The “White Plague” of tuberculosis had always been a major killer, but became epidemic in the crowded slums of the cities of the industrial revolution.

Yet “old” diseases once thought conquered by modern men are now reemerging to be a threat, and in complicated ways.

For example, what does the the “white plague” have to do with Rachel Carson?

Well, Carson is the one who popularized ecology (good) and influenced the ban of DDT. (good). But banning DDT led to an increase in malaria in Africa and other poor countries (BAD).
Now scientists confirm that there an HIV and Malaria l ink. They note that Malaria has an adverse effect on the immune system, allowing HIV to replicate faster.

In English, if you have malaria, your body’s ability to fight and slow down HIV is weaker, so you die faster.

In the early days of HIV in the USA, gays who caught HIV in bathhouses (i.e. places associated with drug use, poor health, and the spread of other STD”s via anonymous sex) died quickly. However, even back in the 1980’s it was noted that hemophiliacs lived a lot longer.

The key seemed to be the immune system. HIV wrecks the immune system, allowing people to die of diseases that most doctors had only seen if they worked overseas or worked with cancer patients whose immune system was destroyed by disease or chemotherapy: mainly PCP pneumonia.

Due to the “cleaning up” of the gay lifestyle, and the otherwise healthy lifestyle of the white homosexual community, HIV is now considered just another chronic disease for gays. However, in the subgroup of heterosexual drug abusers and their sex partners, HIV may not be picked up as early , and so will go untreated in many. It is this reason that routine HIV testing is encouraged for pregnant women and others entering the medical system.

In Africa, however, the disease is different. Part of the difference is the heterosexual spread of the disease. There is also a suspicion that lack of circumcision is one reason for this paradox. But another under emphasized reason is that many clinics, including self proclaimed healers and traditional healers, don’t properly sterilize needles and syringes, and that traditional scarification treatments may spread the disease via unsterilized knives.

But another problem in modern Africa is the spread of Malaria. Partly this is due to increased population density as people emigrate to cities, partly due to lack of infrastructure and money to control mosquito breeding areas, and partly due to the ban on the use of cheap, non toxic (to humans) DDT thanks to the ecology movement.

Now scientists discover that Malaria also decreases the body’s immune response, allowing HIV to infect more quickly and be more lethal. Essentially, if your body has malaria, you can’t fight off the HIV infection, the HIV infection then goes on to destroy your body’s ability to fight off infection, and you are more prone to die of other disease, including malaria.

The recent recommendation of the WHO to allow limited use of DDT in Africa may help a bit. So will programs giving out insecticide treated mosquito nets to sleep under. And newer medicines, including herbal ones now widely used in China, are on the way.

So we fight, one patient at a time. Bush has increase American government funding for HIV treatment to Africans. and Clinton is busy getting private funding to do the same.

Except as a plea to open our pocketbooks in this Christmas season, none of this is about to interfere with the daily lives of most sexually monogamous non drug using Americans or Europeans. However, there is another scenario partly related to HIV that is quite scary: multi drug resistant tuberculosis.

You see, 90 percent of people exposed to tuberculosis will never come down with the disease because their body “fights off” the infection. For those who develop the disease, anti tuberculosis drugs will knock out the germ, but often a few stray germs are left, so the body’s immune system will “wall them off”. Years later, if your immune system is weak, they can break out and “reactivate”, leading to active TB.  And there are many people who were exposed to TB as a child, but whose immune system walled it off, so they never developed the disease.  If that person later develops Diabetes or another chronic disease, or takes immune suppression therapy for Rheumatoid arthritis or needs cancer chemotherapy. Since few Americans have been exposed, this is not a major problem except among immigrants and Native Americans.

I should note that one way to decrease such “reactivation” is to treat people with positive skin tests to TB, to kill off any stray germs left behind by six months of the drug INH. The treatment has side effects in people over age 30, so whether to treat or not is a clinical decision.

However, in Africa, most people have been exposed to TB, and few receive treatment. Some who develop HIV will have their TB infection burst out again. The bad news: we can treat it, but not cure it. When your immune system will not “help” kill off the germs, the germs remain weak but active, ready to restart the moment antibiotics are stopped. The end result is multi drug resistant TB, tuberculosis that cannot be cured with medicine.

Multidrug resistant TB  could again spread to other populations. A single food handler at one institution could spread it to a hundred people, and outbreaks at daycare centers, long term institutions, and even those eating in a cafeteria in the US Congress have been reported at various times. If the TB strain spread was multidrug resistant, such epidemics could skyrocket and the “white plague”, as TB was known 100 years ago, could return.

Nancy Reyes is a retired physician living in the rural Philippines with her husband, Her blogspot is Finest Kind Clinic and Fishmarket and she sometimes writes about medicine on Hey Doc’s Xanga site

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