Tag Archives: tuberculosis

World Tuberculosis Day

24 Mar

Today is World Tuberculosis Day, a day dedicated to raising awareness to one of the world’s deadliest diseases, because no holiday is complete if it doesn’t involve celebrating the misery of millions of people.
That’s why Christmas is so popular.

Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis, which is one of those bacteria that is really awesome to talk about and really annoying to work with.
Really, really, really annoying.
Seriously, you have no idea.
It sucks.

The Disease

Despite how charming Doc Holiday made tuberculosis look, the disease is just as annoying as the bacterium. If you catch tuberculosis, treatment can take anywhere from 6 months to 2 or 3 years, depending on it’s drug resistance. Oh yeah, it’s highly drug resistant. And we only really have 8 types of drugs to treat it with (2 first line and 6 second line drugs) . Mutli-drug resistant TB (MDR-TB) is resistant to rifampicin and isoniazid, the first line of drug defense doctors use. Extensively drug-resistant TB (XDR-TB) is also resistant to three or more of the six classes of second-line drugs. Totally resistant TB was first reported in 2003, and was pretty rare. At first. Now it’s a bit more widespread.
Because it’s an annoying bastard.

Also, if the drug resistance and multi-year treatment isn’t bad enough, in the United States, you have no choice on whether or not you get treated. You HAVE to get treated, because the disease is such a danger to public health. Part of the drug resistance is due to people no continuing their treatment, which can be rigorous. And while there is a vaccine, it’s has varying degrees of effectiveness against pulmonary tuberculosis.

On top of everything else, many cultures have a huge social stigma against those who have it, even after they’ve been cured. During the treatment, they may be completely ostracized from their village and even their families who fear the disease. You can’t blame the people for wanting to protect themselves, but it also leaves the patient , leaving them with no emotional support structure and facing the shame of disease. They will often find themselves alone, and become very depressed and stop taking their treatment. It’s a problem Doctor’s Without Borders has to face every day, and has done their best to bring public attention to the multiple issues surrounding the disease with their adorably named project “TB And Me”.

Most people think that TB is a “third world problem.” But in reality, it’s everywhere. There are parts of London which have rates nearly as high as Chinese provinces. Alaska is facing a tuberculosis epidemic among their homeless and do random sweeps every few weeks. Even my father caught tuberculosis as a boy living in Colorado. It is highly contagious: a person with active TB can infect 10 to 15 people a year. It killed 1.7 million people in 2009. Over 2 billion people are infected, though not all of these cased are active. Of these 2 billion, 10% will develop an active infection during their lifetime.

The Bitchy Diva

It’s a Class III organism, which means you have to use a bunch of annoying precautions when working with it. Not only do you have to process the specimens under a biohood, you have to do it in a special room completely dedicated to working with tuberculosis, and only tuberculosis. This room separated from the rest of the lab by a series of doors and negative air pressure. You also have to wear a special mask so you don’t accidentally inhale it, since the infective dose of M. tuberculosis is fewer than 10 bacterium. And before you work with it, you have to spread bleach-soaked paper towels everywhere, so that if by chance even one bacterium falls onto the counter, it will immediately die a horrible, bleachy death.

We don’t mess around with tuberculosis. It’s not a fun and cute bacteria like E.coli. It’s a high maintenance bitchy little diva that will slowly and violently murder your lungs if it gets a chance.

Science Stuffs

Mycobacterium are a genus of Actinobacteria. There are over 70 species of Mycobacteria, but most people are familiar with M. tuberculosis and M. leprae, the causative agent of leprosy. While most clinically significant bacteria grow within 18-48 hours, Mycobacteria takes it’s time. Some species will form colonies within 7 days (termed “rapid growers,” because microbiologists have a skewed perception of time), while other may take 6 weeks or longer to grow. Maybe they like to take their time growing because they don’t want to come across as desperate. Or maybe they’re just stubborn and will grow when they’re damn well good and ready.
Either way, it’s really annoying.

One of the most significant characteristics of Mycobacterium is their cell wall, which is thicker than most other bacteria and completely stuffed with mycolic acids that give it a waxy appearance. The cell wall consists of the hydrophobic mycolate layer and a peptidoglycan layer held together by the polysaccharide arabinogalactan, which is one of those words I love watching drunk people try to pronounce.

M. tuberculosis is a bacillus and may be considered Gram-positive, but this is actually a huge misnomer. Due to the high lipid content of their unique cell wall and general stubbornness, they do not retain any portion of the Gram stain, and thus are neither truly Gram positive  or Gram negative. While they don’t truly retain crystal violet, upon staining they can appear to be weakly Gram positive, because it likes to laugh in the face of logic. Or they won’t stain at all and be referred to as “ghosts.” Again, either way, it’s really really annoying.

If only they were this cute.

A much more useful stain for this species is the Ziehl–Neelsen stain, commonly referred to as the acid-fast stain.
M. tuberculosis is acid-fast, meaning they are resistant to decolorization by acids during staining.  This is due the the lack of an outer cell membrane. It decided somewhere along the way that outer cell membranes were too mainstream, and never bothered getting one.


 M. tuberculosis is nonphotochromogenic, meaning it won’t produce a pigment in the presence or absence of light. Their colonies are buff-colored, dry, rough, and honestly rather ugly. They look like demented warts.


If growth conditions are optimal in broth cultures, M. tuberculosis will actually grow in long, rope-like strands, which we called “cording,” which is actually pretty cool. M. tuberculosis is strictly aerobic, requiring high amounts of oxygen, which is why it loves to invade your lungs.. They are nonmotile, and lack spores and capsules. In terms of biochemical identification, they are negative for catalase, including the 68 degrees Celsius catalase test which is commonly performed on Mycobacteria species. They are positive for niacin and nitrate.

M. tuberculosis was first described on 24 March 1882 by Robert Koch, a guy every biologist should recognize, if not for all his grand achievements in the field of microbiology, then at least for his dapper style.

 Note the fine beard and bow tie, which can both be used to clean microscopes. He received a Nobel Prize in 1905 for his discovery. In 1998 we sequenced it’s annoying little genome.

Doctors Without Borders have made several awesome infographic posters to help educate about TB rates:
TB-infographic-treatment
TB-effects-infographic2-final

Stop TB - In My Lifetime, World TB Day, March 24. http://www.cdc.gov/tb/events/WorldTBDay/default.htm

Click here to learn more about World TB Day!
Click here to learn more about Tuberculosis and it’s growing drug resistance.

Tuberculosis Infographic

22 Mar

Open Source Drugs

15 Mar

The following was written by Jacqueline of Skepchick.org. I absolutely love this concept, as well as her clear and succinct writing style.

OPEN SOURCE DRUG DISCOVERY

Drug discovery is challenging, lengthy, and extraordinarily expensive. All companies focus on making money and drug companies are no different. They spend their research and development budgets focusing on diseases that affect the affluent world population. As a consequence diseases such as malaria and tuberculosis that are abundant in sub-Saharan Africa and India are left unstudied by industry. Despite the omission by drug companies, other efforts are underway to aid in drug discovery for these diseases.

Just to hash out a few details of where the problem arises– the Center for Disease Control (CDC) states that 35 countries (30 African and 5 Asian) account for 98% of the malarial related deaths. Similarly, in 2010, 8.8 million people became sick with tuberculosis (TB) of which 82% of the cases lived in 22 TB ridden countries. These diseases do exist in other parts of the world, but result in significantly less deaths.

Despite the lack of interest from drug companies for treating these infectious diseases, other organizations have picked up the slack. The Bill & Melinda Gates Foundation has contributed significant funds to these poverty ridden populations in the form of care, research, and vaccines. Much of their focus is on HIV/AIDS treatment in addition to other conditions including malaria and TB. However, while reading Science I recently came across an open source drug design initiative based out of India.

A few years ago, Samir Brahmachari launched the Open Source Drug Discovery (OSDD) network. The initiative began in 2008 and set out to combat India’s leading cause of death, TB. The initial $12 million of seed money was provided by the Indian government and that has led to 5500 participants in 130 countries. So has this global network of researchers provided any results? Their first goal was to sequence the TB genome and the task was accomplished in a mere four months by 500 volunteers. Since then they utilized this information and have determined two viable drug candidates that are currently being tested. Following the principles of OSDD, the data from their clinical trials are open for all to see. It is too soon to tell if the drugs will be successful, but if so they will be on the market as generic drugs.

This approach could produce affordable health care and treatments for many without.

Science Quickies: The Ocean In Space, High Tech Cows, and Racism Drugs

10 Mar

The largest, oldest body of water has been discovered. It lives in space. No, seriously. Space has oceans now. Beachfront resorts are coming soon.

My thoughts and support are with Phumeza Tisile, a Doctors Without Borders tuberculosis blogger who received some bad news this week.

NPR reports on Claudia, the high tech cow who produces 75 gallons of milk a day, as opposed to the 30 gallons by a normal cow. Moo.

In blood news, scientists have examined the crystal x-ray structure of full length human plasminogen, which provides insight on activation and conversion to plasmin.

Bellicum Pharmaceuticals raises $20M to progress cell transplant and cancer vaccine products.  Further proof that all a research scientist has to do is walk into a room and say “cancer,” and money will be thrown at them.

The Journal of Microscopy is offering their first issue of 2012 free online.

Propranolol, a beta blocker which has made the news often with its effective anxiety treatment, “abuse” in the musical performance community as a “performance enhancer,” and promise as a memory erasing post-trauma drug, is back in the news again, with claims that it can cure racism.

Urgent Aid Needed for Myanmar

6 Mar

Medicins San Frontieres/Doctor’s Without Borders recently released a report called “Lives In The Balance,” calling for urgent funding and assistance in helping Myanmar close the devastating gap between people’s need and access to treatment for HIV and TB.


From the their website:
“Tens of thousands of people living with HIV and tuberculosis (TB) in Myanmar are unable to access lifesaving antiretroviral therapy, a dire situation exacerbated by the recent cancellation of a new round of funding from the Global Fund to Fight AIDS, TB, and Malaria.”

New Tuberculosis Center

3 Mar

ASCP Collaborates to Open New TB Testing Center in Swaziland

Tuesday, February 21, 2012

To combat the deadly combination of HIV/AIDS and tuberculosis (TB) decimating its population, a new TB testing center opened on Jan. 26, 2012, in Mbabane, Swaziland. It is a collaboration of ASCP, the U.S. Centers for Disease Control and Prevention (CDC), University Research Corporation, and Doctors Without Borders. The facility, with high technology laboratory equipment, access control, and computerized laboratory to match the requirements of the World Health Organization (WHO), is housed within the five-story National Reference Laboratory.

Swaziland has the world’s most severe HIV/AIDS epidemic, affecting 26.3 percent of its adult population between 15 and 29 years old and 15 percent of children under the age of 15. Due to their weakened immune systems, HIV patients are more vulnerable to TB. Health officials estimate 50 percent of Swaziland’s HIV patients also have TB.

“Correct diagnoses for specific types of tuberculosis are critical in order to treat Swazi patients correctly and efficiently, and turn the tide on this devastating epidemic,” said Dr. Blair Holladay, ASCP Executive Vice President. “Erecting the new TB testing facility finally allows for timely testing to assist these patients in need. Since TB—in all its forms—is highly contagious, laboratory professionals in Swaziland also have a much safer environment to conduct the tests and reverse the current paucity in testing.”

Additionally, a recent national survey about drug resistance in Swaziland revealed a high prevalence of multi-drug resistant (MDR) TB with new cases at 7 percent and re-treatment cases at 33.9 percent. MDR-TB is resistant to isoniazid and rifampicin, the two most powerful anti-TB drugs. Affected patients require extensive chemotherapy (up to two years in treatment) with second-line anti-TB drugs, which are more costly and produce more severe drug reactions.

The high prevalence of disease and deaths among adults in their productive working years poses a serious obstacle toward economic improvement for Swaziland. Between 1990 and 2007, the average Swazi life expectancy fell by half in great part due to the HIV/AIDS epidemic.

To help remedy this situation in 2009, the Government of Swaziland signed the Swaziland Partnership Framework on HIV and AIDS to be undertaken from 2009 to 2013. Established between the U.S. government and the Swazi Government for the President’s Emergency Plan for AIDS Relief (PEPFAR) programs, the Partnership Framework aims to provide a more sustainable approach to fighting HIV/AIDS and other diseases such as TB. The Framework focuses on five pillars: developing a comprehensive national HIV prevention program; improving the coverage and quality of HIV-related treatment and care; mitigating the impacts of HIV/AIDS with a focus on children; increasing access to high-quality medical care; and building the human and institutional capacity to achieve and sustain these goals.

Click here to read the original article, as well as learn more about ASCP.