[ceejayoz]

> It is treatable with antibiotics.

Treating it casually has led to widespread resistance.

https://en.wikipedia.org/wiki/Multidrug-resistant_tuberculos...

https://en.wikipedia.org/wiki/Extensively_drug-resistant_tub...

> People with an active infection feel sick and can spread it to others, while people with a latent infection don't feel sick and can't spread it.

https://www.who.int/teams/global-tuberculosis-programme/tb-r...

"Analysis of data from 14 countries in Africa and Asia suggests that about two thirds of global TB transmission may be from asymptomatic TB (95% prediction interval: 27–92%)."

[eth0up]

>Treating it casually has led to widespread resistance.

I have long suspected this as part of why the subject isn't much discussed, despite being more prevalent than most realize.

The elephant here is (aside from latent infection) the atypically long duration of treatment, which can exceed 6 months and is harsh. Many, even otherwise responsible people, will founder before the proper end of treatment and this, I think, is what terrifies health professionals - so much, that it almost seems to be avoided.

It's probably time we start looking a bit harder for "natural" or alternate treatments. Some in medical journals, are under scrutiny, but inconclusive.

Edit: I also think we'll be finding more about latent infections being involved in an array of other ailments, especially when mixed with the ultra prevalent EBV. And EBV is involved in a lot.

[scythe]

>It's probably time we start looking a bit harder for "natural" or alternate treatments. Some in medical journals, are under scrutiny, but inconclusive.

We are looking, quite hard, in fact. Mycobacterium tuberculosis is among the most studied microörganisms.

Like HIV, it is notable particularly for being able to defeat the attempts of the immune system cells to kill it, and it in fact infects and reproduces within macrophages. Medical researchers have done a lot to understand how this is possible and we (as in humanity) have identified several enzymes and related biomolecules which seem to be crucial to this process, which we might be able to inhibit with a targeted drug.

However, all of this scientific research has the usual problem that it is very difficult and expensive. In order to inhibit the enzyme, the drug must be absorbed by the body, and then make its way into the macrophages, and then it still must be active, and have no other toxicity to the host. It is easy to say "just inhibit isotuberculosinol synthase", but it is much harder to do.

As I understand it, this is also the reason why treating tuberculosis requires such long courses of antibiotics. When treating a normal infection, we are basically just killing most of the pathogens, and we hope that the immune system will mop up the rest. In the case of M. tuberculosis, the drugs have to kill all of the bacteria, which is why multidrug therapy is basically always used and the patient must continue treatment long after symptoms seem to have disappeared. Even when patients have recovered, they are always considered to be at risk of still having latent tuberculosis, which is why hospital screenings often feature a question like "have you ever had a positive test for tuberculosis?"

[Fomite]

This - TB is very well studied compared to most infectious diseases. I think really only HIV and Malaria edge it out.

[eth0up]

Not to say that it's always the case, but research isn't always at face value - i.e., sometimes there's circularity, economical or political dynamics, etc, that perpetuate dead ends while neglecting more viable avenues.

An example might be enzymes (notably in cancer research), where in the US there has been significantly less pursuit than elsewhere. To avoid attacks, I'll cite a source[0] which readers can maim rather than my comment.

0. Enzymes, The Fountain of Life DA, Lopez MD RM, Williams MD PhD K, Miehlke MD

In some pirtions of this book, entities other than pinata boy on HN, express concern regarding the quality, fairness or whatever's of research, with indications that 'research' may not always be equally noble or pragmatically guided. I suspect it's one of many where that particular subject is grazed upon. But my point is, if not overemphasized, that there may be quantity over quality issues, with viable options hiding in plain sight.

[Fomite]

"It's probably time we start looking a bit harder for "natural" or alternate treatments. Some in medical journals, are under scrutiny, but inconclusive."

Antibiotics are found in, and derived from, nature.

[eth0up]

Amazing ain't it? And the use of the word is found in medical literature too!

Reflect for a moment on whether such a comment serves any positive purpose.

[dole]

A few anecdotes about TB:

I was diagnosed with a latent TB infection received from a family member back in the early 1990's as a teen. I believe city and state departments of health must've tracked the "outbreak" back but I don't think it was ever on the news or made a big deal of. By the time we were diagnosed, the family member's symptoms weren't anything worse than their typical smoker's cough and was a heavy cigarette smoker anyway, not sure how active his infection actually was at the time but he never required hospitalization, just similar antibiotics, IIRC.

I was treated with Isoniazid (known as INH, one pill daily for a year), I never felt any symptoms from the infection or side effects from INH, they monitored monthly initially with skin prick tests then chest x-rays and after the year was up, I was done. This did prevent me from donating blood a few years after the infection was cleared; I assume there are still rules in place.

Neither the latent infection nor the year long treatment were harsh. IMHO, TB's a powerful but rather slow-moving internal infectant, and it was historically ravaging because of the earlier conditions of the world and lack of medicine at that time.

[AngryData]

What kind of natural treatments? Because tuberculosis has been a massive problem from the start of human civilization up until the advent of antibiotics, and they tried every natural medicine and treatment under the sun because of how long people can end up living with it before dieing, and they accomplished pretty much nothing in stopping it. In fact it continued to get worse throughout that entire time, at one point being the cause of death for 25% of Europeans.

[eth0up]

I'm not going to devote the time required to search, retrieve and cite extent material. But you will find results if you do, but probably no panacea. Also, I deliberately don't mention specifics in this instance (and many others) due to potentially and probable controversy. As an example, if I were to (but won't!) cite research indicating the universally reviled Ag showing efficacy in mitigating TB, I'd be attacked by waves of hostility as if it was my own rogue idea.

I enjoy discussions, but find it often tends to be argumentative here, so I avoid things I expect to go in that direction. Note the hostility to my use of the forbidden word in quotes. It's a thousand cuts with these kinds of compulsive prison shanks of logic that makes me awkward.

[tbrownaw]

> It's probably time we start looking a bit harder for "natural" or alternate treatments.

Is the idea that a different label would lead to higher compliance rates?

[eth0up]

Resistance. It's not quite the end of the world if TB becomes impervious to, say, catnip or whatever, which isn't front line medicine. And some options might have a more mechanical rather than biological mechanism/function.

Compliance for a 6 month course of just about anything is difficult and more so for something that may seem asymptomatic. Oozing sores, foul oders and overt discomfort would probably help, but alas...

[Eisenstein]

I'm sorry but this doesn't make sense. Antibiotic resistance to TB only affects those who have TB, so if another 'natural' medicine is found and TB gets resistant to it, then it is still just as bad for the people affected.

Natural means nothing in this context. Effective medicine is effective medicine, and there is nothing that makes TB less prone to developing a resistance to a 'natural' effective medicine over any other effective medicine.

[eth0up]

I admit I slipped into the octogon of HN where animals weak and strong come to test their teeth on impulse. Therefore I must be prepared to write essays on semantics even when I use subtle indicators such as quotes.

For the first portion of your reply, I think that if TB became resistant to potatoes with licorice icecream, it would be preferable to having absolutely no recourse with antibiotics. But that's silly. If you are 100% certain that latent TB is innocuous and can't be reactivated, I must admit my logic was flawed.

Edit: is not, eg mrsa, becoming resistant to various things in the environment? Biofilms make many bacteria resistant to even alcohol. Staph, ubiquitous and thus exposed to pretty much anything a person's skin is exposed to is probably resistant to many things it previously wasn't. But it remains vulnerable to a few antibiotics, for now.

[Eisenstein]

I understand now what you mean. The thing is that TB doesn't transfer its resistance to other pathogens like MRSA does. It develops resistance via a different mechanism (mutations of its genome) then MRSA does (horizontal gene transfer).

Thus, you have a misconception about the nature of TB resistance. This accounts for the pushback. People tend to forget that we all have different knowledge bases and we talk past each other.

[BeetleB]

> The elephant here is (aside from latent infection) the atypically long duration of treatment, which can exceed 6 months and is harsh. Many, even otherwise responsible people, will founder before the proper end of treatment and this, I think, is what terrifies health professionals - so much, that it almost seems to be avoided.

The fear is overblown. I've known multiple people do the 9 month treatment and none had issues. One person had tingling sensation and that was resolved by an increase in vitamin intake after consulting with a neurologist.

They were in their early to mid thirties. Most problems occur when older people take the medication.

[eth0up]

Don't take this as a touche, but are you suggesting that full compliance is the rule and that the vast majority completes the course as prescribed?

Again, this isn't some passive aggressive challenge. But I will be genuinely surprised to see this is indeed the case, which very well may be. I certainly know people who'd follow the course with perfection, and some who absolutely wouldn't.

[JoBrad]

On top of it being more resistant, we haven’t made very many new medicines to fight it in the last ~50 years.

[Spooky23]

Yeah… understatement with respect to TB is pretty scary. There’s a limited set of effective antibiotics, some strains are resistant, and some drugs have severe side effects.

You have to be a little suspicious of some of this — folks are looking for political reasons for scary disease outbreaks.