WEBVTT - Ep 9 Tuberculosis: A Slow Burn 0:00:04.120 --> 0:00:07.680 There is a dread disease which so prepares its victims, 0:00:07.720 --> 0:00:12.000 as it were, for death. A dread disease in which 0:00:12.039 --> 0:00:17.840 the struggle between soul and body is so gradual, quiet, solemn, 0:00:18.120 --> 0:00:21.439 and the result so sure that, day by day and 0:00:21.560 --> 0:00:25.680 grain by grain, the mortal part wastes and withers away, 0:00:26.239 --> 0:00:30.400 so that the spirit grows light. A disease in which 0:00:30.520 --> 0:00:34.560 death and life are so strangely blended that death takes 0:00:34.560 --> 0:00:38.479 the glow and hue of life, and life the gaunt 0:00:38.880 --> 0:00:43.640 and grisly form of death. A disease which medicine never cured. 0:00:44.200 --> 0:00:48.520 Wealth warded off or poverty could boast exemption from which 0:00:48.560 --> 0:00:52.440 sometimes moves in giant strides, or sometimes at a tardy, 0:00:52.640 --> 0:00:57.200 sluggish pace, but slower quick. It is ever sure and. 0:00:57.280 --> 0:01:08.200 Certain that that was incredible. 0:01:08.959 --> 0:01:10.000 That was very dramatic. 0:01:10.840 --> 0:01:12.160 Yeah, you did a great job. 0:01:12.240 --> 0:01:12.600 Thank you. 0:01:13.080 --> 0:01:14.280 So what is that from? 0:01:14.560 --> 0:01:19.080 That was from Charles Dickens eighteen seventy nine novel Nicholas Nickleby, 0:01:19.560 --> 0:01:22.440 in which he described tuberculosis. 0:01:22.840 --> 0:01:23.920 Is that why we're here this week? 0:01:24.040 --> 0:01:27.080 That's why we're here this week? Good? 0:01:27.080 --> 0:01:28.440 I think that set us up nicely. 0:01:28.560 --> 0:01:31.280 I think so too. Hi, everybody, welcome. 0:01:31.120 --> 0:01:33.200 Hi, welcome to this podcast, Will Kill. 0:01:33.000 --> 0:01:37.120 You, Episode nine nine. Holy cow. 0:01:37.319 --> 0:01:37.600 I know. 0:01:38.200 --> 0:01:40.520 I'm Aaron Welsh and I'm Erin almon Updyke. 0:01:40.920 --> 0:01:41.959 Thanks for joining us. 0:01:42.360 --> 0:01:47.760 We're very excited. All right. 0:01:48.440 --> 0:01:50.120 Do we have any business to take care of? I 0:01:50.120 --> 0:01:53.840 don't know, do we? Okay, I actually do. 0:01:54.080 --> 0:01:55.680 Oh, I have a self correction. 0:01:55.880 --> 0:02:00.200 Okay, two weeks ago or whenever malaria came out, that 0:02:00.240 --> 0:02:00.920 will be two. 0:02:00.720 --> 0:02:04.840 Weeks ago from when you're listening to this. Yeah. 0:02:05.240 --> 0:02:09.320 I kept using the word sincone to talk about these 0:02:09.480 --> 0:02:14.040 Actually the Sincona tree, which is the tree that whose 0:02:14.080 --> 0:02:18.320 bark contains quinine. So I just you know, whoops. 0:02:18.480 --> 0:02:22.320 It happened. Pronunciations are hard. It's sincona, you know. 0:02:22.960 --> 0:02:27.040 I just needed to I needed to say that. Yeah, 0:02:27.040 --> 0:02:30.080 And I think the other bit of business is, you know, 0:02:30.120 --> 0:02:33.200 I hope everyone is having a great winter break. 0:02:33.440 --> 0:02:35.720 Yeah, if you have that. If you have a break, 0:02:35.800 --> 0:02:39.480 we do for now. So yeah, and have a happy 0:02:39.480 --> 0:02:42.600 New Year. Oh it's already New Year's by now. Yeah, 0:02:42.760 --> 0:02:47.080 this is January tewod Yeah, happy happy. Oh my god, 0:02:47.120 --> 0:02:49.720 it's twenty eighteen. I wonder what it's like like. We 0:02:49.760 --> 0:02:52.040 don't know now because it's not there yet. 0:02:52.080 --> 0:02:55.080 Yeah, I mean maybe everything's magically better. 0:02:55.200 --> 0:02:56.800 Oh, wouldn't that be wonderful? 0:02:57.480 --> 0:03:00.800 All right, wow, well, on that note, let's start drinking. 0:03:00.919 --> 0:03:04.240 Well, let's do it. What are we drinking? Quarantiney time? 0:03:04.800 --> 0:03:13.960 We are drinking alcohol consumption. So thus named because tuberculosis 0:03:14.000 --> 0:03:18.000 was often referred to as consumption, particularly in like the 0:03:18.200 --> 0:03:20.239 seventeen eighteen hundreds. 0:03:20.320 --> 0:03:22.240 Oh that's cool. I never knew the time period of it. 0:03:22.280 --> 0:03:23.919 I just knew like back in the day. 0:03:24.639 --> 0:03:27.120 Yeah, I mean that's a rough estimate. 0:03:27.440 --> 0:03:32.800 I'll go with it. Seventeen hundreds, chios darling. Yeah, I 0:03:32.800 --> 0:03:34.920 don't think it's gonna I don't know if it's not 0:03:34.960 --> 0:03:38.480 a good clink. They're coffee mugs. Oh. By the way, 0:03:38.480 --> 0:03:42.560 an alcohol consumption is essentially a hot toddy, And as always, 0:03:42.560 --> 0:03:44.600 we'll post the recipe on all of our social media, 0:03:44.800 --> 0:03:46.200 so check it out. 0:03:46.960 --> 0:03:47.800 It's delicious. 0:03:47.920 --> 0:03:48.640 It is really good. 0:03:48.640 --> 0:03:51.360 It's way better than I was expecting. That's gonna be 0:03:51.400 --> 0:03:52.160 my winter drink. 0:03:52.400 --> 0:04:07.320 Yeah, it's a good winter drink. So tuberculosis. Tuberculosis a 0:04:07.440 --> 0:04:11.440 big nasty. It's a bigger nasty than I realized. 0:04:11.640 --> 0:04:14.040 I'm thrilled to hear all about the biology of it. 0:04:14.120 --> 0:04:16.640 So take us away, let's do it. 0:04:17.480 --> 0:04:22.760 So tuberculosis is caused by a bacterium. It's not so 0:04:23.000 --> 0:04:25.159 very different from one that we've seen already. Do you 0:04:25.200 --> 0:04:30.360 remember which one so many weeks ago leprosy leprosy, So 0:04:30.600 --> 0:04:34.960 tuberculosis is another bacterium in the same genus, Mycobacterium, this 0:04:35.120 --> 0:04:38.159 time Mycobacterium tuberculosis. So they name them so that you 0:04:38.200 --> 0:04:43.400 can remember them easily. It probably evolved from a cattle bacteria. 0:04:43.640 --> 0:04:44.960 I don't know if you're going to talk about its 0:04:44.960 --> 0:04:48.440 evolutionary history later, very briefly, all right, so we'll very 0:04:48.440 --> 0:04:52.280 briefly cover it here too. Probably evolve from cattle bacteria. 0:04:52.600 --> 0:04:56.359 There's actually still cases of zoonotic tuberculosis that are caused 0:04:56.400 --> 0:05:01.720 by the bacterium that normally causes bovine tb very similar bacteria, 0:05:01.760 --> 0:05:06.680 also similar to leprosy. Tuberculousis is transmitted via respiratory droplets, 0:05:07.080 --> 0:05:09.880 so you cough or whatever, and the spittle that you 0:05:09.920 --> 0:05:13.080 spit out is full of bacteria and when it gets 0:05:13.080 --> 0:05:17.440 into someone's face or also, and this is what's different 0:05:17.480 --> 0:05:23.799 than leprosy, tb can hang out in the actual air 0:05:25.440 --> 0:05:28.320 because they're teeny tiny, little particles, so you can cough. 0:05:28.360 --> 0:05:30.640 If you have TB, and you cough a bunch and 0:05:30.680 --> 0:05:36.480 then another person walks into the room and breathes, they 0:05:36.520 --> 0:05:37.120 can get TB. 0:05:37.560 --> 0:05:40.400 That is a nightmare. I know, that's a horror movie. 0:05:40.520 --> 0:05:44.400 It's crazy. But what's really interesting about TB is that 0:05:44.520 --> 0:05:47.919 if you get infected, you only have about a five 0:05:48.000 --> 0:05:51.720 to fifteen percent chance of actually developing active TV, which 0:05:51.760 --> 0:05:56.160 is the disease TB. So TB can get a little 0:05:56.160 --> 0:05:59.839 bit confusing. So I'm gonna do something a little different today. Okay, 0:06:00.080 --> 0:06:02.799 I'm gonna walk you through what happens in your body 0:06:02.839 --> 0:06:05.120 when you get exposed to tuberculosis. 0:06:05.120 --> 0:06:06.320 Oh my gosh, I'm so excited. 0:06:06.360 --> 0:06:12.640 Oh good, I'm excited that you're excited. Okay. So, so 0:06:13.320 --> 0:06:17.080 you're a little micobacteria. Okay, Hi, I'm going to call 0:06:17.080 --> 0:06:20.760 you teebs. Oh my gosh. Cute. Right, So you're just 0:06:20.839 --> 0:06:25.800 swimming along and then all of a sudden, cho uh oh, 0:06:25.839 --> 0:06:31.520 you get sneezed out into the open air. Luckily, the 0:06:31.520 --> 0:06:34.760 person that you came from was a close talker. So 0:06:34.839 --> 0:06:38.320 you end up flying pretty I know, right, You end 0:06:38.360 --> 0:06:41.960 up flying pretty much directly into the face of a 0:06:42.000 --> 0:06:43.719 brand spanking new human. 0:06:44.120 --> 0:06:46.320 I hope this one is also a close talker, because 0:06:46.480 --> 0:06:47.160 I want to be. 0:06:47.240 --> 0:06:51.920 Exposed to as many people as possible. You will be okay. 0:06:51.960 --> 0:06:54.200 So now here you are with a few of your 0:06:54.200 --> 0:06:56.640 friends that you brought with you, and you find yourself 0:06:56.640 --> 0:06:59.039 in the upper respiratory tract of a new human. 0:06:59.400 --> 0:07:01.200 It's pretty cool, right, Yeah. 0:07:01.360 --> 0:07:04.039 You get settled in, you make yourself at home near 0:07:04.080 --> 0:07:06.520 a bunch of cells that make mucus that are kind 0:07:06.560 --> 0:07:08.800 of trying to get rid of you. It's not exactly 0:07:08.839 --> 0:07:12.680 a warm welcome. They're like beating, they're cilia at you, like, 0:07:13.000 --> 0:07:16.120 who the heck are you? Get out of here? Hey? Man? 0:07:16.600 --> 0:07:18.120 Yeah right, let me hang out here. 0:07:18.120 --> 0:07:18.880 It's no big deal. 0:07:18.920 --> 0:07:22.120 And for most people, or for most bacteria rather, that 0:07:22.160 --> 0:07:25.080 would be enough. They're like, man, I just can't take this. 0:07:25.120 --> 0:07:27.040 I'm out of here and that's the end of the story. 0:07:27.200 --> 0:07:28.880 But I'm not most bacteria, am I? 0:07:28.920 --> 0:07:33.160 No, You're not, little tebes, You're really not all all right? 0:07:33.240 --> 0:07:36.000 So you made it past the beaters and the bloodgers 0:07:36.520 --> 0:07:40.640 up in the upper respiratory drag and you're finding your 0:07:40.680 --> 0:07:43.000 way down to the bottom of the lungs the alveoli, 0:07:43.640 --> 0:07:45.680 all right, these are the pockets in your lungs where 0:07:45.680 --> 0:07:47.320 the gas exchange actually happens. 0:07:47.360 --> 0:07:48.320 And that's what I want. 0:07:48.440 --> 0:07:50.960 That's where you want to be. So you make it there, 0:07:51.360 --> 0:07:56.640 and then all of a sudden, some freaking macrophages. Oh right, 0:07:56.680 --> 0:08:00.120 they're basically like pac men. Okay, they're giant pass back 0:08:00.440 --> 0:08:03.120 and they come in and they are literally trying. 0:08:03.120 --> 0:08:05.200 To eat you. Uh huh. I'm not going to stand 0:08:05.200 --> 0:08:06.080 for that exactly. 0:08:06.440 --> 0:08:09.720 So at this point, your human host he knows you're there, 0:08:10.080 --> 0:08:12.920 right they I mean, they probably don't actually, but their 0:08:13.000 --> 0:08:17.440 their immune system does. So the immune system is now 0:08:17.520 --> 0:08:22.000 basically surrounding you. You and your brothers and your friends 0:08:22.320 --> 0:08:25.320 are just like surrounded by the immune system. 0:08:25.480 --> 0:08:26.120 Uh oh. 0:08:26.160 --> 0:08:29.160 So in a lot of stories, this would be the end. 0:08:29.560 --> 0:08:31.080 The human would kick the infection. 0:08:31.920 --> 0:08:34.360 But is this not most stories? 0:08:34.600 --> 0:08:38.400 This is not most stories. Yes, you little tubes, you 0:08:38.559 --> 0:08:42.640 keep right on kicking. Oh man, you just slowly multiply, 0:08:43.320 --> 0:08:46.319 not as slow as your cousin mike lepre remember him. 0:08:46.360 --> 0:08:49.680 Oh yeah, oh mikey man, what a slow poke, real slow. 0:08:49.960 --> 0:08:52.280 But you're you know, you're pretty slow too. Maybe once 0:08:52.320 --> 0:08:54.640 every twenty five thirty two hours you. 0:08:54.640 --> 0:08:57.079 Might divide, you know, that's fast for some people. 0:08:58.040 --> 0:09:03.320 Your right tubes. Sure, So the immune system just keeps 0:09:03.360 --> 0:09:06.320 trying to fight you off, and you just keep slowly growing. 0:09:06.640 --> 0:09:10.240 And this goes on and on for like two maybe 0:09:10.400 --> 0:09:13.160 twelve weeks. Somewhere in that range. 0:09:13.280 --> 0:09:16.199 Man, we're like at a standoff. Yes you really are, 0:09:16.640 --> 0:09:19.440 but I'm secretly back there, just like building my army. 0:09:19.440 --> 0:09:23.800 Just building building, And eventually you end up pretty trapped 0:09:23.880 --> 0:09:27.920 in a little ball, surrounded by immune cells. The tissue 0:09:27.920 --> 0:09:31.560 around you might become necrotic, it might die a little bit, 0:09:32.040 --> 0:09:35.679 the pH might drop, and the environment will become really acidic. 0:09:36.040 --> 0:09:39.640 They'll stop sending food to you, but you just keep living. 0:09:39.720 --> 0:09:43.000 That's not fair. It's not fair. But you don't do anything. 0:09:43.280 --> 0:09:46.000 You're not even growing much anymore. You're just still there. 0:09:46.679 --> 0:09:50.040 I can just picture myself leaning back, elbows crossed, like, 0:09:50.120 --> 0:09:53.360 go on, keep coming exactly everything you got at me. 0:09:54.040 --> 0:09:58.200 And this, my friends, is the latent stage of tuberculosis. 0:09:59.520 --> 0:10:02.360 So you're here isn't infectious at this point, But that 0:10:02.400 --> 0:10:03.280 doesn't mean you're dead. 0:10:03.400 --> 0:10:03.840 Mm mmm. 0:10:04.320 --> 0:10:08.160 You're just biding your time because eventually, your human host 0:10:08.679 --> 0:10:12.080 it's gonna get old. Listen, Patience is a virtue. Exactly. 0:10:12.559 --> 0:10:14.760 They're gonna get old or they're gonna get sick, and 0:10:14.760 --> 0:10:17.880 then those immune cells around you are gonna have to 0:10:17.920 --> 0:10:20.800 go off and deal with the oldness and the sickness, 0:10:21.440 --> 0:10:24.160 and you, well, your time has. 0:10:23.960 --> 0:10:26.319 Come just when their backs are turned. 0:10:27.360 --> 0:10:30.360 So you'll break free with your friends and your family, 0:10:30.400 --> 0:10:35.160 and you'll go forth and you'll multiply, and that is 0:10:35.160 --> 0:10:37.600 when you get an active TB infection. 0:10:37.840 --> 0:10:44.000 Oh yeah, that fun I loved that good. I could 0:10:44.040 --> 0:10:46.840 see it perfectly, so much better than osmosis Jones. 0:10:47.000 --> 0:10:49.440 Right, make that a movie. Oh my god, I forgot 0:10:49.480 --> 0:10:51.160 about osmosis Jones. 0:10:52.640 --> 0:10:55.280 So I remember our eighth grade science teacher got real 0:10:55.360 --> 0:10:57.160 up in arms about it because it should be really 0:10:57.200 --> 0:10:58.480 called diffusion Jones. 0:10:58.600 --> 0:11:01.840 I remember the sides teachers saying the same thing. 0:11:01.760 --> 0:11:04.120 Because osmosis is only water, right exactly. 0:11:04.559 --> 0:11:05.640 Oh man, that's funny. 0:11:05.800 --> 0:11:07.120 Anyway, that was fantastic. 0:11:07.200 --> 0:11:09.560 Oh good, I'm glad. So that is sort of how 0:11:09.679 --> 0:11:15.000 TB initially happens. So do you want to talk about 0:11:15.000 --> 0:11:15.600 the symptoms? 0:11:15.760 --> 0:11:18.880 Yeah, so am I what's happening now that I'm inside 0:11:19.160 --> 0:11:19.920 somebody else? 0:11:20.120 --> 0:11:24.319 Great question. So the symptoms associated with active TB are 0:11:24.360 --> 0:11:29.280 actually pretty nonspecific, but they are really long lasting, so 0:11:29.320 --> 0:11:34.160 you often end up with progressive fatigue, malaise, general weakness, 0:11:34.520 --> 0:11:38.520 maybe some weight loss. You'll definitely get a cough, right 0:11:38.640 --> 0:11:42.600 because teabes and all of your friends and family are 0:11:42.679 --> 0:11:47.840 just filling your lungs with bacteria. You'll probably have fever, 0:11:48.240 --> 0:11:51.280 night sweats. You probably don't have much of an appetite 0:11:51.400 --> 0:11:54.400 since your immune response is like on high alert. So 0:11:54.400 --> 0:11:56.199 that's why you end up losing a lot of weight. 0:11:57.160 --> 0:12:01.679 And that cough might be not descript and unproductive at first, 0:12:01.720 --> 0:12:05.040 but it eventually will end up with what they call 0:12:05.400 --> 0:12:07.359 purulent sputum. 0:12:07.920 --> 0:12:10.120 That does not that does not sound good. 0:12:10.040 --> 0:12:13.400 Right, and it's often bloody. You've seen the movie, right, 0:12:13.880 --> 0:12:19.000 the movie mo On Moge. Oh, yes, yeah, you've seen that. 0:12:19.080 --> 0:12:21.520 You've probably seen a hundred other movies where somebody dies 0:12:21.559 --> 0:12:23.320 of TB. And the way that you know they're dying 0:12:23.320 --> 0:12:25.439 of TB is they're coughing up blood. And you're like, well, 0:12:25.600 --> 0:12:26.040 there you go. 0:12:26.240 --> 0:12:30.960 I just watched Bleak House, the BBC production, and yeah, 0:12:31.200 --> 0:12:31.720 I don't. 0:12:31.559 --> 0:12:32.160 Know what that is. 0:12:32.200 --> 0:12:33.679 It's a Charles Dickens novel. 0:12:34.000 --> 0:12:35.800 And not Nicholas Nickleby. 0:12:36.080 --> 0:12:39.440 Yeah, anyway, yeah, and so one of the characters spoilers. 0:12:39.440 --> 0:12:41.719 But the book's been out for like over one hundred. 0:12:41.520 --> 0:12:44.280 Hundred years, forty years. Yes, dies of TV. It's not 0:12:44.360 --> 0:12:47.440 much of a spoiler at that point. Yeah. So the 0:12:47.480 --> 0:12:51.840 infection might be mild for like months. You literally could 0:12:51.840 --> 0:12:56.680 be coughing up teabs and friends and family for months 0:12:56.720 --> 0:12:58.640 without going to the doctor because you're like, oh, I've 0:12:58.640 --> 0:13:01.840 got bronchitis or I just have it called or whatever. 0:13:02.440 --> 0:13:06.320 So remember when we talked about are not the number 0:13:06.360 --> 0:13:09.800 of secondary infections that you get from a single infectious person? Right? 0:13:09.960 --> 0:13:11.120 Guess what it is for TV? 0:13:11.600 --> 0:13:15.880 Ooh, and this is under current circumstances, like in today's 0:13:16.280 --> 0:13:17.160 population level. 0:13:17.200 --> 0:13:19.199 You know, that's a good question. This number is from 0:13:19.240 --> 0:13:21.439 the World Health Organization, So I would guess that it's 0:13:21.480 --> 0:13:25.280 in current Okay, if a person goes like undetected and untreated. 0:13:25.360 --> 0:13:27.079 Okay, So I'm gonna guess that are not so the 0:13:27.160 --> 0:13:31.319 number of people that one infectious person can infect with TV? 0:13:31.640 --> 0:13:36.760 Yeah, I'm gonna guess three. Wow, keep going, six. 0:13:37.160 --> 0:13:40.280 Keep going nine, keep going ten. 0:13:40.480 --> 0:13:45.679 Ten to fifteen. Literally you could infect ten to fifteen 0:13:45.720 --> 0:13:48.320 people with TV over the course of a year. My 0:13:48.520 --> 0:13:52.920 jaw drops, I know, and without treatment, the mortality rate 0:13:53.400 --> 0:13:56.959 is forty five percent. I did not I really did 0:13:57.000 --> 0:13:57.520 not know that. 0:13:57.880 --> 0:14:00.040 I have so many questions, but I know that the 0:14:00.160 --> 0:14:03.240 all going to be answered in the current events. So 0:14:03.280 --> 0:14:04.840 I'm just gonna have to hold them in. 0:14:04.800 --> 0:14:10.880 Hold them in, hold them so tight. Yeah. Wow, I know, 0:14:11.040 --> 0:14:14.120 Like I knew that back in the day everybody died 0:14:14.160 --> 0:14:17.360 it was either syphilis or TV that everyone was dying from, 0:14:17.600 --> 0:14:20.280 But I really didn't know that the mortality rate was 0:14:20.400 --> 0:14:21.200 that high. 0:14:21.360 --> 0:14:23.560 It also sounds like a really horrible way to die. 0:14:23.600 --> 0:14:27.520 It's also that's the mortality rate if your immunal competent ooh, 0:14:27.800 --> 0:14:30.880 people with HIV are twenty to thirty times more likely 0:14:30.920 --> 0:14:34.000 to develop active TB and it's almost one hundred percent fatal. 0:14:34.200 --> 0:14:38.120 Twenty to thirty times more likely to develop exactly TB. Yeah, 0:14:38.160 --> 0:14:39.680 and one hundred percent fatal. 0:14:39.400 --> 0:14:41.720 And almost every one of them will die. Like it's 0:14:42.320 --> 0:14:47.000 that's really awful. It's really gnarly. And so, while the 0:14:47.040 --> 0:14:51.200 respiratory system is the most commonplace that tuberculosis invades and 0:14:51.200 --> 0:14:54.920 effects because the root of transmission is respiratory, it's not 0:14:55.080 --> 0:14:58.880 the only place you can get some weird TV as 0:14:58.920 --> 0:15:03.280 it turns out they call it extra pulmonary tb M. 0:15:03.520 --> 0:15:05.680 This is sounding weird, right, keep going. 0:15:05.920 --> 0:15:09.920 It's basically just when you have Mycobacterium tuberculosis growing in 0:15:10.040 --> 0:15:14.160 literally any tissue that's not your lungs, it's considered extra pulmonary. 0:15:14.480 --> 0:15:17.760 The most serious of these, as you might guess because 0:15:17.760 --> 0:15:20.240 it's kind of the most serious place for any creature 0:15:20.320 --> 0:15:22.680 to invade, is your central nervous system. 0:15:22.800 --> 0:15:23.400 Aha. 0:15:23.480 --> 0:15:25.880 So you can end up with meningitis. They call it 0:15:25.960 --> 0:15:30.320 tubercular meningitis. Ok And we've talked about meningitis before. It's 0:15:30.360 --> 0:15:33.120 basically just an inflammation of the outer layer that surrounds 0:15:33.120 --> 0:15:36.040 your brain and spinal cord, your mining's You can also 0:15:36.200 --> 0:15:40.200 end up with essentially almost tumors where you have tons 0:15:40.240 --> 0:15:43.320 of bacteria surrounded by immune cells that just take up 0:15:43.440 --> 0:15:46.920 space in your nervous system, which you can imagine is 0:15:47.000 --> 0:15:47.960 really problematic. 0:15:48.240 --> 0:15:50.360 Yeah. What happens in that case, like do you become 0:15:50.480 --> 0:15:53.680 paralyzed in certain areas or just lose motor function. 0:15:54.360 --> 0:15:58.760 They're called space occupying tuberculomas, Okay, which I'm as far 0:15:58.760 --> 0:16:00.520 as I know, is just a granulma that takes up 0:16:00.560 --> 0:16:03.320 space in your central nervous system, so I would guess 0:16:03.360 --> 0:16:05.320 that you're going to have some kind of nervous involvement, 0:16:05.360 --> 0:16:08.680 but I didn't really look that much into the symptoms 0:16:08.720 --> 0:16:12.120 of it. That's okay. Sorry. Another form of extra pulmonary 0:16:12.200 --> 0:16:15.360 TV that's almost always fatal is when it invades your bloodstream. 0:16:15.520 --> 0:16:20.000 Ooh yeah. You can imagine that having having any bacteria 0:16:20.120 --> 0:16:23.520 grow in your bloodstream is pretty much bad news. And this, 0:16:23.560 --> 0:16:26.680 which is called disseminated TV, is particularly hard to deal 0:16:26.760 --> 0:16:29.800 with because it progresses really rapidly and it's really difficult 0:16:29.840 --> 0:16:34.760 to diagnose. So that sucks. Yeah, that sounds terrible. Yeah. 0:16:34.880 --> 0:16:39.360 Side note is that also is disseminated also called milliary yes, okay. 0:16:39.160 --> 0:16:41.600 Yeah, disseminated TV is also called milliary TV. 0:16:41.720 --> 0:16:44.320 Okay. I kept seeing that pop up in different areas 0:16:44.320 --> 0:16:46.240 than I was like, and yeah, yeah, but it sounded 0:16:46.280 --> 0:16:47.520 like the same thing. And you know why they call 0:16:47.520 --> 0:16:49.720 it milliary, no tell me, because they look. 0:16:49.600 --> 0:16:55.479 Like little millet seeds. So it disperses through your body garrody, yep, garrody. 0:16:55.520 --> 0:16:58.320 You also can get invasion of your lymph system, which 0:16:58.400 --> 0:17:00.840 is actually the most common form of extra pulmonary TV. 0:17:01.240 --> 0:17:04.479 It can infect your bones, your joints, your GI tract, 0:17:04.920 --> 0:17:08.680 your genital tract. Ooh yeah, genital TB is a thing. 0:17:08.960 --> 0:17:11.760 You also can get TB in your skin like it 0:17:11.880 --> 0:17:12.840 just can grow everything. 0:17:12.880 --> 0:17:15.760 You just like throw a dart at a body, and 0:17:15.800 --> 0:17:20.520 you can have TB in any part of that ooh yep, yikes. 0:17:20.680 --> 0:17:27.440 But it's primarily pulmonary. It is primarily pulmonary lungs. Lungs. Yeah, 0:17:27.480 --> 0:17:30.119 and that's basically what I think you want to know 0:17:30.160 --> 0:17:33.080 about the biology of tuberculosis. What do you think. 0:17:33.320 --> 0:17:35.840 I think that's great. I mean, I think you did great. 0:17:36.000 --> 0:17:37.840 I think tuberculosis is terrible. 0:17:37.880 --> 0:17:42.080 It is. Yeah, it's more terrible than I even realized. Yeah, 0:17:42.080 --> 0:17:46.560 that's true of almost almost every disease that we've talked about. Yep. Yeah. 0:17:46.600 --> 0:17:49.560 It turns out the more you read, the more you're horrified. 0:17:49.280 --> 0:17:51.680 The more you know, the more you know, the satter 0:17:51.720 --> 0:17:54.840 you'll be want to stay home and never touch anyone. 0:17:55.280 --> 0:17:56.560 Yeah, not to mention airplanes. 0:17:56.720 --> 0:18:09.960 Oh my god. So you want to tell me how 0:18:09.960 --> 0:18:10.639 this all started? 0:18:10.840 --> 0:18:13.080 I absolutely do you know that. I do. 0:18:13.200 --> 0:18:13.479 I know. 0:18:14.000 --> 0:18:18.120 Okay, every week I start with where the earliest evidence 0:18:18.119 --> 0:18:21.399 for infection can be found for whatever disease we're talking about. 0:18:21.760 --> 0:18:22.680 Can I guess? Can I guess? 0:18:22.800 --> 0:18:27.199 I was gonna say, yeah, please guess is it? No? 0:18:27.200 --> 0:18:29.320 No? No, no, Egypt you got it? 0:18:31.040 --> 0:18:36.840 Winn winner Yep, yeah, Egyptian mummies. As per usual, tuberculosis 0:18:36.920 --> 0:18:39.600 leaves traces of infection on bone, kind of like its 0:18:39.680 --> 0:18:45.000 cousin disease, leprosy. So researchers can actually do post mortem 0:18:45.040 --> 0:18:48.880 diagnosis on skeletons that are thousands of years old, which 0:18:48.920 --> 0:18:50.080 is really cool. 0:18:50.200 --> 0:18:50.960 That's amazing. 0:18:51.560 --> 0:18:55.280 Okay, So we've got skeletal evidence of tuberculosis in Egyptian 0:18:55.359 --> 0:18:59.439 mummies dating from around thirty seven hundred BC. We've also 0:18:59.560 --> 0:19:02.879 got keletal evidence of TB dating back a few thousand 0:19:02.960 --> 0:19:06.320 years in other Old World regions such as India and China. 0:19:06.640 --> 0:19:07.200 Wow. 0:19:07.560 --> 0:19:12.320 But oh, another thing we have, and this is really exciting. 0:19:12.640 --> 0:19:16.360 We have skeletal evidence of tuberculosis in a mummy from 0:19:16.440 --> 0:19:21.040 Peru dating back to almost three thousand years ago. No, 0:19:21.720 --> 0:19:25.439 that means that tuberculosis was in the America's long before 0:19:25.520 --> 0:19:26.600 the European invasion. 0:19:27.119 --> 0:19:27.199 What. 0:19:27.760 --> 0:19:28.800 Yeah, isn't that insane? 0:19:28.800 --> 0:19:33.119 Wait, that's really cool. I mean, it's that's really interesting. 0:19:34.160 --> 0:19:37.639 Yeah, it's incredible. So from what I read It could 0:19:37.680 --> 0:19:40.359 have either been brought over during the early migrations to 0:19:40.560 --> 0:19:43.119 North and South America, or it could have evolved to 0:19:43.160 --> 0:19:46.640 infect humans from the cattleborn version of tuberculosis like you mentioned, 0:19:47.160 --> 0:19:50.880 which was present in ungulates during that time, like alpaca 0:19:51.040 --> 0:19:52.480 or lamas or bison. 0:19:52.680 --> 0:19:54.920 So would that mean that there was like more than 0:19:55.000 --> 0:19:59.320 one evolution of tuberculosis. I don't know if that's the case. 0:19:59.359 --> 0:20:01.680 So the thing is, I don't know the different clinical 0:20:01.720 --> 0:20:06.239 manifestations of the cattle born version of the disease and 0:20:06.320 --> 0:20:07.960 what was on the skeletal remains. 0:20:08.400 --> 0:20:10.960 Okay, but you maybe can't tell in a mummy if 0:20:10.960 --> 0:20:14.200 it was maybe from above I TV versus like actual 0:20:14.320 --> 0:20:17.080 microbactium tuberculosis exactly interesting. 0:20:17.200 --> 0:20:17.879 So I don't know. 0:20:18.119 --> 0:20:18.680 Oh that's so. 0:20:18.720 --> 0:20:23.280 Cool though, Yeah, very cool. Wow. Ancient Greek physicians described 0:20:23.359 --> 0:20:27.120 the pulmonary form of tuberculosis and called it tysis, which 0:20:27.160 --> 0:20:31.919 is spelled horribly all right, you ready ready pH th 0:20:32.160 --> 0:20:33.360 I S, I S. 0:20:33.720 --> 0:20:34.639 Yeah, that's a pH and. 0:20:34.680 --> 0:20:37.919 The thh at the beginnings. I had to look it up. 0:20:37.920 --> 0:20:39.160 I'm pretty sure it's tysis. 0:20:39.240 --> 0:20:41.280 You always look up how to pronounce things, and I don't, 0:20:41.320 --> 0:20:42.960 so probably people are like oh God. 0:20:45.800 --> 0:20:48.320 Also, it just seemed too ridiculous to have to pronounce 0:20:48.320 --> 0:20:55.440 it pthysis phthysis. Well, and anyway, tysus means wasting away, 0:20:55.880 --> 0:20:57.840 which is kind of the precursor of consumption. 0:20:58.040 --> 0:20:58.320 Yep. 0:20:58.640 --> 0:21:02.280 Tuberculosis and ancient Greece was devastating enough to be written 0:21:02.320 --> 0:21:05.520 about for hundreds of years, and writers often noted that 0:21:05.600 --> 0:21:07.960 children were particularly affected by the disease. 0:21:08.359 --> 0:21:09.800 Oh yeah, yep. 0:21:09.640 --> 0:21:12.879 And their method for treating TV blood letting. Of course, 0:21:13.119 --> 0:21:17.879 of course, ancient Greek physicians believed that disease was caused 0:21:17.880 --> 0:21:21.000 by an imbalance in one of the four humors of 0:21:21.040 --> 0:21:25.120 the body, one of them being blood. So when someone 0:21:25.320 --> 0:21:30.360 started coughing up a bunch of blood and showing their doctor, 0:21:30.560 --> 0:21:33.000 the doctor was like, Ugh, you know, you've got too 0:21:33.080 --> 0:21:34.400 much blood in your body. 0:21:34.160 --> 0:21:34.760 Way too much. 0:21:35.000 --> 0:21:35.639 I can't help me. 0:21:37.000 --> 0:21:38.080 Let's get that back. 0:21:38.640 --> 0:21:42.640 Give me your arm, No big deal, oh dear. Obviously 0:21:42.680 --> 0:21:45.120 this did nothing to help the patient and probably made 0:21:45.119 --> 0:21:48.200 them sicker, but I guess you can't really fault them 0:21:48.200 --> 0:21:51.680