World TB Day: What’s in a name?

By Will Murtaugh, Specialist, Infectious Diseases, TB Programs, APHL

World TV Day, you say?!  Sorry, unfortunately not. But since you’re here – let’s talk about World TB Day!  So hit pause on Contagion (you know you’ve already seen it umpteen times), take a look at this guy, and read on.

This German man with the enviable uber-beard once gave an uber-exciting lecture titled “Über Tuberkulose” describing how he discovered the bacilli that causes tuberculosis (TB). He eventually won a Nobel Prize for his discovery, and now, on World TB Day, we’re supposed to celebrate!

Not yet convinced to throw on that party hat? OK, so he’s no Jude Law and maybe this wasn’t the blockbuster climax you were looking for – but the story of “Über Tuberkulose” is far from over…

Imagine that you were this shrewd-looking man surrounded by people who still believed they lived in a “miasma” filled world that caused 1 in 7 people to die with a combination of symptoms including fever, weight loss, and a prolonged productive and bloody cough.  What if this was happening to 7,000,000 people worldwide every year?  What if it was believed incurable and treatment involved being sent away in isolation to a “sanatorium” with a prescription of more fresh air?  You’d surely say,

“…my words have been unheeded. It was still too early, and because of this they still could not meet with full understanding. It shared the fate of so many similar cases in medicine, where a long time has also been necessary before old prejudices were overcome and the new facts were acknowledged to be correct….”

Or something like that – right?

This was the reality of 131 years ago.  But you can thank your lucky pipettes for a “19^th Century scientist giving a speech about discovering germs in a laboratory” that the miasma fog has lifted and exposed the road to TB elimination we continue down today; one in which we can demand, “Stop TB in my lifetime”.  Specifically, you can thank Dr. Robert Koch for revealing to the world on March 24, 1882, in an oft romanticized speech, still considered one of the greatest in medical history, that TB was caused by an identifiable infectious agent, Mycobacterium tuberculosis.

So, what’s in a name?

In the case of M. tuberculosis, an infectious bacilli likely as old as mankind itself, a lot. So don’t throw on your party hats just yet.  Part of observing World TB Day is that we recognize we are still a long way from TB elimination. In 2013, we face a different set of challenges than those of 1882:

• An increasingly mobile global community in which one-third of its population are believed to be carriers of M. tuberculosis.
• The emergence of Multi-Drug Resistant (MDR-TB) and Extensively Drug Resistant (XDR-TB) strains of M. tuberculosis induced by improper use as a result of an expensive and long-term treatment program.

• Systemic societal issues, including marginalized high-risk populations such as persons co-infected with HIV, foreign-born persons, the homeless and those in America’s prison system.

We recognize the progress of science, medicine and public health that has contributed to the global reduction of TB and remember Dr. Koch’s fundamental contribution in naming M. tuberculosis. Specifically here at APHL, we recognize its impact on the development of TB diagnostics used in our public health laboratories today.  Koch contributed to the development of a widely used test for detecting TB infection, the tuberculin skin test (TST, also known as PPD or Mantoux test).  Additionally, he successfully developed a method to both grow and visualize M. tuberculosis that was so valuable similar methods are still used by our public health laboratories to aid in the diagnosis of TB.  As our Mycobacteriology laboratories progress forward, detecting M. tuberculosis with faster, and more advanced technologies, they evaluate many of these tests against the methods pioneered by Koch.  Furthermore, laboratories are developing the capability to “name” M. tuberculosis in greater detail, revealing important information such as the strain responsible for an outbreak and the presence of MDR and XDR-TB.  The value of these laboratory capabilities is becoming increasingly apparent as we overcome the evolving and often overlapping challenges. Important instances of the laboratories’ continued relevance in TB control in the United Stated can be found in still ongoing events such as the outbreak in a largely homeless population in Los Angeles’s Skid Row and the detainment of a Nepalese man in McAllen, TX diagnosed with XDR-TB.

So not to worry, Dr. Koch, with the help of those funny lenses of yours, our public health laboratories see the way forward.  Party hats on!