I’m in my last year of my biology degree, so it’s dissertation time! So I thought I’d give you all a taste of what I’m writing about. The title is “Ways forward in the prevention and treatment of multi-drug resistant tuberculosis”. People have this idea that tuberculosis is a disease of the past, relevant for its effects on the Romantic poets and Victorian novels. But actually it’s one of the top ten killers in the world — and it’s the top cause of death attributed to a single infectious agent.
Why did I choose to write a literature review of tuberculosis? Well, partly because infectious diseases in general fascinate me, but also specifically because tuberculosis is such a key problem and yet the fact surprises people. Probably the main nudge to actually write about it was reading Kathryn Lougheed’s Catching Breath, which is what made me realise how key a problem tuberculosis still is.
Also, it’s a challenging topic. There’s a lot of research out there about it, and some of it is quite esoteric. I do like a challenge, and tuberculosis is definitely that. And it has had an impact on the authors and stories I knew so well in my past life as a literature postgrad, so that felt appropriate too.
M. tuberculosis, the bacteria which causes tuberculosis (aka “consumption” if you’ve been reading Victorian novels) is a notoriously tricksy pathogen, with a cell wall consisting mostly of mycolic acid instead of the more familiar peptidoglycan, and a tendency to quickly become resistant to drugs by all sorts of means — changing the internal targets of the drugs, metabolising things differently so the drugs never get activated, or just pumping the drug right out of the inside of the cell. And as I’ve written before, we’re not making new antibiotics anything like as fast as we would need to, to keep up with the pathogens that cause us the most harm: there are some refinements coming down the line to existing drugs to make them safer to use, but new antibiotics are, at best, years away. And at worst, they’re just not coming.
Worse than that, someone can be pronounced cured from TB only to present a few years later with a drug-resistant case which, surprise! Survived the gruelling treatment regimen they’ve already been through (and those drugs are not gentle). And they can do that in all kinds of tricksy ways, including just transforming the drug into something harmless to them and then sitting there bathed in it, completely unharmed.
So one of the really really key things with tuberculosis control is that we have to prevent it. And that’s what my dissertation has mostly been about: figuring out how we can prevent TB through targeted vaccination programs, screening to find latent cases which we can treat before they become symptomatic (and therefore likely to pass on the disease), figuring out how to treat it effectively, and getting people educated on what tuberculosis is and how to protect themselves.
There’s a lot of stuff out there, and I think my main takeaway has been that we can get tuberculosis under control with the right kind of targeted programs and by ensuring people complete full courses of treatment and are clear of the pathogen before treatment ceases. Are we organised enough to do it? Well… I did read a report that most NHS hospitals don’t even make health staff and visitors to a tuberculosis patient wear proper protection(!), so maybe there’s a long way to go.
(P.S. I super recommend the book I mentioned, Catching Breath: The Making and Unmaking of Tuberculosis. It’s easy to read and understand, and packed with some rather terrifying home truths about the state of play with regard to tuberculosis. Very worth it.)