Tuberculosis on the Rise: The Resurgence of the World's Deadliest Disease

Tuberculosis (TB), historically known as one of the deadliest infectious diseases, is experiencing a concerning increase worldwide. Despite being largely controlled in many developed countries, TB continues to claim over 3,400 lives daily, with over 1.3 million deaths reported in 2023 alone. This disease can attack not only the lungs but also spread to the brain, bones, kidneys, and lymph nodes through the bloodstream if untreated.

In the United States, TB is often perceived as a disease of the past, associated with romanticized images of individuals coughing blood into handkerchiefs. However, the reality is different; TB remains a public health challenge, especially as recent years have seen a resurgence. While control measures, including antibiotics like streptomycin, improved the situation in the mid-20th century, setbacks occurred during the AIDS epidemic and budget cuts in the 1980s. The COVID-19 pandemic further disrupted TB diagnosis and treatment, leading to a 7% annual rise in cases across the nation.

To combat this resurgence, Washington University in St. Louis has launched the MycoPRISM initiative, bringing together experts from diverse disciplines to study TB’s causes and develop new treatments. Alongside this, the university’s new School of Public Health aims to increase awareness, reduce stigma, and address social determinants contributing to TB infections.

Globally, TB continues to spread, with the World Health Organization reporting a record 8.2 million new cases in 2023—the highest in three decades. The disease often remains dormant in many individuals, but a compromised immune system can trigger active disease, which spreads effortlessly across borders.

One of the major challenges in controlling TB lies in its ancient, resilient nature. TB has co-evolved with humans for millennia, developing sophisticated defenses against immune responses. It spreads via airborne droplets, making it highly contagious. Moreover, the long and complex treatment regimens, often lasting six months or more, pose adherence challenges, leading to drug resistance and relapse.

Scientists like Christina Stallings are investigating how TB evades immune defenses. Her research shows that the bacteria’s waxy coating tricks immune cells called neutrophils into assisting its survival. Interestingly, drugs targeting these immune responses may offer new therapeutic avenues.

Other emerging threats include non-tuberculous mycobacteria like Mycobacterium abscessus, which affects vulnerable populations such as cystic fibrosis patients and is even harder to treat. Environmental reservoirs of these bacteria in water and soil are also being studied.

Strengthening immune responses is another research focus. Jennifer Philips is exploring how TB’s lipids interfere with macrophages—another immune cell type—and how T cells can be harnessed to improve resistance. Diagnostic developments, including blood tests, could revolutionize detection, making it easier to identify and treat infections early.

Public health efforts face hurdles, including stigma and adherence issues. Patients often hesitate to endure the lengthy treatment due to side effects and social stigma, compounded by a lack of effective vaccines for adults. Diagnosis is complicated by the disease’s variable presentations and the difficulty in detecting dormant bacteria.

Funding shortages, particularly after cuts by programs like USAID, threaten research and public health initiatives. This financial gap hampers development of new antibiotics, vaccines, and diagnostic tools. Past failures in shortening treatment durations highlight the need for continued research and investment.

In summary, TB remains a formidable global health challenge that requires renewed focus on vaccine development, innovative treatments, early detection, and addressing social determinants. Sustained scientific and public health efforts are crucial to prevent further resurgence and ultimately eliminate this ancient but adaptable disease.