Tuberculosis, commonly known as TB, is one of the oldest known infectious diseases, having been found in Egyptian mummies from 3000 BC.
In 17th and 18th century Europe it was known as “consumption,” and was commonly depicted in literature and opera. Marguerite, the heroine of the novel The Lady of the Camelias and the opera La Traviata dies of TB, as do Fantine in Les Misérables and Mimi in La Boheme.
Only in 1882 did Robert Koch discover Mycobacterium tuberculosis, the bacterium that causes TB.
While TB was widespread in the US until well into the early 20th century, cases are now much less common. TB is very much a disease of poverty and crowding, and economically advanced countries see much less of it.
In the last few years, cases have been rising. There were about 8200 reported cases of TB in the US in 2022, 9600 in 2023 and 10,300 in 2024. Most of these occurred in immigrants, and most represented reactivation of old infections when the person’s immunity dropped.
Worldwide it is a different story. TB is the most common infectious cause of death in the world. In 2023, an estimated 11 million people fell ill with TB and 1.3 million died. TB is very common in southern Africa and central Asia and is a major health problem in India and China.
The best preventive measure, as with most infectious diseases, is vaccination. BCG vaccine (Bacillus Calmette-Guerin) was developed in 1921 and is particularly helpful for children, preventing the worst forms of TB. It is less effective in preventing pulmonary (lung) infection, which is by far the most common form of TB.
Once given universally, BCG vaccine is now routinely used only in Ireland and Portugal among affluent countries and is not commercially available in the US or most western countries. It is routinely given to newborns in much of Asia, southern Africa and South America.
You can still get TB, a highly transmissible illness from someone who has it in their lungs and is coughing. While you are unlikely to catch it in normal tourist sites even in high-incidence countries, it does happen.
Fortunately, active TB is usually easy to diagnose from a standard chest X-ray. Treatment is usually effective, though drug-resistant TB is not rare.
So, forgotten but not gone. As the cuts in USAID funds for disease prevention take hold, there will be a lot more TB, and some of it will hit our shores.
Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.
What Does The Doctor Say?
By Dr. Edward Hoffer