Medical education does not exist

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
2
Tuberculosis has been killing millions for
centuries
3
Symptoms of untreated active TB
Persistent cough and Low grade-fever
Difficulty in 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 young male Homo erectus
Bone lesions indicative of TB
Credit Marsha Miller, the University of Texas
at Austin
5
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
6
The famous and the infamous died of TB
Anton Chekhov
John Keats
Frederic Chopin
Emily Bronte
Simon Bolivar
Henry Thoreau
7
The famous and the infamous died of TB along with
countless known only to their families
George Orwell
Eleanor Roosevelt
DH Lawrence
Franz Kafka
Eugene ONeill
8
In 1900 TB was still the second leading
cause of death in the US
CDC
9
Now infectious diseases are much less prominent
as causes of death and TB has dropped off the list
CDC
10
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.
11
In the US TB is now an almost forgotten disease
US TB deaths in 2004 657
CDC
12
In the US TB is now an almost forgotten disease
US TB deaths in 2004 657
US Influenza deaths in 2004 1100
US deaths due to asthma in 2004 3816
CDC
13
But not in the developing world!
Stats from WHO slide from TBAlliance
14
TB is present world-wide but Incidence rates
differ dramatically
CDC
15
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.hm
s.harvard.edu/news/releases/family_cemetery.html
16
Two billion people --one third of the worlds
population-- are infected with the bacteria that
causes TB
World Lung Foundation (2008)
17
Worldwide TB causes 5 of all deaths 10 of
all adult deaths
Morocco
India
China
South Africa
StatsNIAID/NIH Pix World Lung Foundation
18
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/Tube
rculosis_2.html
19
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/Tube
rculosis_2.html
20
In most cases TB starts as an infection of the
lungs pulmonary TB
http//library.med.utah.edu/WebPath/TUTORIAL/DRUG/
DRUG022.html
21
X-rays used to be the primary means of diagnosis
http//library.med.utah.edu/WebPath/TUTORIAL/DRUG/
DRUG022.html
22
Now TB exposure is diagnosed by a skin test
23
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
24
The next step is a sputum culture
25
The next frontier DNA testing to
identify different strains of TB and assess drug
resistance
Dbtechno.com
26
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!
27
However, the TB bacterium can also Infect many
other organs, causing distinct diseases
http//library.med.utah.edu/WebPath/TUTORIAL/DRUG/
DRUG022.html
28
However, the TB bacterium can also Infect many
other organs, causing distinct diseases
Renal TB
www.vetmed.wsu.edu
29
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
30
TB infecting the spine
Potts disease tuberculous spondylitis
Credit Dr Laughlin Dawes
www3.shropshire-cc.gov.uk/. ../med/med_i03.htm
31
Miliary TB is disseminated throughout the
body Here it is presenting in the eye
www.aippg.net/forum/ viewtopic.php?t11673
32
Scrofula TB of the lymph nodes of neck
King Henry IV of France touching sufferers of
scrofula. André de Laurens, 1609
33
As late as the 1800s, causes and cures of TB
remained mysterious
www.nlm.nih.gov
34
TB sanitoria were built all around the US
www.umdnj.edu/librweb
35
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
36
But they remained in operation until after your
professor 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