X ray of male patient infected with tuberculosis (WHO photo)

 "Countries such as India, and China, Vietnam, the Philippines. There is a list of 23 high burdened countries in the world. It's from this set of 23 countries that 80 percent of the world's TB burden comes from," he says. 

Dr. Iadenmarco says that poverty and poor health conditions contribute significantly to the spread of tuberculosis in those countries. "Many of these 23 high burdened countries, for example, are lower or low income countries. So, they don't have adequate health infrastructure and so, therefore, it is very difficult to coordinate, organize and provide the drugs for adequate TB control. A more social reason is that TB historically is a very stigmatizing disease. People don't want other people to know that they have tuberculosis. This prevents people from going and seeking appropriate treatments," he says. Today, tuberculosis appears to be a disease of the developing world. But, if it is not checked, it could spread anywhere, including the United States. Dr. James Lamberti, a lung specialist in Northern Virginia says last year, the state of Virginia saw a five percent increase in tuberculosis cases over the year before.
 
 

A male patient takes his daily dosage of DOTS drugs (WHO photo - TDR/Crump)

 "In order to get into the United States, one needs to prove that they do not have active tuberculosis. But, many immigrants [who enter the country] have been exposed to tuberculosis, have been infected with tuberculosis, but don't have active tuberculosis," Dr. Lamberti says.

 The inactive, or latent, tuberculosis could become active and contagious any time, if a person's immune system breaks down and can no longer handle the TB germs. Dr. Lamberti says that is how a patient of his developed active TB.

 "I just saw a patient last month, a 26-year-old woman with ovarian carcinoma who had emigrated here about 10 years ago from Bolivia. She had a CAT scan that showed a small TB spot in her lungs. When she got chemotherapy for her ovarian cancer, that spot increased and the spot represented active tuberculosis," he said. Active tuberculosis symptoms include persistent cough, fever and weight loss. According to the Centers for Disease Control in Atlanta, Georgia, approximately 10 to 15 million people in the United States carry latent TB infection. About 10 percent of them will develop active TB at some point in their lives. 

Dr. Lamberti believes it is imperative that people who suffer from latent tuberculosis be treated before they develop its contagious form. But, as he says, treating people in one part of the world is not going to stop the disease from spreading. "If we only think of the United States and don't think globally, we are not going to cure the problem. People travel too much, people emigrate very easily. Unless you really are able to attack the problem worldwide, we are going to keep seeing the problem in the United States," Dr. Lamberti says.

 Dr. Iadenmarco of the Centers for Disease Control says the CDC and other U.S. health agencies, are coordinating their fight against tuberculosis with international health organizations.

 "This global community of people interested in TB control is growing. And so, all types of non-governmental organizations and other professional societies, as well as ministries of health in those countries, are now becoming appropriately interested in tuberculosis and working together to solve this problem," Dr. Iadenmarco says. The World Health Organization has also started an initiative, called "Stop TB Partnership", that urges all industrial powers to help poorer countries improve their TB control by supplying them with urgently needed drugs, funds and medical personnel. At the same time, it calls on tuberculosis-plagued countries to inform their citizens about the dangers of tuberculosis and about ways to control it. And the World Health Organization says observing World Tuberculosis Day on Sunday, March 24, and seriously spreading its message is a step in the right direction. 

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