Update: An Airborne Killer Returns - A new strain of tuberculosis is set to hit Asia

By Catherine Shepherd


TUBERCULOSIS, or TB, was once romanticized as the "artist's disease" in the West. Wasted youth and wan complexions found their way into countless 19th-century poems, paintings and novels. Today, there is no such glamorization. According to a recent report by the World Health Organization (WHO), TB has re-emerged more powerful and more threatening than the outbreak that killed thousands last century. The report, entitled Anti-Tuberculosis Drug Resistance in the World, details the spread of a "super-strain" of TB-causing bacteria. Worse still, the area poised to be hit hardest by the disease is Asia.

Several factors contribute to the danger in the region. The first, perhaps ironically, is the widespread availability of medication. Tuberculosis sufferers in Asia have had access to common anti-TB drugs like isoniazid and rifampicin but have failed to take them properly or completely. This has allowed the organism responsible for TB, Mycobacterium tuberculosis, to mutate and build up resistance.

Secondly, the region has several hundred urban centers, where overcrowding and the constant movement of people can lead to a rapid spread of the disease. The third factor is a familiar one. "All of Asia is at high risk, but there is no greater risk than in Southeast Asia, because HIV is moving so quickly," says Kraig Klaudt, WHO's external advocacy officer. Tuberculosis spreads 30 times faster in AIDS patients than in people whose immune systems are intact.

Carried in sputum droplets, the bacteria are transmitted through the air. Even getting into a cab that was occupied by a TB patient three hours before can lead to infection. "There is nothing a person can do to not get TB," says Klaudt. "You can change your behavior to lower the risk of AIDS, but you cannot stop breathing."

When inhaled, the bacteria are drawn into the lungs where the tissues react to the invaders by coating them with cells -- much the same way an oyster coats a sand grain to form a pearl. The trouble is, these "pearls," or tubercles, grow larger and larger, and eventually prevent the lungs from doing their job. The first symptoms of infection are chest pain, loss of appetite, fever and night sweats. Secondary symptoms: coughing up blood and pus, and severe shortness of breath.

The only program that has been effective against tuberculosis is DOTS, or Directly Observed Treatment, Short-course. Healthcare workers under this program do not just hand out medication; rather, the patient is required to return to the clinic daily to be given the proper dose and is monitored for any adverse reactions.

But only 12% of TB patients were treated with DOTS this year. Because it is more costly and complicated to operate than simply dispensing pills, health officials have been slow to change from their old TB management programs. WHO is calling on governments to implement DOTS and urging citizens to make the same demand. After all, there is no defense against the disease, except treating the infected.