Tuberculosis: a medical evergreen

Autor: Sven-Göran Fransson
Rok vydání: 2015
Předmět:
Zdroj: Acta radiologica (Stockholm, Sweden : 1987). 56(5)
ISSN: 1600-0455
Popis: Tuberculosis was once believed to be a hereditary disease and the cause of death in 25% of the population in Europe in the 17th century. The American physician and poet Oliver Wendell Holmes called it the white plague and the English writer Charles Dickens described it as a disease which medicine never cured. When the German scientist Robert Koch discovered Mycobacterium tuberculosis in 1882 it evoked great hopes for a specific anti-tuberculous drug. His discovery is celebrated annually by the World TB Day. Not until 1944 was Streptomycin proven effective as a single drug and soon after also PAS (paraaminosalicylic acid). Tuberculosis was conquered and the former sanatorium treatment based on fresh air, rest, and good nutrition became obsolete. Collapse therapy also belonged to the sanatorium era. It consisted of different interventional procedures in order to deflate the diseased part of the lung and thereby introduce a less favorable environment for bacterial growth. The introduction of radiology had great impact on diagnosis and follow-up of therapy and was later followed by screening of the general population. Initially successful screening was later abandoned because of low efficiency. There are still patients alive with radiologic signs or even late complications from collapse therapy which must be recognized by the radiologist such as artificial pneumothorax, thoracoplasty, plombage, and phrenic nerve crush with pneumoperitoneum. Furthermore, tuberculosis is almost an iconic disease as described in art, literature, and music (1–6). Thoracoplasty has been dramatically illustrated by Alice Neel in her painting T.B. Harlem from 1940. The author George Orwell experienced both collapse therapy and serious side-effects from Streptomycin therapy. Why is tuberculosis still important? This disease is still a global problem in poor countries but also in the US and Western world because of migration from highburden countries bringing active cases or persons with a risk of reactivation of latent tuberculosis. Drug resistance is now a greater obstacle with multipledrug, extensively, extremely, and even totally drug resistant bacterial strains respectively. In 1993 WHO declared tuberculosis a global emergency and later The Global Plan to Stop TB 2006–2015 was initiated. New diagnostic tests, vaccine, drugs, and socioeconomic improvements are still needed to more effectively fight tuberculosis worldwide (7–11). What is the role of radiology? Like every clinician radiologists must also be aware of tuberculosis as a possible differential diagnosis in order to avoid unnecessary diagnostic delay. Patients may initially be treated as having community-acquired pneumonia (8). Furthermore, it may be possible to radiologically detect active disease (3,7). The radiologist must also have ‘‘peripheral vision’’ and knowledge about extrapulmonary manifestations like tubercular lymph glands, disease in bone, brain, pleura or pericardium, and abdomen (7). The frequency of extrapulmonary tuberculosis was 22% in 2011 within the European Union (12). Furthermore, radiology can be important in diagnosing certain forms of pulmonary atypical or nontuberculous mycobacterial infections which in turn are recognized in increasing frequency (13). From a radiological point view it is worth mentioning reports on skeletal abnormalities such as pectus excavatum and scoliosis that are linked to lung disease with atypical tuberculous mycobacteria (14). Tuberculosis is also described as a mimic of other diseases (7,15). Over the years there have been several excellent reviews and series regarding tuberculosis both from radiological and general medical points of view, including the most recent articles in Acta Radiologica (16–18).
Databáze: OpenAIRE
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