VELRI1TASUNDERSTANDINGRESISTANCETO TUBERCULOSISBarry R.BloomHarvardSchoolofPublicHealthLS-HHMIJuly14,2008
Barry R. Bloom Harvard School of Public Health LS-HHMI July 14, 2008 UNDERSTANDING RESISTANCE TO TUBERCULOSIS
BILLS OFMORTALITY,1632CityofWestminster,9535Burials24%CHRISOMES19%CONSUMPTION12%FEVER6%SMALLPOX5%TEETH3%DROPSIE1%CANCER1%GRIEF.8%PLAGUE.7%MURTHERJohnGraunt,CitizenofLondon,1662Naturaland PoliticalObservations Mentioned ina Following IndexandMadeUponthe Bills of Mortality?
BILLS OF MORTALITY, 1632 City of Westminster, 9535 Burials • CHRISOMES 24% • CONSUMPTION 19% • FEVER 12% • SMALLPOX 6% • TEETH 5% • DROPSIE 3% • CANCER 1% • GRIEF 1% • PLAGUE .8% • MURTHER .7% • John Graunt, Citizen of London, 1662 Natural and Political Observations Mentioned in a Following Index and Made Upon the Bills of Mortality
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TypellCellTypeI CellFluidSurfaceAirSpaceMacrophageFrom J.Clin.Invest..1990,86.1-6
Type II Cell Type I Cell Fluid Surface Air Space Macrophage From J. From J. Clin. Invest., 1990, 86, 1-6 Invest., 1990, 86, 1-6
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THECHALLENGEOFTBDiseasePatternsPrimaryTBReactivatedTBBacillaryLoadChronicTBProgressivePrimaryTB"Latent"TB25yrs50yrsTimeA
THE CHALLENGE OF TB Disease Patterns Time 25 yrs 50 yrs Bacillary Load Progressive Primary TB Primary TB “Latent” TB Chronic TB Reactivated TB Primary TB Reactivated TB “Latent” TB Progressive Primary TB Chronic TB
(A)PARFIGURE6(A) Locationofcalcified parenchymalfoci in 105 individuals with a single primarycomplex,(B) Location of parenchymal lesions in 55 individuals with postprimary tuberculosis. (Reprinted fromMedlar,et al. 1948 Americon Review of Tuberculosis 58, 583611. With permission.)?
PERSISTING PROBLEMS IN TUBERCULOSIS(B)PARFIGURE6ContinuedA
FIGURE9Locationof 268cavities in204patients withcavitary pulmonary tuberculosis.Cavities arelocated almostexclusively in the upperlobes.(Reprinted from Sweany et ol,1931 American Review ofTuberculosis24,558582.Withpermission.)?
Pulmonary Tuberculosis DeathRateinNewYork,Philadelphia,and Bostony400300200100182018401830185018601870188018901900191019201930RobertKochDiscoverstheYearTubercleBacillus
Pulmonary Tuberculosis Death Rate in New York, Philadelphia, and Boston Year D e a t h R a t e p e r 1 0 0,0 0 0 D e a t h R a t e p e r 1 0 0,0 0 0 400 300 200 100 0 1820 1830 1840 1850 1860 1870 1880 1890 1900 1910 1920 1930 Robert Koch Discovers the Tubercle Bacillus