The problem: Tuberculosis has been known to humanity since ancient times. Previously, this disease had been referred to by many names, including "consumption" (due to significant weight loss) and "white plague." Mycobacterium tuberculosis (the bacteria that causes tuberculosis) existed 15,000 to 20,000 years ago. In the 18th century in Western Europe, tuberculosis reached its peak with a frequency of up to 900 deaths per 100,000 inhabitants.2What is tuberculosis (tuberculosis)?Tuberculosis is a contagious, airborne disease that affects the lungs of humans and some animals, such as livestock. If TB is left untreated and spreads, it can also affect the brain, kidneys, spine, or other organ systems. When TB strikes the lungs, a hole may develop, causing air or fluid to build up between the chest wall and the lungs. This causes one of the many symptoms of tuberculosis: chest pain and shortness of breath. (See fig. 2) Infections can erode a blood vessel and the patient may bleed to death, or they may slowly suffocate as the lungs fill with tubercles. 4Cause of Tuberculosis: Tuberculosis can be caused by any of four different organisms belonging to the genus mycobacterium: Mycobacterium bovis, Mycobacterium africanum, Mycobacterium microti and Mycobacterium tuberculosis. However, the main cause of tuberculosis in humans is Mycobacterium tuberculosis9, discovered in 1882 by the German physician Robert Koch.10Mycobacterium is a bacillus – a rod-shaped, cord-forming bacteria. The reason the organism creates problems for its host is because its cell wall contains large lipid-like waxes called mycolic acids. Mycolic acids are strong hydrophobic molecules that form a lipid...... middle of paper ......otic inhibits the β subunit of RNA polymerase. It is an enzyme that transcribes bacterial RNA. Rifampin accomplishes this by binding to RNA polymerase and blocking RNA synthesis, physically preventing the extension of RNA products.27 Pyrazinamide: The enzyme pyrazinamidase, in mycobacteria, converts pyrazinamide to pyrazinoic acid in its active form. Under acidic conditions, pyrazinoic acid slowly escapes and is thought to diffuse into bacilli and accumulate, preventing mycolic acid synthesis.29 Ethambutol: Obstructs cell wall formation. Mycolic acids attach to the 5'-hydroxyl to form a mycolyl-arabinogalactan-peptidoglycan complex in the cell wall. This inhibits the enzyme arabinosyl transferase. Disruption of arabinogalactan synthesis inhibits the formation of this complex and results in increased cell wall permeability..30