Causes

Robert Koch proved with certainty that the dreaded disease, tuberculosis, was caused by specific bacteria. How did he do it? Play the game and find out ! 
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 Source:  "Tuberculosis". Nobelprize.org. Nobel Media AB 2013. Web. 27 Jun 2013. 

What causes Tuberculosis?

  • M. tuberculosis complex (MTBC)

Mycobacterium tuberculosis complex (MTBC)

The M. tuberculosis complex (MTBC) includes consists of six members:
  • M. tuberculosis
M. tuberculosis is the main agent that causes TB.
  • M. bovis
M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has largely eliminated this as a public health problem in developed countries.
  • M. africanum
M. africanum is not widespread, but it is a significant cause of tuberculosis in parts of Africa. 
  • M. canetti
M. canetti is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants.  
  • M. microti 
M. microti is also rare and is mostly seen in immunodeficient people, although the prevalence of this pathogen has possibly been significantly underestimated.
  • M. pinnipedii
M. pinnipedii primarily infects seals. It is a slow-growing mycobacterium. The species is named after the Pinnipeds, the organisms from which M. pinnipedii was first isolated.
 

Mycobacterium tuberculosis

False-colour SEM of Mycobacterium Tuberculosis
Mycobacterium tuberculosis (MTB) is the main cause of most cases of tuberculosis (TB). It was first discovered in 1882 by Robert Koch. M. Tuberculosis is small, aerobic and non-motile. It has an unusual, waxy coating on its cell surface. 

 The physiology of M. tuberculosis is highly aerobic and requires high levels of oxygen. Primarily a pathogen of the mammalian respiratory system, MTB infects the lungs.
M. tuberculosis divides every 15–20 hours, which is extremely slow compared to other bacteria, which tend to have division times measured in minutes (E.Coli can divide roughly every 20 minutes). It is a small bacillus that can withstand weak disinfectants and can survive in a dry state for weeks. Its unusual cell wall, rich in lipids (e.g., mycolic acid), is likely responsible for this resistance and is a key virulence factor.

 M.tuberculosis does not retain any bacteriological stain due to high lipid content in its wall, hence Ziehl-Neelsen staining, or acid-fast staining, is used. Despite this, it is gram-positive bacteria. While mycobacteria do not seem to fit the Gram-positive category from an empirical standpoint (i.e., they do not retain the crystal violet stain), they are classified as acid-fast Gram-positive bacteria due to their lack of an outer cell membrane.

Risk factors for TB

The risk of developing tuberculosis is dependent on both the risk of being infected and the risk of infection leading on to active disease. The former will depend on the incidence of tuberculosis in the community where the individual lives or works. The latter will depend on many factors impinging on the individual both genetic and environmental.

A number of factors make people more susceptible to TB infections.
1. HIV infections
  • they have a lower capacity to fight off tuberculosis due to depressed immune system caused by the concomitant HIV infection. 
  • Co-infection with HIV is a particular problem in Sub-Saharan Africa, due to the high incidence of HIV in these countries. 
  • The risk of developing TB is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection. TB is a leading cause of morbidity and mortality among people living with HIV. 
2. living in areas with a high prevalence of tuberculosis.
3. being in poor health or having a poor diet due to lifestyle and other problems, such as drug misuse, alcohol misuse or homelessness 
  •  Along with overcrowding, poor nutrition may contribute to the strong link observed between tuberculosis and poverty, making it one of the principal diseases of poverty. 
4. living in poor or crowded housing conditions, such as prisons 
  • Prisoners are particularly vulnerable to infectious diseases such as HIV/AIDS and TB.
  • Imprisonment facilities provide conditions that allow TB to spread rapidly due to overcrowding, poor nutrition, and a lack of health services.
5. Silicosis
  • People with silicosis have an approximately 30-fold greater risk for developing TB.
  • Silica is believed to interfere with the body's immune response to the bacteria that cause TB.
6. smoking
  • A survey showed that those who smoked more than 20 cigarettes a day were between two and three times more likely to develop tuberculosis compared with non-smokers.
7. Diabetes
  •  Tuberculosis has a 2-4 fold increase in patients with diabetes.
8. other factors
  • Haemodialysis; Patients undergoing haemodialysis and those with chronic renal failure run an increased risk of 10-15 fold.
  • Gastrectomy and Jejunoileal bypass; the risk of tuberculosis increases by 5 and
    30-60 fold respectively.
  • Carcinoma; Cancer patients with head and neck tumours, malignant lymphomas, lung cancer, lymphosarcoma and reticulum cell sarcoma have up to a 16 fold increased risk.
  • Immunosupressive treatment




Reference: 
1. Davies, P. D. "Risk factors for tuberculosis." Monaldi Arch Chest Dis 63.1 (2005): 37-46.
2. http://www.nhs.uk/Conditions/Tuberculosis/Pages/Causes.aspx
3. http://en.wikipedia.org/wiki/Risk_factors_for_tuberculosis
4. http://www.news-medical.net/health/Tuberculosis-Causes.aspx 
5. "Tuberculosis". Nobelprize.org. Nobel Media AB 2013. Web. 27 Jun 2013. 
 

1 comment:

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