For World Tuberculosis Day, guest author Tomasz Benedyk  from our One Health campaign team looks at what tuberculosis is and the future implications for this fatal infectious disease.

What is tuberculosis?

Tuberculosis (TB) is an infectious disease that manifests mostly in the lungs. The causative agent is Mycobacterium tuberculosis (Mtb), a gram-negative, non-motile bacterium. Humans are the only known hosts for Mtb and it is thought that the bacteria have co-evolved and perfectly adapted to the human niche. As a result, it has co-migrated with humans to every region of the modern world.

Despite global efforts to eradicate the disease, TB is still the 9th leading cause of death worldwide and moreover, in the cases of deaths from a single infection agent, it is the actual leading cause.

Zoonotic tuberculosis

An aspect of TB that particularly requires a One Health approach is the emerging and yet ignored zoonotic tuberculosis caused by closely related bacterial species to the Mtb complex, especially Mycobacterium bovis. M. bovis is found predominantly in cattle and is clinically different from TB caused by M. tuberculosis. It has a major impact on the livelihoods of poor and marginalized communities and caused 147,000 new cases led to 12,500 deaths worldwide in 2016. However, global awareness and surveillance of this disease is low and accurate diagnosis is very limited. As such, those estimates are potentially highly imprecise.

One Health approach

• Zoonotic TB is significantly linked to the health of humans, livestock, wildlife and the environment, which makes it an ideal target for the application of the One Health approach.
• The One Health approach could assist global health agencies in developing disease control programs involving both animal and human populations by enabling the participation of various stakeholders.

What is the current situation?

• Although many of us associate TB with the past, 1.7 million people died from the disease in 2016, meaning that the scale of the problem is larger than in the previous centuries.
• Global concerns on the growing levels of microbial resistance are particularly linked to TB.
• Each year, WHO estimates 600,000 new TB cases with resistance to rifampicine – a routinely used first-line antibiotic, with over 80% of them being multi-drug resistant and leaving patients without any effective treatment.
• Discrepancies in the fatality between regions are enormous. The fatality ratio varies between 5% and 20% for African regions.

Future considerations

• Early diagnosis and prompt treatment can save lives
• Particular focus is needed for drug-resistant cases, which create the biggest potential threat for public health
• Prevention is needed especially among TB-susceptible people, such as  HIV and immuno-compromised patients
• Implementation of cutting-edge digital healthcare technology is needed to facilitate monitoring and resistance control
• Effective policies, informative public campaigns and improved teaching programmes at schools is vital to raise awareness of TB
• Intensified research is the core element of progress and innovation and both are necessary to approach all the above aims

To find out more about tuberculosis, access a range of articles from the FEMS journals on new developments in this emerging field. You can also find out more about One Health in a special FEMS Thematic Issue.