Tuberculosis
Skeletal remains from 4000 BC show tubercular decay in the spines of prehistoric humans. Researchers have found similar decay in Egyptian mummies dating from 3000 to 2400 BC. Genetic studies suggest TB-like bacteria existed in Southern America around AD 140. Hippocrates wrote about phthisis, a disease resembling tuberculosis, around 400 BCE. The Vedas composed between 1500 and 1200 BCE refer to yaksma, which is generally equated with tuberculosis. Evidence of tuberculosis has been found in prehistoric human remains across Europe, Africa, Asia, and the Americas. These earliest findings date back approximately 10,000 to 11,000 years ago. Phylogenetic analysis indicates that ancestors of the tuberculosis bacterium adapted to human hosts in Africa around 70,000 years ago. The pathogen spread globally as humans migrated out of Africa. In the 1800s, consumption caused nearly one quarter of all deaths in Europe. By 1918, tuberculosis still accounted for one death in six in France.
Richard Morton established the pulmonary form associated with tubercles as a pathology in 1689. Benjamin Marten conjectured in 1720 that consumptions were caused by microbes spread by people living close together. René Laennec claimed that tubercles were the cause of pulmonary tuberculosis in 1819. J. L. Schönlein first published the name tuberculosis in 1832. Jean Antoine Villemin demonstrated that tuberculosis could be transmitted from humans to animals in 1865. Robert Koch identified and described the bacillus causing tuberculosis on the 24th of March 1882. He was awarded the Nobel Prize in Physiology or Medicine in 1905 for this discovery. World Tuberculosis Day is marked annually on the 24th of March to commemorate Koch's announcement. Koch announced a glycerine extract called tuberculin in 1890 as a remedy, though it proved ineffective. The extract was later successfully adapted as a screening test for pre-symptomatic tuberculosis. In 1913, the Medical Research Council formed in Britain initially focused on tuberculosis research. Two principal tests exist today: interferon-gamma release assay of a blood sample and the tuberculin skin test.
Between 1838 and 1845, John Croghan brought people with tuberculosis into Mammoth Cave hoping the constant temperature would cure them. Each person died within one year despite the cave environment. Hermann Brehmer opened the first TB sanatorium in 1859 in Görbersdorf, now Sokołowsko, in Silesia. Even under the best conditions at these facilities, 50% of those who entered died within five years by 1916. Albert Calmette and Camille Guérin achieved the first genuine success in immunization against tuberculosis in 1906 using attenuated bovine-strain tuberculosis. This became known as bacillus Calmette-Guérin or BCG. The vaccine was first used on humans in 1921 in France but gained widespread acceptance only after World War II. In 1946, the development of streptomycin made effective treatment and cure of tuberculosis a reality. Prior to this medication, the only treatment involved surgical intervention like the pneumothorax technique which collapsed an infected lung. By the 1950s, mortality in Europe had decreased about 90%. Improvements in sanitation and vaccination began reducing rates even before antibiotics arrived.
The World Health Organization estimates that roughly one quarter of the world's population carry infection with Mycobacterium tuberculosis. New infections occur in about 11 million people each year according to WHO data. Approximately 87% of new TB cases occur in 30 high burden countries including Bangladesh, China, India, Indonesia, Nigeria, Pakistan, and the Philippines. In 2024, tuberculosis newly infected 10.7 million people and caused 1.23 million deaths. It is now the leading cause of death from an infectious disease globally. People living with HIV are estimated 16 times more likely to fall ill with tuberculosis than those without HIV. Sub-Saharan Africa has a particularly high burden of HIV-associated tuberculosis. In 2023, 6.1% of those becoming infected with tuberculosis were also infected with HIV. Lesotho has an estimated 664 new infections per 100,000 population in 2023. This compares favorably with the figure of 1,184 in 2010 but remains one of the highest incidence rates globally. A major factor there is the extremely high prevalence of HIV in the adult population around 23%. Globally, indigenous peoples face disproportionately higher rates. Australian Indigenous populations have rates more than four times those of non-Indigenous Australians.
The World Health Organization declared tuberculosis a global health emergency in 1993. The Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aimed to save 14 million lives between its launch and 2015. Many targets set by this plan were not achieved due to increased HIV-associated tuberculosis and multi-drug resistant strains. In 2014, the WHO adopted the End TB strategy which aims to reduce TB incidence by 80% and deaths by 90% by 2030. By 2020 only a 9% reduction in incidence per population was achieved globally. The European region achieved 19% reductions while the African region achieved 16% reductions. Similarly, the number of deaths fell by 14%, missing the 2020 milestone of a 35% reduction. In 2012, the WHO, Bill and Melinda Gates Foundation, and US government subsidized Xpert MTB/RIF for use in low and middle income countries. This rapid molecular test provides results in about two hours compared to traditional culture methods taking weeks. The DOTS program implemented by member nations led to significant reductions in incidence and mortality by improving case detection.
Tuberculosis has been known as consumption since the nineteenth century and was also called the white death. Major artistic figures including poets John Keats, Percy Bysshe Shelley, and Edgar Allan Poe either had the disease or were surrounded by people who did. Composer Frédéric Chopin and playwright Anton Chekhov also suffered from tuberculosis. Thomas Mann wrote The Magic Mountain set in a sanatorium. Van Morrison released a song titled T.B. Sheets. Puccini composed La bohème and Verdi created La Traviata featuring characters with the illness. Edvard Munch painted The Sick Child depicting his sister Sophie who died of tuberculosis when he was 14. His mother also died of the disease. In 19th century New England, tuberculosis deaths were associated with vampires because infected family members lost health slowly after one person died. Between 42% and 82% of people with tuberculosis report experiencing stigma depending on the setting. Studies in Ghana found individuals with TB may be banned from attending public gatherings. In India, people with tuberculosis may lose their job or be unable to marry due to discrimination.
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Common questions
When did tuberculosis first appear in human history?
Evidence of tuberculosis has been found in prehistoric human remains across Europe, Africa, Asia, and the Americas dating back approximately 10,000 to 11,000 years ago. Skeletal remains from 4000 BC show tubercular decay in the spines of prehistoric humans.
Who discovered the bacterium that causes tuberculosis?
Robert Koch identified and described the bacillus causing tuberculosis on the 24th of March 1882. He was awarded the Nobel Prize in Physiology or Medicine in 1905 for this discovery.
What is the current global death toll from tuberculosis in 2024?
In 2024, tuberculosis newly infected 10.7 million people and caused 1.23 million deaths. It is now the leading cause of death from an infectious disease globally.
How does HIV affect the risk of developing tuberculosis?
People living with HIV are estimated 16 times more likely to fall ill with tuberculosis than those without HIV. In 2023, 6.1% of those becoming infected with tuberculosis were also infected with HIV.
When did effective treatment for tuberculosis become available?
In 1946, the development of streptomycin made effective treatment and cure of tuberculosis a reality. Prior to this medication, the only treatment involved surgical intervention like the pneumothorax technique which collapsed an infected lung.