TB infection (LTBI) and have no symptoms.
Extrapulmonary sites include the pleura, central nervous system (
Meningitis ), lymphatic system (
Scrofula of the neck), genitourinary system, and bones and joints (
Pott's Disease of the spine). An especially serious form is "disseminated", or "miliary" TB, so named because the lung lesions so-formed resemble millet seeds on x-ray. These are more common in immunosuppressed persons and in young children. Pulmonary TB may co-exist with extrapulmonary TB.
Drug-resistant TB is transmitted in the same way as regular TB. Primary resistance develops in persons initially infected with resistant organisms. Secondary resistance (acquired resistance) may develop during TB therapy due to inadequate treatment regimen, i.e. not taking the prescribed regimen appropriately or using low quality medication.
A complete medical evaluation for TB includes a medical history, a physical examination, a tuberculin skin test, a serological test, a chest X-ray, and microbiologic smears and cultures. The measurement of a positive skin test depends upon the person's risk factors for progression of TB infection to TB disease.
Bacteriophage-based assays are among a few new testing procedures that offer the hope of cheap, fast and accurate TB testing for the impoverished countries that need it most.
For all practical purposes, only patients with tuberculosis of the lungs can spread TB to other people. People may become infected with TB but not have active disease: such people are said to have latent TB infection (LTBI) and are not capable of passing the infection on to other people. The reason for treating people with LTBI is to prevent them from progressing to active TB disease later in life (approximately 10% lifetime risk). The distinction is important because treatment options are different for the two groups.
Prevention and control efforts include three priority strategies:
- identifying and treating all persons who have TB disease
- finding and evaluating persons who have been in contact with TB patients to determine whether they have TB infection or disease, and treating them appropriately, and
- testing high-risk groups for TB infection to identify candidates for treatment of latent infection and to ensure the completion of treatment.
In tropical areas where the incidence of atypical mycobacteria is high, exposure to
Nontuberculous Mycobacteria gives some protection against TB.
Many countries use
BCG vaccine as part of their TB control programs, especially for infants. The protective efficacy of BCG for preventing serious forms of TB (e.g.
Meningitis ) in children is high (greater than 80%). However, the protective efficacy for preventing pulmonary TB in adolescents and adults is variable, from 0 to 80%. In the
United Kingdom , children aged 10-14 were typically immunized during school until 2005. (Routine BCG vaccination was stopped as it was no longer cost-effective. The incidence of TB in people born in the UK, and with parents and grandparents who were born in the UK, was at an all time low, and falling. Others continue to be offered BCG vaccination.)
The effectiveness of BCG is much lower in areas where mycobacteria are less
Prevalent . In the USA, BCG vaccine is not routinely recommended except for selected persons who meet specific criteria:
- Infants or children with negative skin-test result who are continually exposed to untreated or ineffectively treated patients or will be continually exposed to multi-drug resistant TB.
- Healthcare workers considered on individual basis in settings in which high percentage of MDR-TB patients has been found, transmission of MDR-TB is likely, and TB control precautions have been implemented and not successful.
The first
Recombinant tuberculosis
Vaccine entered
Clinical Trial s in the United States in 2004 sponsored by the
National Institute Of Allergy And Infectious Diseases (NIAID).
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A 2005 study showed that a DNA TB vaccine given with conventional
Chemotherapy can accelerate the disappearance of bacteria as well as protecting against re-infection in mice; it may take four to five years to be available in humans. PMID 15690060.
Because of the limitations of current vaccines, researchers and policymakers are promoting new economic models of vaccine development including prizes, tax incentives and
Advance Market Commitments .
Tuberculosis can be carried by many
Mammal s. Domesticated species, such as cats and dogs, are generally free of tuberculosis, but wild animals may be carriers. As a result, many places have regulations restricting the ownership of
Novelty Pet s, possibly including such partially domesticated species as
Pet Skunk s; for example, the
American state of
California forbids the ownership of pet
Gerbil s. The strictness of such restrictions generally depends on the
Public Health policies adopted for fighting tuberculosis.
An effort to eradicate bovine tuberculosis from the cattle and deer herds of
New Zealand is underway. It has been found that herd infection is more likely in areas where infected
Vector Species such as Australian
Brush-tailed Possums come into contact with
Domestic Livestock at farm/bush borders. Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a "two-pronged" approach to ridding New Zealand of the disease.
In both the
Republic Of Ireland and
Northern Ireland ,
Badger s have been identified as a vector species for the transmission of bovine tuberculosis. As a result, the government in both regions has mounted an active campaign of eradication of the species in an effort to reduce the incidence of the disease. Badgers have been culled primarily by snaring and gassing. It remains a contentious issue, with proponents and opponents of the scheme citing their own studies to support their position.
[http://news.bbc.co.uk/1/hi/northern_ireland/4044897.stm [http://www.badger-killers.co.uk/Ireland/Ireland_news.html]
Tuberculosis has been present in humans since
Antiquity , as the origins of the disease are in the first domestication of cattle (which also gave humanity viral poxes). Skeletal remains show prehistoric humans (4000 BCE) had TB and tubercular decay has been found in the spines of Egyptian
Mummies from 3000-2400 BCE. There were references to TB in
India around 2000 BCE, and indications of lung scarring identical to that of modern-day TB sufferers in preserved bodies (such as mummies) suggests that TB was present in
The Americas from about 2000 BCE.
Phthisis is a Greek term for consumption. Around 460 BCE,
Hippocrates identified phthisis as the most widespread disease of the times which was almost always fatal.
During the Industrial Revolution, tuberculosis was more commonly thought of as
Vampirism . When one member of a family died from it, the other members that were infected would lose their health slowly. People believed that the cause of this was the original victim draining the life from the other family members. To cure this, people would dig up the body of what they thought was the vampire, open the chest and burn the heart, sometimes with the rest of the body. Furthermore, people who had TB exhibited symptoms similar to what people considered to be vampire traits. People with TB often had symptoms such as red, swollen eyes (which also creates a sensitivity to bright light), pale skin and coughing blood (which people often thought needed to be replenished, so they figured the only way for the afflicted to get blood back was by sucking blood). This may be how much of the common mythology of the vampire originated.
Although it was established that the pulmonary form was associated with 'tubercles' by . During the years 1838-1845, Dr. John Croghan, the owner of
Mammoth Cave , brought a number of tuberculosis sufferers into the cave in the hope of curing the disease with the constant temperature and purity of the cave air. The first TB
Sanatorium opened in 1859 in
Poland , with another opening in the
United States in 1885.
The bacillus-causing tuberculosis, ''Mycobacterium tuberculosis'', was identified and described on
March 24 ,
1882 by
Robert Koch . He received the
Nobel Prize In Physiology Or Medicine in 1905 for this discovery. Koch did not believe that bovine (cattle) and human tuberculosis were similar, which held back the recognition of infected milk as a source of infection. Later, this source was eliminated by the
Pasteurization process. Koch announced a
Glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it 'tuberculin'. It was not effective, but was later adapted by
Von Pirquet in a test for pre-symptomatic tuberculosis.
The first genuine success in immunizing against tuberculosis developed from attenuated bovine-strain tuberculosis by
Albert Calmette and
Camille Guerin in 1906. It was called 'BCG' (
Bacillus Of Calmette And Guerin ). The BGG vaccine was first used on humans on
July 18 ,
1921 in
France , although national arrogance prevented its widespread use in either the
USA ,
Great Britain , or
Germany until after
World War II .
Tuberculosis caused the most widespread public concern in the 19th and early 20th centuries as the
Endemic disease of the urban poor. In 1815, one in four deaths in England was of consumption; by 1918 one in six deaths in France were still caused by TB. After the establishment in the 1880s that the disease was contagious, TB was made a
Notifiable Disease in Britain; there were campaigns to stop spitting in public places, and the infected poor were "encouraged" to enter
Sanatoria that rather resembled prisons. Whatever the purported benefits of the fresh air and labor in the sanatoria, 75% of those who entered were dead within five years (1908).
The promotion of
Christmas Seals was started in 1904 in Denmark as a way to raise money for tuberculosis programs. It expanded to the United States and Canada in 1907-08 to help the National Tuberculosis Association (later called the
American Lung Association ).
In the United States, concern about the spread of tuberculosis played a role in the movement to prohibit public spitting except into
Spittoon s.
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's significance was still such that when the
Medical Research Council was formed in Britain in 1913 its first project was tuberculosis.
It was not until 1946 with the development of the antibiotic
Streptomycin that treatment rather than prevention became a possibility. Prior to then only surgical intervention was possible as supposed treatment (other than sanatoria), including the pneumothorax technique: collapsing an infected lung to "rest" it and allow lesions to heal, which was an accomplished technique but was of little benefit and was discontinued after 1946.
Hopes that the disease could be completely eliminated have been dashed since the rise of
Drug-resistant strains in the 1980s. For example, Tuberculosis cases in Britain, numbering around 50,000 in 1955, had fallen to around 5,500 in 1987, but in 2000 there were over 7,000 confirmed cases. Due to the elimination of public health facilities in New York in the 1970s, there was a resurgence in the 1980s. The number of those failing to complete their course of drugs was very high. NY had to cope with more than 20,000 "unnecessary" TB-patients with many multi-drug resistant strains (i.e., resistant to, at least, both Rifampin and Isoniazid). The resurgence of tuberculosis resulted in the declaration of a global health emergency by the World Health Organization in 1993.
Due to the high prevalence of tuberculosis in the pre-antibiotic era, many historically prominent people developed or died from the condition, often in the prime of their productive period.
- Frédéric Chopin died of consumption in 1849. Historical records indicate episodes of Hemoptysis during performances.
- Legendary father of country music, Jimmie Rodgers (1897 - 1933) sang the woes of having tuberculosis in the song ''T.B. Blues'' (co-written with Raymond E. Hall). Rodgers ultimately died of the disease days after a New York city recording session.
- Luigi Boccherini, Italian cellist and composer, died in 1805 of pulmonary tuberculosis.
- English Romantic poet John Keats (1795-1821) and some of his family were taken by tuberculosis.
- The Brontë family of writers, poets and painters was particularly struck by TB, with Anne , Branwell , and Emily all dying of it within 2 years of each other. Charlotte 's death in 1855 was stated as due to TB at the time, although there is some controversy over this today.
- In A Moveable Feast , Ernest Hemingway (1899-1961) recounts meeting Ernest Walsh, an Irish poet suffering from TB. "... I looked at him and his marked-for-death look and I thought, you con man conning me with your con."
- Neo-romantic Scottish essayist, novelist and poet Robert Louis Stevenson (1850-1894) is thought to have suffered from tuberculosis during much of his life. He spent the winter of 1887–1888 recuperating from a presumed bout of tuberculosis at Dr. E.L. Trudeau's world-renowned Adirondack Cottage Sanatarium in Saranac Lake, New York.
- The 20th century French writer, playwright, activist, and existentialist philosopher, Albert Camus also suffered from TB during his life time, although he died in a car accident.
- Edward Bellamy (1850-1898), a fiction writer who was made famous from his book " Looking Backward ", died from tuberculosis.
- Franz Kafka (1883-1924), a German-language novelist who was made famous from his novel ('' The Metamorphosis ''), died from tuberculosis.
- Masaoka Shiki (1867-1902), Japanese poet famous for revitalizing the haiku. Died after a long struggle with tuberculosis.
- Okita Soji (1844-1868), a young and famous captain of the Shinsengumi , was discovered to have the disease when he coughed blood and fainted during the Ikedaya Affair . He died of it at the age of 25, on May 30th, 1869.
- Edvard Munch (1863-1944), The famous painter who painted ('' The Scream ''), lost two members of his family, his mother, and his beloved sister both to tuberculosis. The loss of his sister was imortalized in the painting "The Sick Child."
It has been speculated that the real-life ubiquity of illness and death due to tuberculosis affected the portrayal of these issues in European art and literature as well as history. The pale, "haunted" appearance of tuberculosis sufferers was fashionable at times, and has been seen as an influence on the works of
Edgar Allan Poe who lost loved ones to this very disease. In recent years, this aesthetic has been revived by the "
Goth " subculture.
- Tuberculosis is portrayed at least twice in the Sherlock Holmes stories by Sir Arthur Conan Doyle, himself a medical doctor. In 'The Final Problem', Dr. Watson gets a message saying that a lady was in 'the final stages of consumption'. In the story 'The Missing Three-Quarter', Godfrey Staunton's young wife dies of 'consumption of the most villianed kind'. 'Consumption' was a common name for 'tuberculosis' in the 19th and early 20th centuries.
- Tuberculosis patients were frequent characters in 19th century Russian Literature , and even inspired a character type; the consumptive nihilist, examples of which include Bazarov from Ivan Turgenev 's '' Fathers And Sons '', Katerina Ivanovna from Fyodor Dostoevsky 's Crime And Punishment , Kirillov from Dostoevsky's ''Demons'' (aka '' The Possessed ''), and Ippolit and Marie from Dostoevsky's '' The Idiot .''
- In the novel '' The Constant Gardener '' by John Le Carré , as well as in the movie adaptation directed by Fernando Meirelles , the plot largely revolves around TB drugs beings tested on unwitting subjects in Africa , and dire predictions about a global Pandemic of a drug-resistant form of the disease appear repeatedly.
- In Sylvia Plath 's novel '' The Bell Jar '', the protagonist Esther's boyfriend Buddy Willard suffers from tuberculosis, much to her liking.
- Celestine, the heroine of Octave Mirbeau 's ''Diary of a Chambermaid'', attempts to contract tuberculosis from her dying lover, Monsieur Georges.
- In '' Nicholas Nickleby '', by Charles Dickens , Nickleby's faithful companion Smike is beset by tuberculosis.
- Extensively, in '' The Magic Mountain '', by Thomas Mann , where a three week visit to a sanitarium turns into a seven year sabbatical and additionaly in the novelle "Tristan" which is set in an alpine sanatorium.
- In '' Hocus Pocus '' by Kurt Vonnegut , the protagonist contracts TB later in his lifetime.
- In the Swedish novel "Körkarlen" by Selma Lagerlöf , the protagonist David Holm is sick with TB, and so are his younger brother Bernard and his friend Sister Edith.
- In the Australian novel Seven Little Australians , Judy becomes consumptive after walking from the Blue Mountains to her home.
- In the 2002 film The Twilight Samurai , the leading character Seibei Iguchi's wife dies of consumption at the beginning of the story. At the end, his opponent tells of the death of his own wife and daughter of consumption.
- In Winter's Tale , by Mark Helprin , Beverly Penn is dying of consumption.
- Richard Yates , (1926-1992), the American writer, suffered from TB shortly after WWII, and wrote about the disease in a number of his short stories, including " No Pain Whatsoever "
- "In the Year Of My Indian Prince", by Ella Thorp Ellis, she contracts TB and is in a TB treatment hospital where she meets, and falls in love with a young Indian prince, who also has TB.
- The hospitalized mother in the movie '' My Neighbor Totoro '' is thought to be suffering from tuberculosis (her ailment is not specifically named in the film, but tuberculosis is cited in the film's novelization). This is an Autobiographical reference to the fact that writer/director Hayao Miyazaki 's own mother spent several years of his childhood hospitalized with TB.
- In the period picture '' Camille '' MGM 1936, consort Greta Garbo ( Camille ) tragically contracts TB (known then as "consumption") and dies in Robert Taylor 's arms.
- In the biographical film, ''A Time for Miracles'' starring Kate Mulgrew . Saint Mother Elizabeth Bayley Seton dies of TB at the age of 46 after founding the American Sisters Of Charity order in Maryland. Seton's husband and one of her five children also died of TB.
- In both of the early 1990's films that dramatized Wyatt Earp 's life ('' Tombstone (film) '' and '' Wyatt Earp (film) ''), Doc Holliday struggles with TB are vividly depicted.
- In the Swedish Film '' My Life As A Dog '' the protagonist Ingemar deals with his mother suffering from TB.
- In the film '' Heavenly Creatures '', directed by Peter Jackson , Juliet Hulme had TB, and her fear of being sent away 'for the good of her health' played a large role in determining the subsequent actions of herself and Pauline Parker .
- In '' Finding Neverland '', Kate Winslet 's character suffers and later dies of TB.
- In One Episode of the animated series '' Drawn Together '', Princess Clara suffers from "the consumption."
- In '' Moulin Rouge '' the prostitute Satine, played by Nicole Kidman , contracts TB and dies.
- In '' The Others '', the servants of the house died of tuberculosis.
- Van Morrison 's song "TB Sheets" (from the eponymous 1974 album) is about the narrator nursing a girl, who is dying of tuberculosis. The song is a reworking of the TB theme in American blues music.
- The Vizier in the acclaimed Prince of Persia: The Sands of Time is revealed to be suffering from the disease. He calls it by the name "Consumption" and is the primary reason for his desire for the Dagger of Time's power.
- The character Tachibana Ukyo from the Samurai Shodown series of games had Tuberculosis, and frequently coughed blood before and after matches.
- ''Core Curriculum on Tuberculosis: What the Clinician Should Know, 4th edition (2000)''. Division of Tuberculosis Elimination, Centers For Disease Control And Prevention (CDC). ( Internet version updated Aug 2003).
- Joint Tuberculosis Committee of the British Thoracic Society. ''Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000''. Thorax 2000;55:887-901 ( fulltext ).
- Thomas Dormandy (1999). ''The White Death: A History of Tuberculosis''. ISBN 0814719279 HB - ISBN 1852853328 PB
- ''Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World''. Tracy Kidder, Random House 2000. ISBN 0812973011. A nonfiction account of treating TB in Haiti, Peru, and elsewhere.
- Ha SJ, Jeon BY, Youn JI, Kim SC, Cho SN, Sung YC. Protective effect of DNA vaccine during chemotherapy on reactivation and reinfection of Mycobacterium tuberculosis. Gene Ther. 2005 Feb 03; ahead of print PMID 15690060
- Blumberg HM, Leonard MK Jr, Jasmer RM. Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA 2005 Jun 8;293(22):2776-84. PMID 15941808
- Nemery B, Yew WW, Albert R, Brun-Buisson C, Macnee W, Martinez FJ, Angus DC, Abraham E. Tuberculosis, nontuberculous lung infection, pleural disorders, pulmonary function, respiratory muscles, occupational lung disease, pulmonary infections, and social issues in AJRCCM in 2004. Am J Respir Crit Care Med. 2005 Mar 15;171(6):554-62. PMID 15753485
