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Life sciences research project on evolution of mycobacterium tubercolosis.

life sciences research project on evolution of mycobacterium tubercolosis.

Nhlohletelo Maluleke

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INTRODUCTION

“Dad always thought laughter was the best medicine, which I guess is why several of us are dying from tuberculosis” – Jack Handey. The previously curable Tuberculosis disease is now slowly evolving to drug resistant TB.

Bacteria is said to be the longest existing microorganism dating back from 3.2 billion years ago as a prokaryote. Some bacteria can be good but some can be pathogenic. The mutation success or failure of the bacteria is fully dependant on its ability to reproduce and overcome new host cell. A lot of pressures also play a role in the success of pathogens such as the hosts immune system, if the immune system is strong, the bacteria would remain dormant. Whereas if the immune system is weak then the host will become infected. Another pressure is the environmental resource limitations as well medical interventions such as antibiotics which has led to evolution of pathogens to form a asymmetric attack and defence strategy. This entails that as the host evolves to be able to defend itself from specific pathogen then the pathogen will also evolve and adapt to new heightened defences and now the host will need to evolve once again and thus a cycle is formed. Those that can adapt during these cycles are more likely to pass gene coding to the next generation thus showing that evolution happens with intent to select arm’s race and leave the best alleles (one or two or more alternatives of a gene that arise by mutation).

When tuberculosis was initially discovered by Robert Koch in 1882, it was identified as a disease that causes fatigue, chills, fever, loss of appetite, unexpected weight loss, chest pain and coughing (with blood) for more than 3 weeks. The disease caused by mycobacterium used to kill one out of every 7 people in the population in 1882. By 2016, this exponentially escalated to 1.3 million cases of deaths caused by TB and an estimate of 558000 have resistant TB.

Drug resistant TB seems tu-be-close-[to]-us in fact it is here. It is caused by patients not using medication appropriately or not finishing course or using no treatment at all (because they have not been scanned). This means that the average antibiotics become ineffective in the patients and while this drug resistant inevitably continue to mutate, they will spread this TB to other people now causing for scientists to investigate for new forms of TB which will cost more money for the government.

MDR-TB (multi drug resistant TB) needs to be researched in other to find out how is evolves as well as medication to cure because if not, it will become the silent killer. WE BEAT TB.

HISTORY

· Bacteria was around 3 billion years prior to discovery (source cdv.org)

· Tuberculosis was first named ‘phthisis’ in Ancient Greek and commonly called tabes in Rome, further more called ‘scachepheth’ in ancient Hebrew. (Cdv.org)

· Was formally named in 1834 by Johann Schonlein (cdv.org)

· Tb in humans originally dates back to 9000 years in Atlit Yam (now swallowed by Mediterranean Sea). History.org

· Archaeologists discovered a tb infected mom buried with her son in areas surrounding Neolithic. (history.org)

· Archaeologists have found thousands of bodies buried and the bones of these had lesions which implies that homo erectile fossils from 500000 years ago suffered from TB. (the guardian)

· The discovery of the earliest human form of tuberculosis was found in bones buried in the coast of Israel. Examination of this ancient DNA confirms the latest theory that bovine TB (slow-growing tuberculosis in cattle and can also infect humans and other species.) evolved later than human TB (science daily)

· About 40000 years ago, mycobacterium caused a population bottle (a sudden rapid reduction of population) towards Homo sapiens sapiens, causing this species to flourish outside of Africa

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· In 1720, the infectious origin of TB was discovered by an English physician Benjamin Marten, while the first successful cure or treatment against TB was the introduction of the sanatorium cure. scientist Robert Koch was able to isolate the tubercle bacillus and presented this remarkable result to the society of Physiology in Berlin on 24 March 1882. Pioneer to pharmacy (ncbi-Nhi)

· Approximately around 1860 there had been outbreaks of TB in places like Butterworth and Queenstown, trading or missionary. It was in such places that the African population came into close contact with white settlers and began to contract diseases that weren’t initially there. These outbreaks were however isolated and the disease did not spread. (tbfacts.org)

· The earliest evidence of American tuberculosis has come from mummified remains from the first millennium recovered at the costal site of Caserones in the Atacama Desert of northern Chile. (history.org)

RELATIONSHIP BETWEEN MYCOBACTERIUM AND HUMANS

· [bookmark: _Hlk536754463]If the immune system of a person who came in contact with TB is strong enough, the infection is contained and walled off by a fibrous capsule in which the bacteria will remain dormant (mind action series)

· If the immune system is not strong enough the bacilli can multiply further and within 4 to 6 weeks the individual will be ill. (mind action series)

· People who live in poor crowded areas have a higher chance of getting TB because should a person be infected, they have a bigger crowd that can get it. (mind action series)

· [bookmark: _Hlk536754631]People with diabetes mellitus, HIV, head or neck cancer, Hodgkin’s disease or leukaemia will have a weakened immune system meaning they are more are prone to getting it should they come in contact with an infected person. (www.nationaljewish.org)

· All HIV positive should be followed up on every 3 months and should be educated about symptoms so they can go to clinic should they be symptomatic.

· Some medical treatments such as corticosteroids or treatments used for rheumatoid arthritis weaken the immune system thus more prone to getting it should they be in contact with TB. (www.nationaljewish.org)

· TB has been labelled a disease of poverty and poor areas are less developed and less educated thus meaning they do not know the dangers of not taking care of one self thus malnutrition and overcrowding play a role. . (www.nationaljewish.org)

· People who are not aware of their TB status contribute to the high TB because should they be infected, they will not get treated and if they are not infected, they will not get vaccinated. (mind action series)

· Keeping in mind that our bodies are the host cell so these pathogens infect our bodies in order to get food and in the process, they destroy body cells, release toxins and absorb material directly from our body. (mind action series)

· People infected may not be able to work at optimum level meaning they won’t be able to provide for their families or afford medication. (socialTB.org)

· Poor relations between patients and health care professionals who are unempathetic can contribute to poor adherence of medication course of patient

· Patient adherence to medication can be worsened when the patient is homeless or is alcoholic or has a drug problem and access to health care is not compromised.

· Insufficient follow up on MDR causes the spread which means more people have to treated for resistant TB

Drug Resistant TB

· To prevent the TB from being resistant DOTS (directly observed Therapy, short course) was created. (mind action series)

· MDR-TB emerged in south Africa around the 1980s (history of TB in south Africa)

· Costs more for the government to treat

SPREAD

A Graph showing the number of citizens that have standard TB or MDR-TB in different countries.

The developed countries (Europe) in effect has the least TB rates due to more medication and the people are literate and well-educated about TB and medicine adherence. Whereas countries such as a China that are still developing have very high TB due to lack of proper health care and education and also they are overcrowded thus spreading the disease is easier.

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Technology:

1. Clemens von Pirquet developed a skin where she put a tuberculin under the skin and observed the bodies reaction . (cdv.org)

1. Charles Mantoux updated this test bus using a needle to insert the tuberculin. (cdv.org)

1. Today we use both the skin test and blood tests

1. [bookmark: _Hlk536755177]Scientists from America and south Africa collaborated to form a new test that determines the presence of TB by the brightness of red blood cells when trehalose is added the blood sample with fluorescent. (healthcareinamerica.us)

1. a new invention is putting a microchip inside the anti Tb drugs that will measure the levels of the drug in a person’s system in near real-time allowing paperless access to their patient’s drug taking behaviour. (health-e.org.za)

1. the introduction of new technology has reduced the time intervals of diagnosing MDR-TB and RR-TB. All MDR-TB patients my be reported to NHLS within 24 hours of diagnosis and treatment must commence with 5 days after diagnosis.

Present and past

1. they are looking at more ways to treat TB most cost effectively (tbfacts.org)- drug resistant TB is very expensive to treat and requires a lot of research because it is constantly evolving to suit the new defence mechanisms.

1. tuberculosis diagnostics reinvented – initially in 1882, diagnosing TB entail putting special paper under your skin thus meaning and the colour the paper turned would show whether you infected or not. Today they are looking at machines that can detect the TB accurately in less than an hour. (healthcareinamerica.us)

1. diagnostics of latent infection. (healthcareinamerica.us)

1. antituberculotic drug discovery

1. vaccines have now been invented such as BCG vaccine and use of mobile clinics to vaccinate children at schools. (healthcareinamerica.us)

1. TB preventative therapy for asymptomatic patients of MDR-TB. HIV-infected children should begiven INH preventative therapy regardless of tuberculin response.

climate change and TB

· Droughts and lack of food may cause poor communities to have weakened immune system making them vulnerable to TB. (www.gyanvihor.org)

· Change in climate causes change in UV thus causing more weakened immune system

· When it is more humid, TB can be transported easier through the air making it dangerous

· In very hot areas Tb can flourish and infect other people

In conclusion, the evolution of mycobacterium tuberculosis from treatable TB to drug resistant TB is a threat to how medicine is currently being practiced. Often when a patient is screen for this more advanced TB, they might have already a relative amount of disability (not the average routine) and the help or therapy they can be offered is very limited. It is important to do more research on Tb because every time a new antibiotic is created, resistance quickly follows, so without a broad understanding of how it evolves we are doomed to repeat past failures.

REFERENCES

· “Basic TB Facts”. CDC. 13 March 2012. Archived from the original on 6 February 2016. Retrieved 11 February 2019.

· P Cegielski, “The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals”, Int. J. Tuberc. Lung Dis. 2004;8:286-98 RETRIEVED 8 february 2019

· –18. Archived from the original on 4 August 2010.Retrieved 13 february 2019..

· ^ Hawn TR, Day TA, Scriba TJ, Hatherill M, Hanekom WA, Evans TG, Churchyard GJ, Kublin JG, Bekker LG, Self SG (December 2014). “Tuberculosis vaccines and prevention of infection”. Microbiology and Molecular Biology Reviews. 78 (4): 650–71. doi:10.1128/MMBR.00021-14. PMC 4248657. Retrived 13 february 2019

· ^ Harris, Randall E. (2013). Epidemiology of chronic disease: global perspectives. Burlington, MA: Jones & Bartlett Learning. p. 682. ISBN 978-0-7637-8047-0. 8 february 2019

· [bookmark: _Hlk1010310]^ Jump up to:a b Organization, World Health (2008). Implementing the WHO Stop TB Strategy: a handbook for national TB control programmes. Geneva: World Health Organization. p. 179. ISBN 978-92-4-154667-6.retrieved 8 february 2019.

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· ^ Jump up to:a b “Tuberculosis”. World Health Organization. 2002. Archived from the original on 8 february 2019.

· Jump up to:a b c d e f g h i j k l m n o Kumar V, Abbas AK, Fausto N, Mitchell RN (2007). Robbins Basic Pathology (8th ed.). Saunders Elsevier. pp. 516–22. ISBN 978-1-4160-2973-1. retrieved 8 february 2019.

· Lawn SD, Zumla AI (July 2011). “Tuberculosis”. Lancet. 378 (9785): 57–72. doi:10.1016/S0140-6736(10)62173-3. PMID 21420161.

· Schiffman, G (15 January 2009). “Tuberculosis Symptoms”. eMedicine Health. Archived from the original on 12 feb 2019

· Njie, GJ; Morris, SB; Woodruff, RY; Moro, RN; Vernon, AA; Borisov, AS (August 2018). “Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis”. American Journal of Preventive Medicine. 55 (2): 244–52. doi:10.1016/j.amepre.2018.04.030. PMC 6097523. PMID 29910114. 29 January 2019

· ^ Menzies D, Al Jahdali H, Al Otaibi B (March 2011). “Recent developments in treatment of latent tuberculosis infection”. The Indian Journal of Medical Research. 133 (3): 257–66. PMC 3103149. PMID 21441678.

· ^ Arch G.; III Mainous (2010). Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance. Totowa, NJ: Humana Press. p. 69. ISBN 978-1-60327-238-4. Archived from the original on 6 September 2015.

· ^ Jump up to:a b c Karumbi J, Garner P (May 2015). “Directly observed therapy for treating tuberculosis”. The Cochrane Database of Systematic Reviews (5): CD003343. doi:10.1002/14651858.CD003343.pub4. PMC 4460720. PMID 26022367. 8 feb 2019

· ^ Liu Q, Abba K, Alejandria MM, Sinclair D, Balanag VM, Lansang MA (November 2014). “Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment”. The Cochrane Database of Systematic Reviews (11): CD006594. doi:10.1002/14651858.CD006594.pub3. PMC 4448217. PMID 25403701. 8 feb 2019

· ^ O’Brien RJ (June 1994). “Drug-resistant tuberculosis: etiology, management and prevention”. Seminars in Respiratory Infections. 9 (2): 104–12. PMID 7973169. Njie, GJ; Morris, SB; Woodruff, RY; Moro, RN; Vernon, AA; Borisov, AS (August 2018). “Isoniazid-Rifapentine for Latent Tuberculosis Infection: A Systematic Review and Meta-analysis”. American Journal of Preventive Medicine. 55 (2): 244–52. doi:10.1016/j.amepre.2018.04.030. PMC 6097523. PMID 29910114. 8 feb 2019

· ^ Menzies D, Al Jahdali H, Al Otaibi B (March 2011). “Recent developments in treatment of latent tuberculosis infection”. The Indian Journal of Medical Research. 133 (3): 257–66. PMC 3103149. PMID 21441678. 8 feb 2019

· ^ Arch G.; III Mainous (2010). Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance. Totowa, NJ: Humana Press. p. 69. ISBN 978-1-60327-238-4. Archived from the original on 29 January 2019.

· ^ Jump up to:a b c Karumbi J, Garner P (May 2015). “Directly observed therapy for treating tuberculosis”. The Cochrane Database of Systematic Reviews (5): CD003343. doi:10.1002/14651858.CD003343.pub4. PMC 4460720. PMID 26022367. 29 January 2019

· ^ Liu Q, Abba K, Alejandria MM, Sinclair D, Balanag VM, Lansang MA (November 2014). “Reminder systems to improve patient adherence to tuberculosis clinic appointments for diagnosis and treatment”. The Cochrane Database of Systematic Reviews (11): CD006594. doi:10.1002/14651858.CD006594.pub3. PMC 4448217. PMID 25403701.

· ^ O’Brien RJ (June 1994). “Drug-resistant tuberculosis: etiology, management and prevention”. Seminars in Respiratory Infections. 9 (2): 104–12. PMID 7973169.29 January 2019

· ^ Centers for Disease Control and Prevention (CDC) (March 2006). “Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs – worldwide, 2000–2004”. MMWR. Morbidity and Mortality Weekly Report. 55 (11): 301–05. PMID 16557213. Archived from the original on 29 January 2019.

· ^ Jump up to:a b Maryn McKenna (12 January 2012). “Totally Resistant TB: Earliest Cases in Italy”. Wired. Archived from the original on 14 January 2012. Retrieved 12 January

· ^ Centers for Disease Control and Prevention (CDC) (March 2006). “Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs – worldwide, 2000–2004”. MMWR. Morbidity and Mortality Weekly Report. 55 (11): 301–05. PMID 16557213. Archived from the original on 8 february 2019

· ^ Jump up to:a b Maryn McKenna (12 January 2012). “Totally Resistant TB: Earliest Cases in Italy”. Wired. Archived from the original on 14 January 2012. Retrieved 30 anuary

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Standard TB south africa china south america europe 322000 570000 277000 192000 MDR-TB south africa china south america europe 108000 57000 94000 63000 Column2 south africa china south america europe

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