What is the history of tuberculosis?

History of Tuberculosis

Tuberculosis has coexisted with humans for more than 40,000 years, evolving from a devastating epidemic to a manageable disease through scientific discoveries, public health measures, and effective treatments. 1

Ancient History and Early Recognition

• Evidence of tuberculosis (TB) has been found in human skeletons dating back to 5000 BC 1
• Early descriptions of TB appear in ancient writings from India, China, and in the Bible 1
• In ancient Greece, TB was not considered contagious, though Aristotle recognized the contagious nature of scrofula (TB of the lymph nodes) in animals 1
• The Arabian physician Avicenna first suggested the contagious nature of TB and proposed isolation to reduce transmission in his work "The canon of medicine" 1

Middle Ages to 18th Century

• During the Middle Ages, scrofula (TB affecting cervical lymph nodes) emerged as a recognized clinical form of TB 2
• The disease was known as "king's evil" in England and France, with the belief that a royal touch could heal afflicted persons 2
• In 1699, the Health Council of the Republic of Lucca established the first "sanatorium" concept for care and isolation of TB patients 1
• By the 18th and 19th centuries, TB reached epidemic proportions in Europe and North America, earning the name "Captain Among these Men of Death" 3

19th Century: Scientific Breakthroughs

• Théophile Laennec advanced the understanding of TB pathogenesis in the early 19th century 3
• In 1865, Jean-Antoine Villemin demonstrated the transmissibility of TB infection 3
• The infectious origin of TB was first proposed by English physician Benjamin Marten in 1720 2
• The most significant breakthrough came on March 24,1882, when Robert Koch announced the discovery of Mycobacterium tuberculosis as the causative agent of TB 1, 3
• In the same period, Rudolf Virchow improved awareness of risk factors and preventive behaviors among the general population 1

Early 20th Century: Diagnosis and Treatment Advances

• Clemens von Pirquet developed the tuberculin skin test in 1907 and demonstrated latent TB infection in asymptomatic children three years later 3
• The sanatorium movement expanded, providing rest therapy supplemented with pulmonary collapse procedures 3
• BCG (Bacillus Calmette-Guérin) vaccination was widely employed following World War I 3
• Public health measures to combat TB spread emerged following Koch's discovery of its bacterial cause 3

Modern Era of TB Treatment (1940s onward)

• The modern era of TB treatment began with the discovery of streptomycin in 1944 3, 4
• However, drug resistance appeared rapidly after streptomycin's introduction 1
• Para-aminosalicylic acid, discovered in 1945, when combined with streptomycin greatly reduced drug resistance 4
• In 1952, Selman Waksman won the Nobel Prize for discovering streptomycin, the first active drug against TB 1
• Isoniazid, discovered in 1952, opened the modern era of treatment as it was inexpensive, well-tolerated, and safe 4
• Ethambutol replaced para-aminosalicylic acid in the early 1960s due to better tolerability 4
• Rifampin became a keystone in TB therapy in the 1970s, enabling treatment reduction to nine months 4
• The addition of pyrazinamide to first-line regimens further reduced treatment duration to six months 4

Recent Developments and Current Challenges

• After decades of decline, TB experienced a resurgence in the 1980s-1990s due to the HIV epidemic, deteriorating social conditions, and emergence of drug resistance 5
• From 1985-1991, reported TB cases in the US increased by 18%, representing approximately 39,000 more cases than expected 5
• Multidrug-resistant TB (MDR-TB) emerged as a serious concern, with outbreaks occurring in institutional settings 5
• In response, substantial resources were invested at national, state, and local levels to rebuild TB control infrastructure 5
• These efforts resulted in a 44% decrease in TB incidence in the US from 1993-2003 5
• Recent advances include new drugs (bedaquiline, delamanid, and pretomanid) and promising clinical trials for shorter treatment regimens 5
• Despite progress, TB remains a global health challenge with an estimated 10.6 million new cases in 2021 5

Ongoing Challenges in TB Control

• Drug resistance remains a significant challenge in TB treatment worldwide 1
• The goal of TB elimination in the US has been reaffirmed, though at current rates of decline, elimination could take 70+ years 5
• Future research aims to individualize regimens while preventing drug resistance and ensuring affordable, patient-centered access to new treatment options 5