An outbreak of tuberculosis, commonly known as TB, began in January 2024 in Kansas City, Kansas, and has extended to two nearby counties. As of early March 2025, the outbreak continues, with 147 confirmed cases of TB reported. Out of these, 67 individuals have developed symptoms, while the remaining 80 have contracted what is termed a latent infection, meaning they are infected but show no symptoms. This situation highlights the serious nature of TB, which is the leading infectious cause of death globally, second only to COVID-19 during the pandemic's initial three years.
The causative agent of TB is the bacterium Mycobacterium tuberculosis, a pathogen that has affected humans for thousands of years. Archaeological evidence suggests that TB was present as far back as 9,000 years ago in the Eastern Mediterranean region. Historical accounts trace back to around 410-400 B.C.E., when the physician Hippocrates referred to TB as "phthisis," an old term describing a progressive "wasting away" characteristic of the disease. The term "consumption" was also used due to the significant weight loss experienced by afflicted individuals.
During the Middle Ages, TB was often referred to as the "white plague" or "white death," a reflection of the anaemic appearance of those suffering from the disease. Without treatment, active TB can be highly lethal, with approximately 50% of untreated cases resulting in death. In contrast, treatment can reduce the mortality rate to just 12%. Another colloquialism for TB was "the king's evil," as it was believed that a king's touch could cure the neck lesions associated with a specific form of TB known as scrofula. Furthermore, the disease was ominously dubbed the "robber of youth" due to its tendency to strike individuals aged 15 to 30.
Tuberculosis primarily spreads through small infectious droplets released into the air when an infected person coughs, sings, or even breathes. While it is uncommon, TB can also be transmitted through unpasteurized dairy products or through bone grafts from infected donors. As of early March 2025, the source of the current TB outbreak in Kansas remains unidentified, with reports indicating that it has disproportionately affected low-income communities and resulted in two fatalities.
A single untreated TB patient has the potential to infect between 10 and 15 others, underscoring the critical need for public health interventions.
The COVID-19 pandemic has significantly impacted the resurgence of TB, with global cases increasing by 4.6% from 2020 to 2023, reversing decades of progress in TB control. In the U.S., TB cases rose by over 15% from 2022 to 2023. During pandemic-related lockdowns, many individuals were unable to access healthcare services for early TB diagnosis or to obtain necessary medications due to fears of contracting COVID-19 in medical facilities. This disruption has been linked to nearly 700,000 excess TB-related deaths globally, exacerbated by supply shortages of critical TB medications in the U.S. between 2021 and 2023.
The primary method for curing TB and halting its spread is through multidrug treatment. Before the late 1930s, TB treatments included archaic methods such as bloodletting and the consumption of cod liver oil. Patients were often sent to isolated sanatoriums in high-altitude regions, believed to offer a healing environment, although there is no scientific evidence supporting this. In the 1940s, the introduction of streptomycin marked the first antibiotic treatment for TB. However, the bacterium quickly developed resistance, leading to the creation of additional antibiotics like isoniazid in the 1950s.
Today, healthcare providers use two- and four-drug combinations to treat both active and latent TB infections. Active TB requires a minimum of six months of continuous treatment to prevent further disease spread and the emergence of multidrug-resistant TB, which necessitates longer treatment durations and additional medications. The quality of life for TB patients can be significantly affected during treatment, with many experiencing deterioration in well-being. Early detection and treatment of TB are crucial, as they not only reduce the disease's transmission but also mitigate the potential toxic effects of treatment.
It is essential for the public to recognize that TB remains a significant global health issue. Education on TB transmission, treatment, and the ongoing need for active eradication efforts is vital. Individuals with latent TB may carry the microorganism for years without symptoms, making them unlikely to seek care unless identified during an outbreak, as seen with over half of the Kansas patients. Increasing awareness and understanding of TB can aid in combating this ancient yet persistent disease.
