Innovative Trials are passionate about ensuring our diverse population is adequately represented within medical research. Whether it is wanting to see more people from underrepresented communities choosing science as a career and pushing for greater patient diversity in clinical trials or focusing on what we are doing internally to celebrate and promote equality and diversity. This month we celebrate International Childhood Cancer Day. So far the Equality, Diversity, and Inclusion Committee at Innovative Trials has written blogs to raise awareness surrounding several illnesses, their effects, and treatments such as World Lupus Day, Malaria, Pride Month, Sickle Cell, Endometriosis , Pancreatic Cancer Awareness Month , Parent Mental Health Day , International Day of Women and Girls in Science and International Childhood Cancer Day.

Background

Tuberculosis (TB) is a severe airborne infectious disease that affects the lungs (pulmonary tuberculosis), although some forms of TB can affect health away from the lungs (extrapulmonary tuberculosis).  TB is caused by inhalation of various strains of mycobacteria, which most commonly is Mycobacterium tuberculosis.  Globally, 10 million people fall ill with TB annually and 15% of these patients die as a result. It remains one of the deadliest infectious diseases in the world.

Not everyone who is infected with TB bacteria falls ill: a quarter of the world population is infected with TB, with immunocompromised people being at the highest risk of illness. 

What are the Symptoms, Diagnosis, Treatment?

TB symptoms can vary depending on the area where the infection strikes. Pulmonary TB is identified by the presence of a cough, with sputum (mucus) or blood, chest pain, weakness and shortness of breath. In comparison, extrapulmonary TB can affect any other part of the body aside from the lungs and the symptoms will be related to the area infected:

  • Miliary (bloodstream)
  • Genitourinary (kidneys, bladder, prostate, fallopian tubes)
  • Meningeal (Meningitis, most serious form of TB)
  • Peritoneal (abdominal)
  • Pericardial (heart function)
  • Tuberculous lymphadenitis (lymph nodes)
  • Cutaneous (skin)
  • Tuberculosis of bones and joints
  • Gastrointestinal (mouth, stomach, bowels)
  • Tuberculosis of the liver

Many of these forms of TB lead to pain, swelling, ulcerations, blockages, ruptures and organ failure, in the most severe cases. 

Diagnosis

Diagnosis of TB occurs following testing after patients present with respiratory symptoms, fever or illness of unexplained origin. Tests for TB include:

  • Chest x-ray, with visual confirmation of lesions, signs of recent infection
  • Acid-fast stain and culture to check for tubercle bacilli
  • Tuberculin skin test (TST)/ interferon-gamma release assay (IGRA)
  • Nucleic acid amplification test (NAAT)

Treatment

Therapy for TB can take the form of preventing further infections through isolation or wearing of personal protective equipment (PPE). For more serious cases requiring treatment, the first line of treatments include: corticosteroids, isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (EMB).  Sometimes antibiotics are used later on in the treatment journey  (streptomycin, kanamycin, amikacin, capreomycin). For patients with regular TB infections, drug/antibiotic resistance can become a serious threat to the progression of the disease. Surgery is an urgent resort to remove sections of infected tissue that may be unresponsive to treatment. 

Diversity

TB primarily affects populations in low-to-middle income regions around the world. Bangladesh, China, India, Indonesia, Nigeria, Pakistan, Philippines and South Africa are the countries where around 50% of TB patients can be found. 

Children with TB are more likely to develop illness, when compared to adults. Elderly patients and those with HIV are also at higher risk of developing more serious symptoms of TB. 

Research

Research and innovation has been key to improving outcomes for patients who fall ill as a result of TB infections. Efforts have been focused on preventing the levels of incidence and also treating patients who are ill. 

There is a substantive diagnostic testing development pipeline. Different ways of testing for TB include: computer-aided detection (CAD), aerosol-capture technology (ACT), antigen-based skin testing. 

Vaccine development is being explored by a number of researchers, with 16 in various stages of testing as of 2022. These included vaccines looking at preventing infection and also to help with improving treatment outcomes. 

Similarly, in 2022 it was noted that there were 26 different drugs for TB treatment in various phases of clinical trial. 

Conclusion

An estimated 75 million people have been saved as a result of health initiatives fighting TB since the year 2000. It is hoped that with the significant number of vaccines and treatments in development, patients will have multiple options available for treatment that will help counter the challenges caused by variations in severity, increasingly drug-resistant TB strains and immunocompromised patients who are already on multiple forms of treatment.

 

References

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