Dying from tuberculosis is no longer romantic

Note to readers

The first half of the 19th century is considered the golden age of romanticism, a cultural and philosophical movement that put the heart before reason.

And it is precisely at this time that one of humanity's most devastating infectious diseases, tuberculosis, also reached its peak.

More information

• Economic and life losses due to tuberculosis, the world's largest pandemic, are estimated for the first time

• The shortage of medicines leaves the public health without vaccines against tuberculosis

• Tuberculosis killed 1.4 million people in 2019

The relationship that was established between disease and beauty is curious.

The aesthetics of tuberculosis patients, with their thin and pale skin, their blush on their cheeks and the intensity of their lips, due to fever, was closely linked to the canon of beauty that was imposed at the time.

Furthermore, the alienation and delusions caused by the disease in its final stages were associated with the highest expression of artistic creativity.

For this reason, at this time, the disease was synonymous with romanticism, and there was no greater aspiration for a romantic writer, painter or composer than to die of tuberculosis.

But the industrial revolution, which also took place at that same historical moment, was associated with the overcrowding of the working class in homes that were humid and poorly ventilated, favoring the spread of germs.

So by the end of the 19th century, tuberculosis went from being related to romanticism to being linked to marginality.

And it is in this context that the German doctor Robert Koch comes into play, who for the first time, in 1882, thanks to the use of a novel staining method, shows that the cause of the disease is a microbial agent called

(or Koch's bacillus, in honor of the scientist).

Today we know that tuberculosis is caused not only by the bacterium

, but also by other bacteria of the same genus such as

or

.

We also know that these have an elongated shape between 1 and 10 microns in length and that their growth is slow in the laboratory - it takes up to three weeks for visible colonies to appear on plates grown at 37 degrees.

And we know that it is affected, above all, of the lung type, and that every year it kills more than a million people around the world.

Staining techniques continue to be essential for its diagnosis, since they allow its visualization under an optical microscope.

The two most commonly used stains are the so-called Ziehl-Neelsen stain, the classic one, and the fluorochrome stain, much more current.

Microbiological cultures and the use of biochemical techniques are also important for a correct diagnosis and monitoring of the disease.

In 2006, tandem repeats of intercalated microbacteria units (MIRUs, for their English translation) were defined that made it possible, not only a correct diagnosis of the disease, but also the genetic identification (genotyping) of the organism that the cause.

This, from the health point of view, was a real revolution in the field of tuberculosis, since by means of PCR amplification of multiple DNA fragments, for example, possible epidemiological links between patients with tuberculosis can be established.

The genomics of tuberculosis

But molecular biology is growing by gigantic steps, and just a decade after the mirutyping technique (use of MIRUs to genotype) was established as the best option to know genetically the organisms that cause tuberculosis, it has been seen that there is another option which is much more reliable to know the dynamics of disease transmission.

It is the use of the sequence of the complete genome of the bacterium, which has increased in an astonishing way the specificity in the definition of the transmission groups.

Thus, it can be considered that the genomic epidemiology of tuberculosis has been born.

Alienation and delusions caused by disease in its final stages were associated with the highest expression of artistic creativity

The new analysis methodologies based on the reading of the complete genome sequence (WGS,

, in English) have turned out to be a fundamental tool in the cross-border surveillance and control of tuberculosis, being able to discriminate even between imported cases and recent broadcasts.

However, this is not yet as cheap and affordable a technique as other less precise and specific ones.

So more work will have to be done to develop options that facilitate its application.

Tuberculosis has long ceased to be a disease associated with beauty and creativity.

It is no longer romantic to die of tuberculosis.

In the XXI century, this is one of the ten leading causes of death in the world, and the World Health Organization has set itself the fundamental objective of reducing the number of deaths by 95% and the incidence rate by 90% before 2035. The space once occupied by magic or fetishism is now occupied by science.

We are in luck.

José Antonio Garrido Cárdenas

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