An alarming outbreak of tuberculosis (TB), a serious lung disease often characterized by a persistent cough, began in January 2024 in Kansas City, Kansas, and has since affected two nearby counties. As of early March 2025, the outbreak continues, with a total of 147 confirmed diagnoses of TB, out of which 67 individuals have fallen ill. The remaining 80 diagnosed cases are classified as latent infections, meaning those individuals carry the bacteria but do not exhibit any symptoms. It is vital to note that TB remains the leading infectious cause of death globally, second only to COVID-19 during the initial three years of the pandemic.
The causative agent of TB is the bacterium Mycobacterium tuberculosis, which has been infecting humans for thousands of years. Archaeological evidence suggests that TB existed as far back as 9,000 years ago, with findings from the Eastern Mediterranean region. Historical accounts reveal that the physician Hippocrates referred to TB as "phthisis," meaning a progressive wasting away, due to the emaciation seen in affected individuals. Throughout history, TB has been dubbed various names such as "consumption," "the white plague," and "the white death," reflecting its devastating impact and the pallor of its victims.
Active TB, particularly untreated cases, has a high mortality rate, with approximately half of those infected dying from the disease. In contrast, modern treatment reduces this death rate dramatically to about 12%. One particularly notable aspect of the disease is its historical nickname, "the king's evil," which refers to a form of TB that causes neck swelling and lesions. In the Middle Ages, people believed that a king's touch could cure this condition, showcasing the disease's long-standing impact on society. The microorganism responsible for TB was finally isolated by German physician Robert Koch in 1882, a discovery celebrated annually on World TB Day.
Tuberculosis spreads through small infectious droplets released into the air when an infected person coughs, sings, or even breathes. In rare cases, TB can also be transmitted through unpasteurized dairy products or bone grafts from infected donors. The source of the ongoing outbreak in Kansas remains unidentified as of early March 2025. This outbreak has had a disproportionate impact on low-income communities, leading to two reported deaths. Importantly, an untreated TB patient can potentially infect 10 to 15 others, highlighting the disease's contagious nature.
The COVID-19 pandemic has significantly influenced the resurgence of TB cases worldwide. From 2020 to 2023, global TB cases increased by 4.6%, reversing decades of progress in controlling the disease. In the United States alone, TB cases surged by over 15% between 2022 and 2023. The pandemic's mandatory shutdowns hindered access to healthcare services, preventing timely TB diagnoses and treatments. Many individuals avoided medical facilities out of fear of contracting COVID-19, leading to nearly 700,000 excess TB-related deaths during this period. Furthermore, supply chain disruptions contributed to a shortage of essential TB medications in the U.S. between 2021 and 2023, complicating treatment efforts.
The most effective way to combat TB is through multidrug treatment, which is essential for curing the disease and halting its spread. Before the advent of antibiotics in the late 1930s, TB treatment included ineffective methods such as bloodletting and the consumption of cod liver oil. Patients were often isolated in sanatoriums located in high-altitude areas, believed to provide a therapeutic environment. The first antibiotic, streptomycin, emerged in the 1940s, but TB quickly developed resistance. Subsequent antibiotics, such as isoniazid, faced similar challenges due to the microorganism's adaptability. Today, combinations of two to four drugs are utilized to treat both latent and active TB infections.
Active TB treatment requires at least six months of consistent medication. Disruptions in treatment can lead to further disease transmission and the emergence of multidrug-resistant strains, necessitating prolonged therapy and additional medications. It is crucial for patients to understand that all TB medications can be toxic, and the quality of life for those undergoing treatment often deteriorates. Early detection and treatment of TB are imperative to minimize disease spread and reduce drug toxicity.
It is essential for the public to recognize that TB continues to pose a significant global health challenge. Increased education about TB transmission, treatment options, and the necessity for active eradication efforts forms the cornerstone of effective public health strategies. One critical issue is that many individuals with latent TB may carry the bacteria for years without any symptoms, making them unlikely to seek medical help. This was evident in the Kansas outbreak, where more than half of the diagnosed cases were asymptomatic.
In summary, raising awareness and promoting education about tuberculosis is vital for controlling its spread and ensuring timely treatment. By understanding this ancient disease and its modern implications, communities can better protect themselves and work towards eradicating TB once and for all.
