Authors: L. Cedric Rolling, MD; Craig Oberg, PhD. Department of Microbiology, Weber State University.

Of all the diseases that I have studied and treated tuberculosis (TB) scares me the most. This is the most ancient and resilient disease known to humankind. Tuberculosis has infected humans on the Earth for over 3,000 years. At one time it was the leading cause of death in the United States and is currently the biggest infectious-disease killer in the world. In the year 2005, it was estimated that nine million people would be diagnosed with tuberculosis worldwide, two million of these were predicted to die from the disease and another forty million would be infected without knowing it. In Peru and developing countries TB is endemic. There are thousands of people inflicted with this disease. You as the reader might wonder why this should be important to know, the reason is this disease can be contracted very easily. On an airplane, in a supermarket, hotel, or anyplace where people are, you can contract TB.

My experience in Peru has opened my eyes to the world of TB. I have seen 20 year old males with TB die within 24 hours upon admission to the hospital. I have seen a 25 year old male with HIV and TB. I’ve seen a 68 year old with chronic TB spitting up 50 cc of blood every day. Tuberculosis is spread rather easily through direct or indirect contact with those who are infected. Usually it is transmitted through the air (infected people coughing or sneezing). The bacteria belongs to the group know as mycobacterium which causes tuberculosis. The bacterium is a very slow bacterium that divides every 16 to 20 hours, which helps the disease get established in people.



About one third of the world’s population is infected with tuberculosis. It is easily spread from person through aerosol droplets containing the bacterium from those with active tuberculosis. Close and prolonged contact with the infected individual is the highest risk in becoming infected with tuberculosis. This disease has a tremendous affect for people who are immunocompromised such as HIV, health care workers, and young children.
The transmission begins when the infected individual coughs, sneezes, or talks. The bacterium travels into the air, and then may be inhaled by an uninfected person. When tuberculosis bacteria are inhaled they are engulfed by macrophages, which are present in the air sacs of the lungs. Their job is to remove pathogens from the lungs. The bacteria then begin to multiply within the lungs, before spreading to other parts of the body. If the tuberculosis bacterium gets into the bloodstream the brain, liver, bones, joints or kidneys can all become infected.

There are two forms of tuberculosis: TB infection and TB disease. Only 10% of patients with tuberculosis infection develop tuberculosis disease or active TB. Most patients have an immune system capable of fighting the TB bacteria and stopping them from multiplying and spreading with the human body. About two weeks after becoming infected with TB, the immune system responds by walling off the infected cells. The bacteria are not killed, but become dormant and are stored inside the body.
Antibiotics are used to treat both active and latent TB. Treatment for active tuberculosis may include taking four medicines: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. Active TB is usually treated with six to nine months of multiple antibiotics. During the long treatment process one may become lazy in taking their meds or think it’s not necessary after symptoms disappear. However, if one does not finish treatment or misses doses, TB may still be present even if symptoms are not. This may leave the stronger bacteria to multiply and an entire new generation of drug-resistant bacteria to grow. “Patients with drug-resistant tuberculosis are four times more likely to die than patients with standard tuberculosis.” It is imperative that once treatment has begun the patient stays on his medications. Doctors are even using “direct observational treatment.” This may include daily visits to the physician to take your medicine under observation to ensure the patient is following medication instructions. Surgery may also rarely be used to treat complications of TB. Surgery may repair lung damage or remove pockets of bacteria that cannot be killed.

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Patients with latent TB may be treated with antibiotics to keep from developing active TB. Their antibiotic regimen may include just one or two different medicines. TB is easier to treat in the latent state and in some opinions should be the focus of eradicating the disease. Vaccines are used in many parts of the world but are discouraged in the United States, because people who receive the vaccine test positive for tuberculosis. This positive test eliminates early diagnostic testing, when the disease is treated easier. Other possible vaccinations are being explored including one using gene therapy to boost the immune system and its defenses.

Travel and immigration make tuberculosis the world’s problem. My experience in Peru and the magnitude of TB and the effects it has on other South American, Central American and Caribbean countries is staggering. The shear impact is not just on treating people but the effect TB has on the economy of these areas due to lost days of work and productivity. If we have an aggressive program for education and prevention of TB maybe we can improve the standard living conditions in these societies. Maybe one day this nightmare disease will be a distant memory. One of my colleagues who is an emergency one doctor at EsSalud hospital in Iquitos has had three of his classmates from medical school die from TB. These were educated professionals and had full medical treatment. TB is the nightmare for the ages unless we developed a very effective prevention and educational program that is administered world wide. I believe we are losing because it is a silent and hidden disease.

tags : Peru Iquitos health medicine Tuberculosis vaccination Aids HIV

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17 Comments

# Maryann Lickliter says :
5 June, 2007 [ 11:57 ]

I am planning a trip to Peru on Sunday June 10th. Is there some specific way I should prepare for this trip to be the safest fro contacting TB?

# Marcia Pasternak says :
17 June, 2007 [ 07:11 ]

Vitamin D is the best defense and treatment for TB. Cod liver oil is a good source for Vitamin D. Direct sunlight is good also.

# Brad Wynn, OMS IV says :
8 August, 2007 [ 03:57 ]

I am very shocked and interested by the comment above by Marcia Pasternak, I never knew that something as simple as Vitamin D was so powerful. Amazing. 
    According to published standards based on the American Thoracic Society and Infectious Diseases Society of America, along with the CDC, Treatment of Tuberculosis (TB) can be acheived only after a 6 month  regimen, consisting of a 2 month course of daily antibiotics - Isoniazid, Rifampin Pyrazinamide and Ethambutol, followed by 4 months of treatment with Isoniazid and Rifampin.  TB strains that are resistant as mentioned in the article above will require different treatment approaches of varying duration and drug selection.  Prevention is a difficult matter, your best defense is using an approved respiratory mask any time you may be in contact with persons infected with TB.  In the U.S. there are extensive programs in place to ensure that individuals are tested for TB so drug treatment can be initiated soon after contracting the disease.  Airborne isolation and early treatment for individuals with the disease is one of the best preventive measures.

# Jason McMillin says :
26 January, 2008 [ 05:10 ]

I'm not sure I would believe anything this quack says. Why does he claim to be a medical doctor when he is a podiatrist that lost his license to practice in Missippi? Just Google his name. I friend of mine that goes to Salt Lake Community College told me about this nut.

# Kamille Ann Cruz says :
11 March, 2008 [ 09:10 ]

what do you think is the best way or thing to do when the country is under that disease?
or maybe a person can encounter that?
or when a person has already have?
i can't believe that vitamins can help to prevent the diseases. i think

# amita achrekar says :
4 April, 2008 [ 03:40 ]

Hello
my brother is suffering from tb and doc said his boths lungs has damaged fully so what r the chances of his surival

regds
amita

# Abigael An says :
10 April, 2008 [ 12:22 ]

hi amita . he has chances to survive just tell him to continue the medicines everyday.. dont miss to drink.. and follow what the doctors instructions.. no smoke.. no alcohol.. more rest... eat healthy foods.. no stress.. and sleep early... im suffering oftb right now.. but the good thing is im in a stage 1... so all i feel is chest and back pain.. always.. but im following what my doctors instructions so.. so far.. so good.. tb can be cure but you can die in this sickness too.... actually i always feel i cant breath.. but im lucky coz thats the only thng i can feel.. so for guys out there that doesnt have tb.. be careful when someone is coughing sneezing around you.. might get this sickness too.. especially when u dont have a good health..  

# Jason martin says :
21 April, 2008 [ 04:26 ]

very  good information. i would love to help the people around the world. we need to do somthing because this disease is a killer. We need have a better understanding of the problem...keep up the good work....

# meg jensen says :
21 April, 2008 [ 04:50 ]

a good article dr rolling.  we need more people like you in the world. its sad....

# Thomas Jones says :
21 April, 2008 [ 04:58 ]

dr rolling  Iam in your Tropical medicine class. Thanks for the information on TB. I look forward to going on one of your trips to the jungle. I cannot wait to come into your world and a make difference. Most people are cowards.  Like you said,,,, if you cannot keep up don't step up. To see a person with this disease is like looking at your soul, I cannot believe how small we are, when it comes to TB

# HARDEV SINGH MINHS says :
10 June, 2008 [ 04:41 ]

# Olan Meteoro says :
11 June, 2008 [ 06:54 ]

a person with a minimal ptb?? can they easily be cured?? how long and what medications and vitamins should they take??

# Vidya Narayan says :
30 June, 2008 [ 03:37 ]

I am a core medical trainee in the UK and am very keen to pursue my interest in Infectious diseases, i would like to know if it is possible to do an attachment in tropical or infectious diseases in peru. I can manage upto 3 weeks from my employment to go out and get some overseas experience.
Could you please tell me whom to approach to organise this.

# Jason McMillin says :
4 August, 2008 [ 02:02 ]

Why does this man think he is a doctor? Does he have a valid medical practice in the United States? Or is he just taking advantage of people in countries that don't know he doesn't have a valid medical license? I almost had to take a class from him at SLCC, but luckily I was able to fit the same bio class with another teacher into my schedule. My friend took a class from this quack at Salt Lake Community College and he could go on for hours about how unprofessional this guys is. I'd like to meet him some day and ask him if he is really trying to save the world or just serve is own agenda.

http://www.msbml.state.ms.us/boardactionreportnarr2004.htm

October 15, 2004

Lane Cedric Rolling, D.P.M.

Jackson, MS

License revoked.

# Jason McMillin says :
4 August, 2008 [ 02:10 ]

Oh and for those of you from the UK or outside the USA, D.P.M. stands for doctor of podiatric medicine aka foot doctor. They can only practice medicine below the knee (if they have a valid license). Why does this fool think he knows about tuberculosis? He must have done a lot of web browsing. I googled the Oberg guy who co-autored this article. He seems  to be a legit microbiology PhD at weber state. Maybe he wrote the whole article. He probably knows a lot more about TB than this quack.

# Jason McMillin says :
4 August, 2008 [ 02:15 ]

# Jason McMillin says :
4 August, 2008 [ 02:19 ]

I also found this on:

https://secure.utah.gov/llv/llv

Details for LANE CEDRIC ROLLING

License Information
Name:	LANE CEDRIC ROLLING
City, State, Zip:	EDEN, UT 84310
Profession:	PODIATRIC PHYSICIAN
License Type:	PODIATRIC PHYSICIAN
License Number:	501075-0501
Obtained By:	ENDORSEMENT
License Status:	EXPIRED
Status Change Reason:	FAILURE TO FILE RENEWAL
Original Issue Date:	01/20/2000
Expiration Date:	09/30/2006
Disciplinary Action:	NONE
Docket Number:	N/A

It looks like he lost his license in utah as well.

Also be sure to check out this:

http://www.ratemyprofessors.com/ShowRatings.jsp?tid=846837

1/19/08	BIOL1610	3	1	2	5				Dr. Rolling..err..should I say license revoked "Dr."? The first week of the semester he was absent due to the fact he was in Peru conducting various surgeries. He's not licensed to practice in Utah bc failure to renew .https://secure.utah.gov/llv/llv He talks over you while you're asking a question. He says "tostesterone". Pretentious, and rude.
5/31/06	MICR 1113	5	2	2	4				The only thing i learned in this class was how 409 is the devil himself. You will learn noting about micro if you take it, you will laugh alot and get an A but you will learn nothing
5/17/06	Intro to M icro	5	2	1	1				If you want an easy A, take him. If you want to actually learn something, run like hell in the opposite direction. Vague, unclear, and sometimes innacurate. Very funny and entertaining guy, but I really question whether he bought his degree off the internet or something. Made the exams take home and way too easy. Very disappointing.

I'm not sure I would dare go into the jungle with this loony quack.

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