The Many Faces of Tuberculosis: A Web-based
Exploration
Elliott Gimble, Life Science/HHMI Outreach Program
Summer, 2008
Introduction: Microbes are typically defined as tiny forms of life too
small to be seen without a microscope. These include members of the
bacteria, archaea, fungi, and protists. (Viruses also fit this description
but cannot reproduce on their own and so, are not considered living
organisms on their own.) Though we cannot see them, they are vital to
life on earth, even life inside your body. Ninety percent of the cells
that make up your body are, in fact, bacteria.
Appreciating microbes is important for many reasons. They play ecological roles fixing
nitrogen and decomposing dead organic material. They live symbiotically (together) with
others, including humans, providing key nutrients for example. Some can boost the
immune system and some can cause disease or even death.
This web-based activity will introduce the details of a microbial disease with a huge
impact. Tuberculosis (TB) has already infected 2 billion people (1 out of every 3 people
on Earth) and it kills 2 million people each year. For 90% of those infected,
Mycobacterium tuberculosis (the bacteria that causes TB) will lie dormant in the body
and remain inactive, possibly throughout their lifetimes. For others it can cause chronic
cough -- which may involve coughing up blood, pain in the chest, holes in the lung, and,
if not properly treated, death. HIV patients are especially vulnerable to tuberculosis and
it is a leading cause of death for those with HIV. Meanwhile, improved patient care and
a global response are urgently needed to counter the rise of TB pathogens resistant to
antibiotics and other treatments. (NIAID, 2005)
(www3.niaid.nih.gov/topics/tuberculosis/Research/introduction.htm)
Activity Roadmap:
Part 1. Review of the Immune System
Part 2. TB – The pathogen and the disease
Part 3. Resistance Rising
Part 4. Global Impacts
Part 5. Additional options (tutorial/slide show, games,
discussion articles)
QuickTime™ and a
TIFF (Uncompressed) decompressor
are needed to see this picture.
http://en.wikipedia.org/wiki/Image:Mycobacterium_tubercul
osis.jpg#file
Summer 2008 Workshop in Biology and Multimedia for High School
Teachers
Harvard University Life Sciences – HHMI Outreach Program
Part 1 – Review of the Immune System
Immune System Overview
Go to and read: http://nobelprize.org/educational
games/medicine/immunity/immune-overview.html as you answer the following
questions.
1. Name one defense your body uses to protect itself from intruders before an infection
strikes.
2. Is inflammation (swelling) beneficial to the body or not? Explain.
3. What are immune cells used for and where are they made?
4. What are antibodies and what do they act against?
5. Define antigen pathogen –
The Immune System in More Detail
Go to and read: http://nobelprize.org/educational
games/medicine/immunity/immune-detail.html as you answer the following questions.
6. Describe briefly the important immune cells and their key roles in the space provided:
granulocytes -
macrophages -
dendritic cells –
Lymphocytes (made in the _____________________)
Helper T cells (mature in the T____________) Killer T cells –
Summer 2008 Workshop in Biology and Multimedia for High School
Teachers
Harvard University Life Sciences – HHMI Outreach Program
B lymphocyte cells –
B plasma cells –
B memory cells –
Immune System Animations
Go to: http://outreach.mcb.harvard.edu/index.htm and select Scientific Animations from
the menu bar. Click on Teacher Animations under Immunology on the right hand bar and
view the animations on immunity.
Part 2 – TB: The pathogen and the disease
Go to: http://www3.niaid.nih.gov/topics/tuberculosis/Understanding/
and click on “Overview”. Answer the following questions:
1. How many people are thought to be infected with TB worldwide?
2. What is the name of the bacteria that causes TB?
3. How many people worldwide have active TB? (8 million) How many a year die of it?
4. Although many people have TB in their body (are infected) only ___ in 10 will ever
see the disease become active during their lifetime.
(Note: Patients with TB in the body but no symptoms has a case of “latent TB”; those
with symptoms have “active TB.”)
5. In the US, the Centers for Disease Control estimate ________ people in the United
States have active TB and another ___ to ____ million have latent TB.
Click on the reverse arrow and click on “What is TB?” in the left-hand menu; select
“Detailed Explanation of TB”. Answer the following:
6. Tuberculosis typically affects what part of the body?
7. How is TB passed on from person-to-person?
8. Why are people with weak immune systems more susceptible to developing active TB?
9. What does the TB bacteria do in someone with active TB?
10. Symptoms include:
Summer 2008 Workshop in Biology and Multimedia for High School
Teachers
Harvard University Life Sciences – HHMI Outreach Program
11. How are Multidrug-Resistant (MDR-TB) and Extensively Drug-Resistant (XDR TB)
Tuberculosis different than regular TB?
Click on “Cause” in the left-hand menu and answer the following:
12. When was Mycobacterium tuberculosis (Mtb) discovered and who did so?
13. Name the organism(s) where Mtb is found:
Click on “Treatment” and answer the following:
14. TB can be treated successfully by using __________________ but these must be
taken for months or even years. Multi-drug resistant TB requires even more drug therapy
over longer periods.
Click on “TB and HIV” and answer the following:
15. Approximately _______________ people suffer from HIV and TB, according to the
WHO; which disease is the primary cause of death for these patients?
Part 3 - Resistance Rising
Go to: http://www.pbs.org/wgbh/evolution/educators/teachstuds/svideos.html
And view Video 6: Why Does Evolution Matter Now?
16. Explain briefly how selection has increased bacterial resistance to antibiotics and
why:
Go to: http://www.pbs.org/wgbh/rxforsurvival/series/diseases/tuberculosis.html
And click on and watch the video clip “Part I: Poverty and the Rise of MDR TB in Peru”
17. a. What are some of the similarities between the situation in the Russia prisons and
the situation in Carabayllo, the town in Peru?
Summer 2008 Workshop in Biology and Multimedia for High School
Teachers
Harvard University Life Sciences – HHMI Outreach Program
b. What does “DOTS” stand for and why is it so key to effective treatment of TB?
Go to: http://www.cdc.gov/tb/xdrtb/overview.htm and answer the following:
18. What is XDR-TB?
Part 4 - Global Impacts
Go to: the “Global Health Atlas” at
http://www.pbs.org/wgbh/rxforsurvival/series/atlas/index.html, read the introduction and
click on “Launch Global Health Atlas”
19. Click on the “Health and Prosperity” map and click on the “Tuberculosis” tab at the
bottom to see incidence by country. Read the “Overview” text in the sidebar at right
and explain which regions have the highest incidence of TB and why:
20. Compare the maps for “Life Expectancy” with the maps for “Health and Prosperity”
and “Health and Education” reading the text on the side bars at right as you do so.
From any map, you can also click on the snapshot icon and read a summary of the
nation’s population and health issues. Do so for the United States, Russia, and Peru
and be sure to scroll down using the scroll bar at right so that you can read the whole
essay.
21. Characterize the economies and health profiles of each nation briefly below:
United States -
Russia -
Peru -
Summer 2008 Workshop in Biology and Multimedia for High School
Teachers
Harvard University Life Sciences – HHMI Outreach Program
22. What general trend between economic status and health do you observe as you
consider these three countries?
Part 5 - Additional Options
Human Face of TB Film
Go to: http://www.stoptb.org/ Scroll to the bottom of the page and click on this video for
an overview of the impact and reach of TB.
10 Facts About Tuberculosis
http://www.who.int/features/factfiles/tb
facts/en/index.html
This slide show reviews key points about TB as a global health threat.
Nobel Prize - Robert Koch and TB
http://nobelprize.org/educational
games/medicine/tuberculosis/readmore.html
Nobel Prize - TB Game
http://nobelprize.org/educational
games/medicine/tuberculosis/
Visit these sites to read up on Robert Koch’s discovery of tuberculosis and to play a game
simulating how he did so. Be sure to read the game’s “walk through” instructions,
however, before playing.
Partners in Health
http://www.pih.org/home.html
Web site of Partners in Health, a non-profit working to create sound health policy
working locally and globally for HIV/AIDS, TB and other diseases with both medical
and moral purpose. Peruse their site and programs.
Summer 2008 Workshop in Biology and Multimedia for High School
Teachers
Harvard University Life Sciences – HHMI Outreach Program