Tuberculosis, once considered a disease in decline, shows alarming signs of resurgence across America and worldwide. Recent outbreaks, including a significant cluster in Kansas affecting 147 people, raise questions about why this ancient lung disease continues to threaten public health despite modern medicine.

While the 20th century saw significant advances in controlling TB, recent years have brought a troubling resurgence of cases worldwide and in the United States. This trend prompts a re-evaluation of current control strategies and highlights the need for effective public health interventions. Historical names for TB, such as “white death,” emphasize its devastating impact before effective treatments were available. The resurgence of TB indicates a potential decline in factors that previously helped control it or new challenges facilitating its spread. 

Notably, TB was the second leading infectious cause of death during the early years of the COVID-19 pandemic, reinforcing its status as a critical global health crisis that requires ongoing attention and resources.

What Defines Tuberculosis?

Tuberculosis, caused by Mycobacterium tuberculosis, primarily affects the lungs but can attack other body parts. People with active TB often develop persistent coughs, chest pain, weight loss, fever, and night sweats. Without proper treatment, active TB can prove fatal.

Medical historians found evidence of tuberculosis dating back 9,000 years. Ancient physicians like Hippocrates called it “phthisis,” meaning progressive wasting away – a reference to how patients became increasingly emaciated as the disease progressed.

From “consumption” to “white plague,” historical names reflected visible symptoms and almost certain death, caused by untreated TB. Among the most colorful historical terms was “king’s evil,” describing a form causing neck swelling once believed curable by royal touch.

How TB Spreads Among Communities

Mycobacterium tuberculosis travels through the air when infected persons cough, speak, sing, or sometimes even breathe normally. Each untreated patient potentially infects 10-15 others through microscopic droplets carrying bacteria.

Kansas officials still search for the origin of the current outbreak, which disproportionately affects low-income communities. Two deaths have already occurred, highlighting the continued dangers posed by disease once thought manageable.

Some rarer transmission routes exist – unpasteurized dairy products occasionally spread bovine tuberculosis, and medical procedures like bone grafts have transmitted infection in isolated cases.

Pandemic Disruptions Drive New Cases

The COVID-19 pandemic played a significant role in the tuberculosis resurgence. Global cases increased 4.6% between 2020 and 2023, reversing decades of steady decline. American cases alone jumped 15% from 2022 to 2023. Pandemic-related disruptions resulted in approximately 700,000 excess TB deaths globally, highlighting preventable losses and healthcare system vulnerabilities.

Several factors contributed to rising numbers:

1. Access Barriers: Mandatory shutdowns limited healthcare availability for early TB diagnosis
2. Care Disruptions: Fear of COVID exposure kept people from medical facilities
3. Supply Problems: Drug shortages affected TB treatment between 2021 and 2023
4. Delayed Diagnoses: Many cases went undetected until more advanced stages

Modern Treatment Approaches

Historically, the battle against tuberculosis (TB) was a harrowing one, characterized by primitive “treatments” such as bloodletting, the consumption of cod liver oil, and the relocation of suffering patients to mountain sanatoriums, where it was believed that the crisp, cold, and dry air could provide a miraculous cure. However, the evolution of modern medicine has introduced a revolutionary approach that employs complex multidrug regimens, meticulously designed to combat TB bacteria from various angles.

Current treatment protocols emphasize a rigorous regimen that spans a minimum of six months of uninterrupted therapy for individuals diagnosed with active TB. This comprehensive strategy utilizes combinations of several antibiotics, a critical measure that helps thwart drug resistance development, a growing concern in the medical community. 

In the face of drug-resistant TB strains, treatment becomes increasingly complex, often requiring an extended commitment of nine months or more, alongside additional medications to effectively manage the infection. It is important to note that while these life-saving drugs are crucial, they can come with significant toxicity issues. As a result, patients frequently report a marked decrease in their quality of life throughout and even after the treatment process, underscoring the challenging journey of recovering from this relentless disease.

Latent TB: Hidden Risk Factor

Many infected individuals carry latent tuberculosis-harboring bacteria without showing symptoms. Without testing, people may unknowingly maintain an infection for years, potentially developing active disease later when immunity weakens.

In the Kansas outbreak, more than half of the diagnosed cases were latent infections discovered through contact tracing. People with latent TB feel healthy but remain at risk for developing active disease and potentially spreading infection if left untreated.

Who Faces the Highest Risk?

Various groups of individuals are particularly vulnerable to the threat of tuberculosis (TB), each facing unique challenges that elevate their risk:

Individuals with Weakened Immune Systems

Those living with conditions such as HIV, diabetes, or those undergoing specific medical treatments that suppress their immune response find themselves at a significantly higher risk of contracting TB. Their bodies are less equipped to fight off infections, making them prime targets for diseases like tuberculosis.

Healthcare Workers

Healthcare professionals, including doctors, nurses, and support staff, are frequently exposed to TB through patient interactions. Their workplaces place them in direct contact with individuals who may carry the bacteria, thereby increasing their chances of infection.

Residents of Congregate Settings

Individuals living in close quarters, such as those in homeless shelters, correctional facilities, or refugee camps, are at an elevated risk. The cramped environments and shared facilities can facilitate rapid transmission, leading to outbreaks in these vulnerable populations.

Recent Immigrants from High-Prevalence Countries

Individuals who have recently migrated from regions where tuberculosis is common may arrive with latent infections or a greater susceptibility to the disease. Their transition to new surroundings can pose both health and logistical barriers to accessing timely TB screening and treatment.

Close Contacts of Active TB Patients

Family members, friends, or work colleagues of individuals currently battling active TB are at increased risk of infection. The proximity and shared airspaces make it likely for the bacteria to spread to those in frequent contact.

Individuals Experiencing Homelessness or Poverty

The intersection of social and economic factors heightens the vulnerability of those living in poverty or experiencing homelessness. Limited access to healthcare, inadequate nutrition, and unsanitary living conditions create an environment where TB can thrive.

Prevention Strategies For Communities

Effective TB control requires a comprehensive approach beyond individual treatment:

• Making Sure Treatment Gets Finished: Supporting patients in taking all their medication correctly for the full duration. This might involve community health workers or volunteers checking in regularly (like with Directly Observed Treatment, Short-course – DOTS) or providing other forms of support, like reminders or help with transport to clinics.
• Testing High-Risk Groups: Identifying people with the TB germ who aren’t sick yet (latent TB infection or LTBI). This often includes people who were contacts of an active TB case, people with weakened immune systems (like those with HIV), and others at higher risk.
• Better Air Flow: Improving ventilation in homes, workplaces, clinics, schools, and other indoor public spaces can help reduce the concentration of TB germs in the air.
• Fighting Stigma: Reducing the fear and misunderstanding surrounding TB encourages people to seek testing and treatment without shame, leading to earlier diagnosis and less spread.
• BCG Vaccination: The Bacille Calmette-Guérin (BCG) vaccine is given to infants and young children in many countries with high TB rates. While it doesn’t always prevent lung TB in adults, it does offer protection against severe forms of TB in children.

Warning Signs Everyone Should Know

​​Knowing the potential warning signs of Tuberculosis (TB) helps catch it early. If TB disease is active, it usually affects the lungs (pulmonary TB) but can also affect other body parts. If TB affects other body parts (extrapulmonary TB), symptoms will depend on the area involved. For example, TB in the spine might cause back pain, while TB in the kidneys could cause blood in the urine.

Here are common warning signs everyone should be aware of:

• A Persistent Cough: A cough that lasts for three weeks or longer is a key sign.
• Coughing Up Sputum or Blood: Producing phlegm (sputum) or noticing blood when you cough.
• Chest Pain: Pain that might occur with breathing or coughing.
• Feeling Tired or Weak: General fatigue that doesn’t have another explanation.
• Losing Weight Without Trying: Dropping pounds when not dieting or changing your habits.
• Fever: Often a low-grade temperature that may come and go.
• Night Sweats: Waking up drenched in sweat during the night.
• Loss of Appetite: Not feeling hungry or interested in food.
• Chills: Feeling cold even when others don’t.

My Personal RX on Tuberculosis Prevention

Tuberculosis remains among the most persistent infectious threats facing humanity. As a physician watching disease rates climb after years of decline, I feel strongly about raising awareness regarding risks and prevention strategies. Many forget that TB continues to cause illness and death worldwide despite available treatments. Taking proactive steps against this ancient disease benefits personal and public health alike. My recommendations for protection against TB:

1. Early Symptom Recognition: Know warning signs like persistent cough lasting weeks, unexplained weight loss, night sweats, and ongoing fatigue – early detection saves lives and prevents transmission
2. Risk Assessment: Evaluate your risk factors, including immune status, occupation, travel history, and community exposure
3. Testing Consideration: Request TB skin testing or blood testing during regular check-ups if working in healthcare, corrections, or with vulnerable populations
4. Vaccination Awareness: Discuss BCG vaccination with healthcare providers if traveling to high-prevalence regions or working in high-risk settings
5. Immune Support: Try MindBiotic with its unique combination of probiotics, prebiotics, and Ashwagandha KSM 66 to support overall immune function, which may help your body resist or contain TB infection
6. Ventilation Habits: Maximize fresh air circulation in homes, workplaces, and gathering spaces – TB spreads more easily in poorly ventilated areas
7. Gut-Brain Connection: Read my guide “Heal Your Gut, Save Your Brain” to understand how digestive health influences immune system strength and resilience against infections like TB
8. Healthcare Access: Maintain regular medical check-ups and report concerning symptoms promptly – delays in diagnosis allow disease progression
9. Global Awareness: Support organizations working toward TB elimination worldwide – disease anywhere represents risk everywhere
10. Prevention Education: Share knowledge about TB with family and community members – awareness saves lives when symptoms receive prompt attention

Source: 

Groenweghe, E., Swensson, L., Winans, K. D., Griffin, P., Haddad, M. B., Brostrom, R. J., Tuckey, D., Lam, C. K., Armitige, L. Y., Seaworth, B. J., & Corriveau, E. A. (2023b). Outbreak of Multidrug-Resistant Tuberculosis — Kansas, 2021–2022. MMWR Morbidity and Mortality Weekly Report, 72(35), 957–960. https://doi.org/10.15585/mmwr.mm7235a4 
Li, Y., De Macedo Couto, R., Pelissari, D. M., Alves, L. C., Bartholomay, P., Maciel, E. L., Sanchez, M., Castro, M. C., Cohen, T., & Menzies, N. A. (2022). Excess tuberculosis cases and deaths following an economic recession in Brazil: an analysis of nationally representative disease registry data. The Lancet Global Health, 10(10), e1463–e1472. https://doi.org/10.1016/s2214-109x(22)00320-5