백사병: 인류의 가장 오래된 적이자 현재 도전 과제

### 백사병: 결핵, 완벽한 인간 포식자
* 결핵균에 의해 발생하는 결핵은 지난 200년 동안 **10억 명이 사망한 오래된 질병**으로, **사망자 수가 가장 많은 전염병**입니다.
* 🎯 이 박테리아는 기도를 통해 체내에 들어와 면역 방어를 피하고 **매우 느리게 복제하는 '완벽한 인간 포식자'**입니다.
* 🛡 면역 세포가 박테리아를 죽이지 못하면 육아종을 형성하여 박테리아를 억제함으로써 **'교착 상태의 결핵'**이 발생합니다.
* 🚨 활동성 결핵은 **폐에 육아종이 파열**되어 심각한 손상을 일으키고 **수백만 개의 박테리아를 퍼뜨리는 응급 상황**입니다.
* 🌍 결핵은 기침이나 재채기에서 나오는 작은 비말을 통해 전파되기 때문에 **가족, 친구, 동료와 같은 밀접 접촉자**가 가장 취약합니다.
* 💊 활동성 결핵의 경우 대부분 항생제로 치료할 수 있지만, **치료제의 전 세계적 보급 부족과 항생제 내성**으로 인해 결핵은 여전히 지구상에서 가장 치명적인 전염병으로 남아 있습니다.
* 결핵 퇴치를 위한 노력은 **새로운 약품의 개발과 더 나은 백신의 개발** , 그리고 결핵이 퇴치될 때까지 **결핵을 퇴치할 수 있는 기회**로 진전을 보이고 있습니다.

결핵균에 의해 발생하는 결핵은 항생제 내성을 가진 은밀하고 느린 살인자이며 전 세계에 영향을 미칩니다.

Hello, Steve here. Today I am moving over as the voice of kurzgesagt for something really special. Our dearest friend John Green would like to tell you a story that's very close to his heart. So, let's hear it from him directly. Hey, John! Hey, Steve. Thanks so much! Lets dive right in: The white death has haunted humanity like no other disease following us for thousands, maybe millions of years. It was there when we tamed fire, invented culture, and ventured out of Africa to conquer the world. In 1815 it caused one in four deaths in Britain. In the last 200 years it killed a billion people, way more than all wars and natural disasters combined. Even today it’s the infectious disease with the highest kill count. But… Do you even know what we are talking about? We’re talking about Mycobacterium tuberculosis, which causes tuberculosis or TB – our original arch enemy.

Right now, one in four humans alive are infected with the bacterium – you may be one of them. So how is it possible that we never hear about TB? Well, the White Death is the perfect human predator: very infectious but very quiet most of the time, careful not to murder recklessly. Perfectly adapted to your immune system and just physically incredibly hard to kill. What exactly makes it so powerful? The Perfect Human Predator. Usually, the bacterium enters your body through the airways and sets up home in the lungs, a giant living cave system, defended by billions of macrophages, powerful guard cells that hunt and kill intruders. The TB bug is quickly attacked and devoured alive. Unfortunately, this is its plan. The white death is the worst kind of parasite – an immune system parasite. Macrophages grab their victims, trap them inside a phagosome, and flood it.

with acid that rips them to pieces.
But TB evolved a thick, waxy coat that makes it completely immune to those acids.
Worse, it captures and modifies the macrophage to be a perfect host. Like a tiny vampire, the
parasite slowly consumes the cell. TB then replicates extremely slowly. Other microbes that
make you sick multiply up to 60 times faster, exploding their numbers before the immune system
can eradicate them. But the white death is so well adapted to you, it has already
won by being here. No need to rush things. When its host cell is sucked dry and dies, the bacteria infect new macrophages.
Although these bacteria are stealthy, the decaying corpses they leave behind do
activate a proper immune response – your body knows something is up and mobilizes its
forces. But once again, this is part of the plan. Macrophages and many other immune cells
try to kill the bacteria, but that thick cell wall

makes them a formidable fortress and resistant 
to many attacks. And it infects its attackers in   the process. So when your cells can’t kill them, 
they do the next best thing: keep the parasites   from escaping. A granuloma is formed, a sort of 
white blob. In the center is a core of infected   and dead macrophages – a pleasant home and food 
for the bacterium. Other immune cells surround   this sphere of death to contain it – creating 
a safespace where TB can sit for years. Worse,   it is perfectly protected from medication and 
releases chemicals that make it hard for your   heavy immune weapons to be activated. This 
is the stalemate version of Tuberculosis.   The infection is sleeping and the bacteria is 
doing its thing. This is going on right now in   up to two billion people! But in one in ten 
of them, the disease will become active. Active Tuberculosis is an emergency. But again, a 
slow one. If your immune system can’t contain the

infection anymore. Granulomas burst suddenly. Your lungs are filled with macrophage corpses and fresh bacteria. Your immune system panics and overreacts. Hordes of soldiers leave your blood and rush to the infected areas. They order inflammation and fluids flood into your lungs. But unfortunately, your lungs are not made to be a battlefield. In their panic, your immune cells don’t care – they’re running around with flamethrowers, trying to purge the infection but causing terrible damage. As fluids and dead tissue amass, it becomes difficult to breathe and you begin coughing hard, sometimes even coughing up blood. And again, this is part of the plan because now you spread millions of bacteria catching rides in tiny droplets. You burn a high fever and lose weight as your body is severely stressed. You turn into a ghost version of yourself. Even if you are treated, this phase

can last weeks to months and is very serious. 
Insufficiently treated, TB will over months, years, or even decades slowly overtake your body. 
Especially for children or those already weakened, this can be too much and the disease wins the 
war. The bacterium spreads to other organs, lung function breaks down, and the patient dies. 
1.3 million people died this way in 2023 alone. The Worst Kind of Problem Tuberculosis is the worst kind of 
problem: A slow one. Instead of killing millions quickly like Covid, scaring a 
panicked humanity into frantic action, TB is a smoldering fire. Killing too 
slowly for our short attention span. The symptoms are often mild for many months, so 
you don’t feel in danger. Tuberculosis doesn’t want to kill you, of course, it wants to 
stay alive and spread. And to do this, it exploits human behavior: The people you are 
most likely to infect are your family and friends.

coworkers or neighbors, the people you spend a lot 
of time with. When Covid brought the world to a   halt, the average patient infected 2-3 people. An 
active TB patient infects 5-15 people in a year. Most people catch it via breathing 
in tiny droplets from a cough or   sneeze. This is especially common in crowded,   poorly ventilated housing or workplaces. 
Which is why TB exploded during the   Industrial Revolution. And indeed wherever we 
see new unplanned and overcrowded urbanization,   from Lagos to St. Petersburg, we tend to 
see a rise of the White Death alongside it. Today most cases of active Tuberculosis 
– the version that spreads the disease   further – can be cured with a four-month 
regimen of four different antibiotics. But   if that’s the case… How is this still the 
deadliest infectious disease on earth? Between 1940 and 1965, humans developed 
several drugs to fight TB, finally making it

curable. It was a true achievement of human 
ingenuity. But we didn’t do a great job of distributing the cure. While Tuberculosis 
is almost extinct in much of Europe, the US and the Middle East, it is still a 
very real threat in most of the world. TB kills people primarily in Africa, South 
America and Asia. In 2022, two-thirds of all TB cases were in just six countries: 
India, China, Indonesia, the Philippines, Pakistan and Nigeria. Almost half of all 
Tuberculosis deaths happened in South East Asia. But as it is a slow problem like climate change, 
it was ignored instead of fought aggressively, which enabled more and more strains of 
TB to develop antibiotic resistance. Which is a problem because we 
kinda stopped making new drugs. In the first twenty-five years of the 
antibiotic era, we developed eight different classes of drugs to treat TB. And 
then, in the 47 years between 1965 and 2012,

we developed none. Developing new drugs 
is extremely expensive, and there was no concentrated effort to eradicate TB, 
and there simply wasn’t enough profit incentive. There is a vaccine, but it’s over 
100 years old and not particularly effective. But beginning in 2012, we did finally develop 
two new classes of drugs that treat TB, and we may finally be at an inflection 
point again, as better vaccines are on the horizon. Companies that made Covid tests 
also developed a quick test for TB. So, we now have a real opportunity to push 
this disease back until it dies forever. But only if we get enough people to know about 
TB – like you do now – and to care about it. A century ago in the United States, there were 
almost as many hospital beds for TB patients as for treating all other illnesses and injuries 
combined. The White Death was a leading cause of death in the US, and then one day it just 
wasn’t anymore. And we can do this again.

4,000 people died of tuberculosis yesterday, 
and we simply don’t have to accept a world where so many of us still die of a disease 
we know how to cure. The White Death has been with us for millions of years. It is 
time to continue our journey without it. If you want to learn more about 
tuberculosis and the folks working to fight it through clinical trials and care 
delivery and also learn how you can help, check out the organization Partners in Health 
at pih.org/programs/tuberculosis. We’ve put a link in the description for you. Also, 
if this wasn’t enough TB for you, there’s a Crash Course Lecture on the history and presence 
of TB. We’ll include a link to that as well. Steve, I'll see you on Fri....no! This isn't 
Vlogbrothers...soon. I'll see you soon, Steve.

This Disease is Deadlier Than The Plague

Animation videos explaining things with optimistic nihilism since 12,013.

We’re a team of illustrators, animators, number crunchers and one dog who aim to spark curiosity about science and the world we live in. To us nothing is boring if you tell a good story.

For updates on our videos and other news from the kurzgesagt universe follow us on Twitter, Facebook, Instagram and LinkedIn.


Kurzgesagt – In a Nutshell

결핵이라고도 알려진 결핵균은 지난 200년 동안 10억 명의 사망자를 발생시킨 역사상 가장 치명적인 세균입니다.

전염성이 매우 강하지만 발견하기 어렵고 박멸하기 어려운 경우가 많아 완벽한 인간 포식자입니다.

폐에 침입하여 인체의 면역 체계를 교란하는 박테리아의 능력은 정복하기 매우 어렵고 강력한 적입니다.

결핵균은 산에 대한 내성과 숙주 세포를 천천히 소모하도록 진화하여 적응력이 매우 뛰어납니다.

결핵균의 두꺼운 세포벽은 면역 공격에 대한 저항력을 높여 보호 육아종을 형성하고 수년 동안 휴면 상태를 유지할 수 있게 합니다.

경우에 따라서는 면역 체계가 이를 억제하기 위해 고군분투하면서 질병이 활성화되어 응급 상황을 초래할 수 있습니다.

결핵에 감염되면 면역 체계가 공격적이고 손상된 반응을 일으켜 호흡 곤란과 피를 토하는 기침이 발생합니다.

결핵을 치료하지 않고 방치하면 서서히 신체를 잠식하여 장기 부전과 사망으로 이어질 수 있으며, 2023년에는 130만 명이 결핵으로 사망할 것으로 예상됩니다.

결핵은 느리지만 치명적인 문제이며, 인간의 행동을 악용하여 전파되고 경미한 증상을 보이는 경우가 많아 대처하기가 어렵습니다.

결핵은 전염성이 매우 강하며, 사람들이 밀집되어 있고 환기가 잘 되지 않는 곳에서 확산되는 경향이 있습니다.

4개월간의 항생제 치료로 완치가 가능하지만 여전히 전 세계적으로 가장 치명적인 전염병으로 남아 있으며, 아프리카, 남미, 아시아에서 대부분의 사례와 사망자가 발생하고 있습니다.

결핵에 대한 적극적인 대응이 부족하여 항생제 내성 균주가 개발되었고, 1965년 이후 결핵 치료를 위한 신약 개발은 현저히 감소했습니다.

결핵 치료를 위한 신약 개발은 수익성 부족으로 인해 역사적으로 소홀히 여겨져 왔지만, 현재 새로운 약물과 더 나은 백신이 개발되고 있습니다.

결핵은 미국에서 주요 사망 원인이었지만 최근의 진전으로 결핵 퇴치에 대한 희망이 생겼습니다.

결핵의 오랜 역사에도 불구하고 파트너스 인 헬스와 같은 단체의 지속적인 노력으로 이제 결핵을 퇴치할 수 있는 진정한 기회가 찾아왔습니다.