Kifua kikuu : Tofauti kati ya masahihisho

"Kifua kikuu," "MTB," au "TB" (kifupi cha '' tubercle [[Bacillus (shape) | bacillus]]'') ni ugonjwa unaosambazwa, na mara nyingi ni wa hatari ni [[ugonjwa wa kuambukiza]]. Ugonjwa huu husababishwa na aina mbalimbali za vimelea [[Mycobacterium | mycobacteria]], pia hujulikana kama '' [[Mycobacterium tuberculosis]]''.<ref name=Robbins>{{cite book |author=Kumar V, Abbas AK, Fausto N, Mitchell RN |year=2007 |title=Robbins Basic Pathology |edition=8th |publisher=Saunders Elsevier |pages=516–522 |isbn=978-1-4160-2973-1}}</ref> Kifua kikuu kwa kawaida kinaathiri [[mapafu]], lakini pia kinaweza kuathiri sehemu nyingine za mwili. Kifua Kikuu husambazwa kutoka kwa mtu mmoja hadi mwingine kwa kupitia hewa wakati anapokoa, kupiga chafya, au mate yake yakiwa hewani AP <ref name=AP>{{cite journal|author=Konstantinos A |year=2010|title=Testing for tuberculosis |journal=Australian Prescriber |volume= 33 |issue=1|pages=12–18 |url= http://www.australianprescriber.com/magazine/33/1/12/18/}}</ref> Maambukizi mengi [[hayana dalili]] hayaleti madhara. Lakini moja kati ya kumi ya maambukizi yasiyoleta madhara hatimaye huendelea na kuwa ugonjwa unaoleta madhara. Kama kifua kikuu kisipotibiwa, kinaua zaidi ya 50% ya watu walioambukizwa.

Dalili za kawaida za maambukizi ya kifua kikuu kinacholeta madhara ni [[kikohozi | kikohozi sugu]] na [[Hemoptysis | kukohoa damu]], [[Kohozi]], [[homa]], [[kutokwa na jasho usiku]], na [[kukonda]]. (Kifua kikuu kilikuwa kinaitwa "matumizi" kwa sababu watu walioambukizwa hupunguza uzito.) Maambukizi ya viungo vingine husababisha dalili mbalimbali. [[Njia ya kiutaalamu ya utambuzi | utambuzi]] wa kifua kikuu kwa kutumia eksirei ya kuchunguza ugonjwa hujulikana kama eksirei ya kifua na pia wanatumia maikroskopi} na kufanya uchunguzi wa [[vimelea maradhi]] vya majimaji ya mwilini. Uchunguzi wa kifua kikuu kisicholeta madhara hutumia kipimo kiitwacho [[Mantoux test | tuberculin skin test au kipimo cha ngozi]] (TST) na vipimo vya damu. [[Matibabu ya kifua kikuu | tiba]] si rahisi na inabidi kupewa dawa nyingi za kinga mwili kwa kipindi kirefu. Mawasiliano ya kijamii pia yanapimwa na kutibiwa kama inavyotakiwa. [[Dawa kushindwa kutibu magonjwa]] ni tatizo kubwa la maambukizi [[mbalimbali sugu ya kifua kikuu | mengi sugu ya kifua kikuu]] (MDR-TB). Ili kuzuia kifua kikuu, ni lazima watu wapimwe ugonjwa na [[wachanjwe]] na chanjo ya [[Bacillus Calmette-Guérin | bacillus Calmette - Guérin]] .

Wataalamu wanaamini kwamba theluthi moja ya [[Idadi ya watu duniani]] wameambukizwa'' kifua kikuu'', <ref name=WHO2012data>{{cite web|url=http://www.who.int/mediacentre/factsheets/fs104/en/index.html|title=Tuberculosis Fact sheet N°104|publisher=[[World Health Organization]]|date=November 2010|accessdate=26 July 2011}}</ref> na kila sekunde kuna mtu ambaye anaambukizwa <ref name= WHO2012data /> Mwaka 2007, kadri ya watu 13,700,000 duniani waliambukizwa na kifua kikuu kinacholeta madhara sugu <ref name= WHO2009 -Epidemiology> {{cite book |title=Global tuberculosis control: epidemiology, strategy, financing |author=World Health Organization |year=2009 |isbn=978-92-4-156380-2|chapter=Epidemiology|chapterurl=http://who.int/entity/tb/publications/global_report/2009/pdf/chapter1.pdf |accessdate=12 November 2009 |pages=6–33}}</ref> Mwaka 2010, kadri ya milioni 8.8 ya watu waliambukizwa na milioni 1.5 ya watu walifariki baada ya kuambukizwa na kifua kikuu, na wagonjwa wengi wanapatikana katika [[nchi zinazoendelea | nchi zinazoendelea.]] <ref name=WHO2011>{{cite web|title=The sixteenth global report on tuberculosis|author=World Health Organization|url=http://www.who.int/tb/publications/global_report/2011/gtbr11_executive_summary.pdf|year=2011}}</ref> Idadi halisi ya wagonjwa wa kifua kikuu imekuwa ikipungua tangu mwaka 2006, na kesi mpya zimeshuka tangu mwaka 2002.<ref name=WHO2011/> Kifua kikuu sio ugonjwa unaosambazwa kisawasawa duniani kote. Kadri ya 80% ya watu katika nchi nyingi za Asia na Afrika waliofanyiwa kipimo cha ngozi walionekana wameambukizwa, lakini ni asilimia 5-10% tu ya wananchi wa Marekani ambao walionekana na ugonjwa huo.<ref name= Robbins/> Watu wengi waliopo katika [[nchi zilizoendelea | zinazoendelea duniani]] wanaambukizwa na kifua kikuu kwa sababu ya kutokuwa na kinga. Kwa kawaida, hawa watu wanaambukizwa na kifua kikuu baada ya kuambukizwa na [[VVU]] na hatimaye wanapatwa na [[UKIMWI]].<ref name=Lancet11/>

== Dalili na ishara ==

[[FilePicha:Tuberculosis symptoms.svg| thumb | Dalili kuu na ishara tofauti pamoja na hatua za kifua kikuu zinajulikana <ref>{{cite web|url=http://www.emedicinehealth.com/tuberculosis/page3_em.htm|title=Tuberculosis Symptoms|publisher=[[eMedicine]]Health|author=Schiffman G|date=15 January 2009}}</ref> Dalili nyingi huchanganyika na ishara zingine, ingawa kuna dalili zingine ambazo (ingawa sio lazima) ni za aina fulani ya kifua kikuu. Aina mbalimbali za kifua kikuu zinaweza kuwepo kwa pamoja.]]

Kuna kadri ya 5-10% ya watu ambao hawana VVU ingawa wameambukizwa na kifua kikuu na wanapatwa na madhara katika maisha yao <ref name=Pet2005>{{Cite book|author=edited by Peter G. Gibson ; section editors, Michael Abramson ... ''et al.''|title=Evidence-based respiratory medicine|year=2005|publisher=Blackwell|location=Oxford|isbn=978-0-7279-1605-1|pages=321|url=http://books.google.ca/books?id=sDIKJ1s9wEQC&pg=PA321|edition=1. publ.}}</ref> Kwa upande mwingine, 30% ya watu ambao wameambukizwa na VVU pamoja na kifua kikuu, huwa wanapatwa na madhara ya ugonjwa huo <ref name= Pet2005 /> Kifua Kikuu kinaweza kuambukiza sehemu yoyote ya mwili, lakini kwa kawaida hutokea katika mapafu (na inajulikana kama kifua kikuu cha mapafu) <ref. name= ID10 /> TB Extrapulmonary ni kifua kikuu kinachotokea sehemu yoyote ya mwili yaani nje ya mapafu. TB Extrapulmonary inaweza pia kuwepo pamoja na kifua kikuu cha mapafu <ref. Name= ID10 /> Ishara na dalili ni pamoja na [[homa]], [[Homa ya (dawa) | baridi]], [[Kutokwa na jasho usiku]], [[Hamu hasara | kupoteza hamu ya kula]], [[kukonda ]] , na [[uchovu (matibabu) | uchovu.]] <ref Name= ID10 /> Kuna uwezekano mkubwa wa [[kujikunja kwa kucha pembeni]] <ref. Name= Pet2005 />

=== Mapafu ===

Kifua kikuu kikiambukiza kinaathiri mapafu kwa 90% ya wagonjwa <ref name= Lancet11/> <ref>{{cite book|last=Behera|first=D.|title=Textbook of pulmonary medicine|year=2010|publisher=Jaypee Brothers Medical Pub.|location=New Delhi|isbn=978-81-8448-749-7|pages=457|url=http://books.google.ca/books?id=0TbJjd9eTp0C&pg=PA457|edition=2nd ed.}}</ref> Dalili zake huweza kuwa [[maumivu ya kifua]] na kikohozi cha muda mrefu chenye makohozi.<ref Name=Lancet11/> Kadri ya 25% ya watu hawana dalili yoyote (yaani, wao hawaonyeshi "dalili") <ref name= Lancet11/> Wakati mwingine, wagonjwa. [[Hemoptysis | wanakohoa damu]] kwa kiasi kidogo. Wakati mwingine, ugonjwa unaweza kusababisha [[mshipa wa mapafu]] imomonyoke, na kusababisha damu nyingi kuvuja hali hii inaitwa [[Rasmussen's aneurysm]].<ref name=ID10/> Kifua kikuu kinaweza kusababishwa na vimelea sugu na kusababisha makovu katika masikio ya juu ya mapafu.<ref Name=ID10/>. Mara nyingi ni mapafu ya juu yanayoathirika <ref name=ID10/> Sababu haijulikani vizuri <ref name=" Robbins "/> Labda mapafu ya juu yanaathirika zaidi kwa sababu yanapata hewa kwa njia bora <ref name=" Robbins "/> au kwa sababu ya ukaushaji mbaya wa [[limfu]].<ref Name= ID10 />

=== Kifua kikuu katika sehemu nyingine ya mwili ===

== Visababishi ==

=== Mycobacteria ===

[[FilePicha: Mycobacterium tuberculosis.jpg | thumb | [[Skanning elektroni mikrografu]] ya '' [[Mycobacterium tuberculosis ]]'']]

IKisababishi kikubwa cha kifua kikuu ni '' [[Mycobacterium tuberculosis]]'', ni kiumbe kidogo, [[kinachohitaji oksijeni]] na kisichotembea [[bacillus]]<ref name=ID10>{{cite book|author=[edited by] Gerald L. Mandell, John E. Bennett, Raphael Dolin|title=Mandell, Douglas, and Bennett's principles and practice of infectious diseases|year=2010|publisher=Churchill Livingstone/Elsevier|location=Philadelphia, PA|isbn=978-0-443-06839-3|pages=Chapter 250|edition=7th}}</ref> Sifa nyingi za kipekee za kiumbe hiki zinaletwa na ongezeko kubwa la [[mafuta]] <ref>{{cite book|author=Southwick F |title=Infectious Diseases: A Clinical Short Course, 2nd ed. |publisher=McGraw-Hill Medical Publishing Division |date=10 December 2007 |pages=313–4 |chapter=Chapter 4: Pulmonary Infections |page=104|url=http://pharma-books.blogspot.com/2009/01/infectious-disease-clinical-short.html |isbn=0-07-147722-5|archiveurl=http://archive.is/rSN4|archivedate=13 July 2012}}</ref> Ina seli inayojigawa kila baada ya masaa 16 hadi 20. Kiwango hiki si kikubwa ukilinganishwa na bakteria zingine, ambazo kwa kawaida vinajigawa kwa muda usiopungua saa mmoja <ref>{{cite book|last=Jindal|first=editor-in-chief SK|title=Textbook of pulmonary and critical care medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-93-5025-073-0|pages=525|url=http://books.google.ca/books?id=rAT1bdnDakAC&pg=PA525}}</ref> Mycobacteria wana [[muundo wa seli ya bakteria | utando wa nje]] utando wa mafuta <ref name=Niederweis2010>{{cite journal |author=Niederweis M, Danilchanka O, Huff J, Hoffmann C, Engelhardt H |title=Mycobacterial outer membranes: in search of proteins |journal=Trends in Microbiology |volume=18 |issue=3 |pages=109–16 |year=2010 |month=March |pmid=20060722 |pmc=2931330|doi=10.1016/j.tim.2009.12.005}}</ref> Kama jaribio la [[Gramu stain]] likifanywa, MTB haikolei sana rangi yaani "Gram-positive" haipatikani na rangi haionekani kwa sababu utando wake una mafuta mengi [[mafuta]] pamoja na asidi [[Mycolic acid]].<ref name=Madison_2001>{{cite journal |author=Madison B |title=Application of stains in clinical microbiology |journal=Biotech Histochem |volume=76 |issue=3 |pages=119–25 |year=2001 |pmid=11475314 |doi=10.1080/714028138}}</ref> MTB inaweza kuhimili kemikali [[dhaifu]] na hivi vimelea vinaweza kuishi katika [[kijimbegu au | sehemu kavu]] kwa wiki moja. Kwa kawaida, bakteria zinaweza kukua na kuishi tu ndani ya seli ya [[kiumbe (biolojia) | kiumbe]] viumbe, lakini'' M. tuberculosis' inaweza kukuzwa [[ndani in vitro|ya maabara]].<ref name=Parish_1999>{{cite journal |author=Parish T, Stoker N |title=Mycobacteria: bugs and bugbears (two steps forward and one step back) |journal=Molecular Biotechnology |volume=13 |issue=3 |pages=191–200 |year=1999| pmid=10934532 |doi = 10.1385/MB:13:3:191}}</ref>

Kwa kutumia vipimo vya kimaabara vya kansa [[Histology | histological]] kwa kuweka madoa juu ya sampuli ya [[mate]] yaliyotoka kwenye [[makohozi]], wanasayansi wanaweza kutambua MTB chini ya makroskopi (nyepesi) ya kawaida. (Phlegm pia inaitwa "kohozi.") MTB huacha madoa hata baada ya kuchanganywa na asidi, na hivyo hujulikana kama [[Acid-fast bacillus]] (AFB)<ref name= Robbins/><ref name="Madison_2001"/> acid-fast bacillus. Kuna njia mbili zinazotumia vipimo vya asidi :. Kipimo kinachojulikana kama [[Ziehl - Neelsen stain]], kinageuza rangi ya vimelea AFB na kuwa vyekundu na vinaonekana wazi wazi dhidi ya sehemu ya bluu,<ref name=Stain2000>{{cite book |author= |title=Medical Laboratory Science: Theory and Practice|publisher=Tata McGraw-Hill |location=New Delhi |year=2000 |pages=473 |isbn=0-07-463223-X|url=http://books.google.ca/books?id=lciNs3VQPLoC&pg=PA473}}</ref> na [[auramine-rhodamine stain]] ambayo hufuatiwa na makroskopi yenye kuakisi mwanga.<ref>{{cite book|last=Piot|first=editors, Richard D. Semba, Martin W. Bloem; foreword by Peter|title=Nutrition and health in developing countries|year=2008|publisher=Humana Press|location=Totowa, NJ|isbn=978-1-934115-24-4|pages=291|url=http://books.google.ca/books?id=RhH6uSQy7a4C&pg=PA291|edition=2nd ed.}}</ref>

Mycobacteria zingine zinazojulikana ni pamoja na " [[Mycobacterium leprae | M. leprae]], " " [[Mycobacterium avium complex | M. avium]], " na " [[Mycobacterium kansasii | M. kansasii]] ". Hizi aina mbili za mwisho zinajulikana kama " [[nontuberculous mycobacteria]] "(NTM). NTM hazisababisha kifua kikuu au [[ukoma]], lakini husababisha magonjwa ya mapafu yanayofanana na kifua kikuu <ref name=ALA_1997>{{cite journal |title=Diagnosis and treatment of disease caused by nontuberculous mycobacteria. This official statement of the American Thoracic Society was approved by the Board of Directors, March 1997. Medical Section of the American Lung Association |journal=Am J Respir Crit Care Med |volume=156 |issue=2 Pt 2 |pages=S1–25 |year=1997 |pmid = 9279284 |author=American Thoracic Society }}</ref>

Idadi ya sababu za kufanya watu wahusike zaidi na maambukizi ya TB. Muhimu zaidi ni hatari ya kimataifa [[ Virusi ya Ukimwi ]] ; 13% ya kesi zote TB wameambukizwa na virusi.<ref name=WHO2011/> Hili ni tatizo hasa katika [[ Afrika kusini mwa Sahara ]] , ambapo viwango vya HIV ni kubwa .<ref>{{cite web author=WorldHealthOrganization|url=http://www.who.int/tb/publications/global_report/en/index.html|title=Global tuberculosis control–surveillance, planning, financing WHO Report 2006|accessdate=13 October 2006}}</ref><ref>{{cite journal|last=Chaisson|first=RE|coauthors=Martinson, NA|title=Tuberculosis in Africa--combating an HIV-driven crisis|journal=The New England Journal of Medicine|date=13 March 2008|volume=358|issue=11|pages=1089 92|pmid=18337598|doi=10.1056/NEJMp0800809}}</ref> Kifua Kikuu ni uhusiano wa karibu na wote msongamano na utapiamlo, na kuifanya moja ya magonjwa [[ makuu ya umaskini ]] . This link Wale walio katika hatari ya juu hivyo ni pamoja [[ ugonjwa ya umaskini]].<ref name=Lancet11/> watu ambao hujidunga dawa haramu, wenyeji na wafanyakazi wa locales ambapo watu wanaoishi katika mazingira magumu kukusanya (km magereza na malazi makazi), jamii wasiojiweza kimatibabu na wasio na mtaji, ya hatari kwa makabila madogo, watoto katika mawasiliano ya karibu na hatari ya hali ya juu kwa jamii ya wagonjwa na watoa huduma ya afya ya kuwahudumia wateja.<ref name=Griffith_1996>{{citejournal |author=Griffith D, Kerr C|title=Tuberculosis: disease of the past, disease of the present |journal=J Perianesth Nurs |volume=11 |issue=4|pages=240–5 |year=1996|pmid = 8964016|doi = 10.1016/S1089-9472(96)80023-2}}</ref> uvimbe sugu ni sababu nyingine hatari ya ugonjwa. Kwa [[Silicosis]] kuongeza hatari kuhusu mara 30. <ref name=table3>{{cite journal |title=Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society |journal=MMWR Recomm Rep |volume=49 |issue=RR6|pages=151|year=200|month=June|pmid=10881762|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4906a1.htm#tab3|author1=ATS/CDC Statement Committee on Latent Tuberculosis Infection}}</ref> Wale ambao moshi [[sigara]]s kuwa karibu mara mbili ya hatari ya TB ya wasiovuta sigara.<ref>{{cite journal|last=van Zyl Smit|first=RN|coauthors=Pai, M, Yew, WW, Leung, CC, Zumla, A, Bateman, ED, Dheda, K|title=Global lung health: the colliding epidemics of tuberculosis, tobacco smoking, HIV and COPD.|journal=The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology|date=2010 Jan|volume=35|issue=1|pages=27-33|pmid=20044459|quote=These analyses indicate that smokers are almost twice as likely to be infected with TB and to progress to active disease (RR of ∼1.5 for latent TB infection (LTBI) and RR of ∼2.0 for TB disease). Smokers are also twice as likely to die from TB (RR of ∼2.0 for TB mortality), but data are difficult to interpret because of heterogeneity in the results across studies.}}</ref> Baadhi ya dawa hasa yanaweza pia kuongeza hatari ya kifua kikuu katika mataifa yaliyostawi, [[ ulevi ]] <ref name=Lancet11/> na [[ Ugonjwa wa kisukari ]] (kuongezeka maratatu ).<ref>{{cite journal|last=Restrepo|first=BI|title=Convergence of the tuberculosis and diabetes epidemics: renewal of old acquaintances journal=Clinical infectious diseases : an official publication of the Infectious Diseases Society of America|date=15 August 2007|volume=45|issue=4|pages=436–8|pmid=17638190|doi=10.1086/519939|pmc=2900315}}</ref> Baadhi ya dawa, kama vile [[corticosteroids]] na [[infliximab]] (an anti-αTNF monoclonal antibody) kuwa inazidi muhimu hatari, hasa katika [[nchi zilizoendelea]].<ref name=Lancet11/> Kuna pia, [[ upungufu maumbile ]] <ref>{{cite journal|last=Möller|first=M|coauthors=Hoal, EG|title=Current findings, challenges and novel approaches in human genetic susceptibility to tuberculosis|journal=Tuberculosis (Edinburgh, Scotland)|date=2010 Mar|volume=90|issue=2|pages=71–83|pmid=20206579|doi=10.1016/j.tube.2010.02.002}}</ref> kwa umuhimu ambayo kwa ujumla ni bado siowekwa wazi .<ref name=Lancet11/>

== Mkakati ==

[[ImagePicha:TB poster.jpg|thumb|Public health campaigns in the 1920s tried to halt the spread of TB.]]

=== Uenezaji ===

Watu wenye TB kwa muda mrefu akiwa , mara kwa mara, au karibu na watu na TB ni hatari hasa juu ya kuambukizwa, na kiwango cha wastani 22% ya kuambukiza.<ref name=Ahmed_2011>{{cite journal |author=Ahmed N, Hasnain S |title=Molecular epidemiology of tuberculosis in India: Moving forward with a systems biology approach |journal=Tuberculosis |volume=91|issue=5 |pages=407–3 |year=2011|pmid = 21514230|doi = 10.1016/j.tube.2011.03.006}}</ref> Mtu aliye na kifua kikuu hai, lakini hajatibiwa anaweza kuambukiza 10-15 (au zaidi) watu wengine kwa mwaka.<ref name="WHO2012data"/> Maambukizi lazima huwepo tu kutoka kwa watu wenye TB hai. Wale wenye maambukizi ya fiche hawadhaniwi kuambukiza. <ref name=Robbins/> uwezekano wa maambukizi kutoka kwa mtu mmoja hadi mwingine inategemea sababu kadhaa , , ikiwa ni pamoja na idadi ya matone ya kuambukiza kufukuzwa na mwenezaji , ufanisi wa uingizaji hewa, muda wa mfiduo, [[virulence]] ya ''M. kifua kikuu'' [[strain (biolojia )|strain]], kiwango cha kinga katika mtu ambaye hajaambukizwa na wengine .<ref name=CDCcourse>{{cite web|publisher=[[Centers for Disease Control and Prevention]] (CDC), Division of Tuberculosis Elimination|url=http://www.cdc.gov/tb/education/corecurr/pdf/corecurr_all.pdf|title=Core Curriculum on Tuberculosis: What the Clinician Should Know|pg=24|edition=5th|year=2011}}</ref> ili kupunguza maenezi ya mtu-kwa-mtu tenga watu wenye TB hai (" ya wazi ") na kuweka kwenye regimenti dawa za kupambana na TB. Baada ya wiki mbili ya matibabu ya ufanisi, masomo na maambukizi [[ kiuavijasumu ycha upinzani| kutokana-upinzani ]] maambukizi kwa ujumla hayazidi kuenea kwa wengine .<ref name="Ahmed_2011"/ mtu akiambukizwa yeye huchukua wiki 3 – 4 kabla ya kuanza kuambukiza wengine .<ref>{{cite web | url=http://www.mayoclinic.com/health/tuberculosis/DS00372/DSECTION=3|title=Causes of Tuberculosis|accessdate=19 October 2007|date=21 December 2006|publisher=[[Mayo Clinic]]}}</ref>

=== Pathojenesisi ===

TB maambukizi huanza wakati mycobacteria TB maambukizi huanza wakati [[Pulmonary alveolus pulmonary alveoli]], ambapo wao kuvamia na kuiga ndani [[endosomes]] ya alveolar [[macrophages]] tundu la mapafu.<ref name=Robbins/><ref name=Houben>{{cite journal |author=Houben E, Nguyen L, Pieters J | title=Interaction of pathogenic mycobacteria with the host immune system |journal=Curr Opin Microbiol | volume=9 | issue=1 | pages=76–85 | year=2006 | pmid=16406837 | doi=10.1016/j.mib.2005.12.014}}</ref> tovuti ya msingi ya maambukizi katika mapafu, unaojulikana kama " [[ lLengo Ghon focus]]", ni kwa ujumla iko katika sehemu ama juu ya tundu ya chini, au sehemu ya chini ya [[pafu| tundu juu]].<ref name=Robbins/> Kifua kikuu cha mapafu pia huweza kutokea kupitia maambukizi kutoka mkondo wa damu, Hii inajulikana kama [[ lengo Simon ]] . A Simon focus na ni kawaida kupatikana katika kilele cha mapafu.<ref>{{cite book|last=Khan|title=Essence Of Paediatrics|year=2011|publisher=Elsevier India|isbn=978813122803|pages=401|url=http://books.google.ca/books?id=gERCc6KTxwoC&pg=PA401}}</ref> maambukizi haya ya hematogenous yanaweza pia kusambaza maambukizi kwa maeneo ya mbali zaidi, kama vile nodiya limfu ya pembeni, mafigo, ubongo na mifupa.<ref name=Robbins/><ref name=Herrmann_2005>{{cite journal |author=Herrmann J, Lagrange P |title=Dendritic cells and ''Mycobacterium tuberculosis'': which is the Trojan horse? |journal=Pathol Biol (Paris) |volume=53 |issue=1|pages=35–40 |year=2005|pmid = 15620608 |doi=10.1016/j.patbio.2004.01.004}}</ref> Maeneo yote ya mwili yanaweza kuathirika kwa ugonjwa huo, ingawa kwa sababu isiyojulikana ni mara chache tu huathiri [[ moyo]], [[skeletal misuli ]]s, [[ kongosho ]] , au [[tezi]].<ref>{{cite journal |author=Agarwal R, Malhotra P, Awasthi A, Kakkar N, Gupta D |pmc=1090580 |title=Tuberculous dilated cardiomyopathy: an under-recognized entity? |journal=BMCInfectDis |volume=5 |issue=1 |page=29 |year=2005|pmid=15857515 |doi=10.1186/1471-2334-5-29}}</ref>

Kifua Kikuu huainishwa kama moja ya magonjwa [[granuloma]] ya inflamesheni tatizi. [[Macrophage]]s, [[T cell|T lymphocytes]], [[B cell|B lymphocytes]], na [[fibroblast]]s ni miongoni mwa seli zinazoungana kuunda limfu [[granuloma]]s. [[Lymphocytes]] na lymphocytes jirani macrophages kwa walioambukizwa. Granuloma huzuia usambazaji wa mycobacteria na hutoa mazingira ya mahali hapo kwa ajili ya mwingiliano wa seli ya mfumo wa kinga. Bakteria ndani ya granuloma inawezalala, kusababisha maambukizi ya fiche. Kipengele kingine cha granulomas ni maendeleo ya kifo isiyo ya kawaida katikati ([[necrosis]]) katika kituo cha [[Tubercle (anatomia) |tubercles]]. Kwa jicho uchi, hii ina umbo la jibini laini, nyeupe na inaitwa [[caseous]] [[necrosis]]. <ref name=Grosset> {{cite journal |author=Grosset J |title=Mycobacterium tuberculosis in the Extracellular Compartment: an Underestimated Adversary |journal=Antimicrob Agents Chemother |volume=47|issue=3 |pages=833–6 |year=2003|pmid = 12604509|doi = 10.1128/AAC.47.3.833-836.2003 |pmc=149338}} </ref>

Bakteria ya TB inaweza kuingia kwenye mfumo wa damu kutokana na eneo la tishu kuharibiwa. Zinaweza kuenea kwa mwili na kuanzisha maenezi ya ukimwi, tubercles zote huonekana vidogo, nyeupe katika tishu. <ref>{{cite book|last=Crowley|first=Leonard V.|title=An introduction to human disease : pathology and pathophysiology correlations|year=2010|publisher=Jones and Bartlett|location=Sudbury, Mass.|isbn=978-0-7637-6591-0|pages=374|url=http://books.google.ca/books?id=TEiuWP4z_QIC&pg=PA374|edition=8th ed.}}</ref>Aian hii kali ya ugonjwa wa TB hupatika kawaida zaidi kwa watoto wachanga na wale wanaoishi na VVU, inaitwa [[kifua kikuu military ]] .<ref>{{cite book|last=Anthony|first=Harries|title=TB/HIV a Clinical Manual.|year=2005|publisher=World Health Organization|location=Geneva|isbn=978-924154638|pages=75|url=http://books.google.ca/books?id=8dfhwKaCSxkC&pg=PA75|edition=2nd }}</ref> Watu wenye TB hii huwa na kiwango cha juu cha vifo hata kwa matibabu (takriban 30%).<ref name=Gho2008>{{cite book|last=Ghosh|first=editors-in-chief, Thomas M. Habermann, Amit K.|title=Mayo Clinic internal medicine : concise textbook|year=2008|publisher=Mayo Clinic Scientific Press|location=Rochester,MN|isbn=9781420067491|pages=789|url=http://books.google.ca/books?id=YJtodBwNxokC&pg=PA789}}</ref><ref>{{citejournal|last=Jacob|first=JT|coauthors=Mehta, AK, Leonard, MK|title=Acute forms of tuberculosis in adults.|journal=The American journal of medicine|date=2009 Jan|volume=122|issue=1|pages=12-7|pmid=19114163}}</ref>

== Uaguzi ==

[[FilePicha:TB in sputum.png|thumb|'' [[Mycobacterium tuberculosis]]'' ([[Ziehl-Neelsen stain|stained red]]) in [[sputum]]]]

=== Kifua Kikuu hai ===

Ni vigumu kuagua kifua kikuukwa misingi ya ishara na dalilitu<ref name=DiagP2011>{{cite journal|last=Bento|first=J|coauthors=Silva, AS, Rodrigues, F, Duarte, R|title=[Diagnostic tools in tuberculosis].|journal=Acta medica portuguesa|date=2011 Jan-Feb|volume=24|issue=1|pages=145–54|pmid=21672452}}</ref>Ni vigumu pai kuagua ugonjwa huo kwawatu wenye [[ wanashida ya kinga]].<ref name=Clinic2009>{{cite journal|last=Escalante first=P|title=In the clinic. Tuberculosis. journal=Annals of internal medicine|date=2009 Jun 2|volume=150|issue=11|pages=ITC61-614; quiz ITV616|pmid=19487708}}</ref> hata hivyo watu wenye dalili za magonjwa ya mapafu [[ walio na dalili ]] au dalili za kudumu muda mrefu zaidi ya wiki mbili wanaweza kuwa na TB.<ref name=Clinic2009/> [[ kifua X-ray]] na nyingi [[sputum utamadumi ]] kwa [[ bacilli asidi haraka ]] ni kawaida sehemu ya tathmini ya awali.<ref name=Clinic2009/> Interferon-γ kutolewa assays na vipimo vya tuberculin ya ngozi hazisaidii katika nchi zinazoendelea.<ref>{{cite journal|last=Metcalfe first=JZ|coauthors=Everett, CK, Steinhart, KR, Cattamanchi, A, Huang, L, Hopewell, PC, Pai, M|title=Interferon-γ release assays for active pulmonary tuberculosis diagnosis in adults in low- and middle-income countries: systematic review and meta-analysis.|journal=The Journal of infectious diseases|date=2011 Nov 15|volume=204 Suppl4|pages=S11209|pmid=21996694}}</ref><ref>{{citejournal|last=Sester|first=M|coauthors=Sotgiu, G, Lange, C, Giehl, C, Girardi, E, Migliori, GB, Bossink, A, Dheda, K, Diel, R, Dominguez, J, Lipman, M, Nemeth, J, Ravn, P, Winkler, S, Huitric, E, Sandgren, A, Manissero, D|title=Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis.|journal=The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology|date=2011 Jan|volume=37|issue=1|pages=100-11|pmid=20847080}}</ref>IGRAs mapungufu sawa katika wale wanaoishi na VVU.<ref>{{cite journal|last=Chen|first=J|coauthors=Zhang, R, Wang, J, Liu, L, Zheng, Y, Shen, Y, Qi, T, Lu, H|title=Interferon-gamma release assays for the diagnosis of active tuberculosis in HIV-infected patients: a systematic review and meta-analysis.|journal=PloS one|date=2011|volume=6|issue=11|pages=e26827|pmid=22069472}}</ref><ref>{{cite journal|last=Sester|first=M|coauthors=Sotgiu, G, Lange, C, Giehl, C, Girardi, E, Migliori, GB, Bossink, A, Dheda, K, Diel, R, Dominguez, J, Lipman, M, Nemeth, J, Ravn, P, Winkler, S, Huitric, E, Sandgren, A, Manissero, D|title=Interferon-γ release assays for the diagnosis of active tuberculosis: a systematic review and meta-analysis.|journal=The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology|date=2011 Jan|volume=37|issue=1|pages=100-11|pmid=20847080}}</ref>

[[Nucleic asidi amplification mithani ]] na kupita [[ Triphosphate deaminase]] huweza kuruhusu uchunguzi wa haraka wa TB.<ref name=DiagP2011/> Vipimo hivi, hata hivyo, si mara kwa mara ilipendekeza, kama wao mara chache kubadilisha jinsi mtu ni kutibiwa.<ref name=NICE2011/> Vipimo vya damu ili kuchunguza kingamwili siyo maalum au nyeti [[ kingamwili siyo maalum au nyeti ]] na [[ unyeti na maalum au nyeti ]] , hivyo si ilipendekeza.<ref>{{cite journal|last=Steingart|first=KR|coauthors=Flores, LL, Dendukuri, N, Schiller, I, Laal, S, Ramsay, A, Hopewell, PC, Pai, M|title=Commercial serological tests for the diagnosis of active pulmonary and extrapulmonary tuberculosis: an updated systematic review and meta-analysis.|journal=PLoS medicine|date=2011 Aug|volume=8|issue=8|pages=e1001062|pmid=21857806|doi=10.1371/journal.pmed.1001062|pmc=3153457}}</ref>

== Kifua kikuu sioonekana ==

[[FilePicha:Mantoux tuberculin skin test .jpg thumb|[[Mantoux test|Mantoux tuberculin skin test]]]] [[Mantoux mithani |Mantoux tuberculin ngozi mithani mara nyingi hutumika kwa watu screen katika hatari kubwa ya TB.<ref name=Clinic2009/> Wale ambao wamekuwa awali chanjo wanaweza kuwa na uongo chanya mtihani matokeo.<ref name=Rothel_2005>{{cite journal author=Rothel J, Andersen P |title=Diagnosis of latent ''Mycobacterium tuberculosis'' infection: is the demise of the Mantoux test imminent?|journal=Expert Rev Anti Infect Ther |volume=3 |issue=6 |pages=981–93 |year=2005|pmid = 16307510|doi = 10.1586/14787210.3.6.981}}</ref>mtihani inaweza kuwa uongo hasi katika wale walio na [[sarcoidosis]], [[Hodgkin's lymphoma]], na [[utapiamlo]]. au wengi hasa, katika wale ambao kweli kufanya wana kifua kikuu hai.<ref name=Robbins/> [[Interferon assays katika vivuli mbalimbali ya njano lioenea, kuashiria juu ya watu 300 kwa kila 100,000, na kwa Marekani, Canada, Australia, na Ulaya ya kaskazini katika vivuli ya bluu kirefu, kuashiria kiwango cha maambukizi karibu 10 kwa kila watu 100,000. Asia ni njano lakini si hivyo kabisa mkali, kuashiria kiwango cha maambukizi ya kuzunguka 200 per mbalimbali 100,000. Amerika ya Kusini ni ya njano nyeusi. Mwaka 2007, kiwango cha maambukizi ya TB kwa watu 100,000 ilikuwa ya juu katika Afrika Kusini mwa Sahara, na pia alikuwa kiasi katika Asia.<ref>{{cite book |title=Global tuberculosis control: epidemiology, strategy, financing |author=World Health Organization |year=2009 |isbn=978-92-4-156380-2|chapter=The Stop TB Strategy, case reports, treatment outcomes and estimates of TB burden|chapterurl=http://who.int/tb/publications/global_report/2009/annex_3/en/index.html|accessdate=14 November 2009|pages=187–300}}</ref> [[ kutolewa gamma ]] (IGRAs) juu ya sampuli ya damu, ni ilipendekeza kwa wale ambao ni chanya kwa mtihani Mantoux.<refname=NICE2011>{{NICE|117|Tuberculosis|2011}}</ref> IGRAs Haya si walioathirika na chanjo au zaidi [[mazingira mycobacteria]], hivyo wao kuzalisha wachache [[matokeo ya uongo]] na HIV. <ref>{{cite journal|author=Pai M, Zwerling A, Menzies D|title=Systematic Review: T-Cell–based Assays for the Diagnosis of Latent Tuberculosis Infection: An Update |journal=Ann. Intern. Med. |volume=149 |issue=3 |pages=1–9 |year=2008 |pmid=18593687 |pmc=2951987}} </ref> hivyo wao kuzalisha wachache matokeo ya uongo na HIV. Hata hivyo wao walioathirika na M. szulgai, M. marinum na M. kansasii.”<ref>{{cite book|last=Jindal|first=editor-in-chief SK|title=Textbook of pulmonary and critical care medicine|publisher=Jaypee Brothers Medical Publishers|location=New Delhi|isbn=978-93-5025-073-0|pages=544|url=http://books.google.ca/books?id=rAT1bdnDakAC&pg=PA544}}</ref> IGRAs inaweza kuongeza usikivu wakati kutumika kwa kuongeza mtihani ngozi lakini inaweza kuwa chini zaidi kuliko mtihani nyeti ngozi wakati kutumika peke yake.<ref>{{cite journal|last=Amicosante|first=M|coauthors=Ciccozzi, M, Markova, R|title=Rational use of immunodiagnostic tools for tuberculosis infection: guidelines and cost effectiveness studies.|journal=The new microbiologica|date=2010Apr|volume=33|issue=2|pages=93107|pmid=205181}}</ref>.

== Chanjo ==

[[Chanjo]] tu sasa inapatikana kama ya 2011 ni [[bacillus Calmette-Guérin|bacillus Calmette&ndash; Guérin]] (BCG). Ambayo, wakati ni ufanisi dhidi ya ugonjwa kusambazwa katika utoto, unampa ulinzi dhidi ya kuambukizwa TB haiendani mapafu. <ref>{{cite journal|last=McShane|first=H|title=Tuberculosis vaccines: beyond bacille Calmette–Guérin|journal=Philosophical transactions of the Royal Society of London. Series B, Biological sciences|date=12 October 2011|volume=366|issue=1579|pages=27829|pmid=21893541|doi=10.1098/rstb.2011.0097|pmc=3146779}}</ref> Hata hivyo, ni wengi sana kutumika chanjo duniani kote, na zaidi ya 90% ya watoto wote kuwa [[chanjo]]. <ref name=Lancet11/>Hata hivyo, kinga ni kuvuta itapungua baada ya miaka kumi.<ref name=Lancet11/> Kama kifua kikuu ni kawaida katika zaidi ya Canada, Uingereza, na Marekani, BCG ni tu unasimamiwa na watu katika hatari ya juu. <ref>{{cite web|url=http://www.cdc.gov/tb/topic/vaccines/|title=Vaccine and Immunizations: TB Vaccine (BCG)|publisher =Centers for Disease Control and Prevention|year=2011|accessdate=26 July 2011}}</ref><ref>{{cite web|title=BCG Vaccine Usage in Canada -Current and Historical|url=http://www.phacaspc.gc.ca/tbpclatb/bcgvac_120eng.php|work=Public Health Agency of Canada|accessdate=30 December 2011|year=2010|month=September}}</ref><ref name=UK06>{{cite journal|last=Teo|first=SS|coauthors=Shingadia, DV|title=Does BCG have a role in tuberculosis control and prevention in the United Kingdom?|journal=Archives of Disease in Childhood|date=2006 Jun|volume=91|issue=6|pages=529–31|pmid=16714729|pmc= 2082765|doi=10.1136/adc.2005.085043 }}</ref> Sehemu ya hoja akisema dhidi ya matumizi ya chanjo ni kwamba inafanya [[ ngozi tuberculin mtihani ]] uongo chanya, na kwa hiyo, hakuna wa matumizi katika uchunguzi.<ref name=UK06/> idadi ya chanjo mpya ni sasa katika maendeleo<ref name=Lancet11/>

=== Afya ya Jamii ===

Shirika la Afya Duniani alitangaza TB "ya afya ya kimataifa dharura" katika 1993. <ref name=Lancet11/> na katika 2006, TB Stop Ushirikiano maendeleo [[Mpango wa Kimataifa Stop kifua kikuu]] kwamba lengo la kuokoa maisha ya milioni 14 kati ya uzinduzi wake na 2015.<ref>{{cite web|url=http://www.stoptb.org/global/plan/|title=The Global Plan to Stop TB|publisher=[[World Health Organization]]|year=2011|accessdate=13 June 2011}}</ref> idadi ya malengo ya wana kuweka si uwezekano wa kupatikana kwa 2015, hasa kutokana na ongezeko katika kifua kikuu HIV-kuhusishwa na kuibuka wa kifua kikuu sugu nyingi (MDR-TB).<ref name=Lancet11/> [[ mfumo wa kifua kikuu] uainishaji maendeleo na [[ Jamii ya Marekani Thoracic ]] hutumiwa hasa katika mipango ya afya ya umma. .<ref>{{cite book|last=Warrell|first=ed. by D. J. Weatherall ... [4. + 5. ed.] ed. by David A.|title=Sections 1 - 10.|year=2005|publisher=Oxford Univ. Press|location=Oxford[u.a.]|isbn=9780198570141|pages=560|url=http://books.google.ca/books?id=EhjX517cGVsC&pg=PA560|edition=4.ed.,paperback.}}</ref>

== Menejimenti ==

Tiba ya TB anatumia [[kiuvijasumu]] na kuua vimelea. Ufanisi kutibu TB ni vigumu, kutokana na muundo wa kawaida na cha kemikali katika ukuta mycobacterial kiini, ambayo inazuia kuingia ya madawa ya kulevya na hufanya kiuvijasumu wengi ufanisi. <ref>{{cite journal |author=Brennan PJ, Nikaido H |title=The envelope of mycobacteria|journal=Annu.Rev. Biochem. |volume=64 |pages=2963 |year=1995 |pmid=7574484|doi=10.1146/annurev.bi.64.070195.000333}}</ref> kiuvijasumu mbili ya kawaida kutumika ni [[isoniazid]] na [[rifampicin]], na matibabu yanaweza ziongezwe, kuchukua miezi kadhaa. <ref name=CDCcourse/> kutibu ya sioonekana TB kawaida inaajiri antibiotic moja, <ref name=Latent2011/> wakati kazi ugonjwa wa Kifua Kikuu ni bora kutibiwa na mchanganyiko wa kiuvijasumu kadhaa ili kupunguza hatari ya bakteria kuendeleza [[upinzani antibiotiki]]. <ref name=Lancet11/>. Watu wenye maambukizi ya latent pia kutibiwa kuwazuia inaendelea kwa ugonjwa kazi TB baadaye katika maisha.<ref name=Latent2011>{{cite journal|last=Menzies|first=D|coauthors=Al Jahdali, H, Al Otaibi, B|title=Recent developments in treatment of latent tuberculosis infection.|journal=The Indian journal of medical research|date=2011 Mar|volume=133|pages=257-66|pmid=21441678}}</ref> [[ Moja kwa moja aliona tiba]], yaani kuwa na huduma ya afya mtoa kuangalia mtu kuchukua dawa zao, ni ilipendekeza na WHO katika jitihada za kupunguza idadi ya watu si ipasavyo kuchukua antibiotiki.<ref>{{cite book |author=Arch G., III Mainous |title=Management of Antimicrobials in Infectious Diseases: Impact of AntibioticResistance |publisher=HumanaPr |location= |year=2010 |pages=69 |isbn=1603272380 |oclc=|url=http://books.google.ca/books?id=hwVFAPLYznsC&pg=PA69}}</ref> ushahidi wa kuunga mkono kitendo hiki juu ya watu tu kutumia dawa zao kwa kujitegemea ni maskini. <ref>{{cite journal |author=Volmink J, Garner P |title=Directly observed therapy for treating tuberculosis |journal=CochraneDatabaseSystRev |volume= |issue=4 |pages=CD003343 |year=2007|pmid=17943789 |doi=10.1002/14651858.CD003343.pub3 |url=}}</ref> Mbinu ya kuwakumbusha watu kuhusu umuhimu wa tiba wala hata hivyo kuonekana ufanisi.<ref>{{cite journal|last=Liu|first=Q|coauthors=Abba, K; Alejandria, MM; Balanag, VM; Berba, RP; Lansang, MA|title=Reminder systems and late patient tracers in the diagnosis and management of tuberculosis.|journal=Cochrane database of systematicreviews(Online)|date=2008Oct8|issue=4|pages=CD006594|pmid=18843723}}</ref>

=== Matumizi ya Kawaida ugonjwa ===

=== Upinzani ya Dawa ===

Upinzani Kanuni hutokea wakati mtu huwa wameambukizwa mnachuja sugu wa TB. Mtu aliye na TB kikamilifu wanahusika inaweza kuendeleza sekondari (alipewa) upinzani wakati wa tiba kwa sababu ya tiba za kutosha, si kuchukua regimen eda ipasavyo (ukosefu wa kufuata), au kwa kutumia chini quality dawa.<ref name=OBrien>{{cite journal |author=O'Brien R |title=Drug-resistant tuberculosis: etiology, management and prevention |journal=SeminRespir Infect |volume=9 |issue=2|pages=10412 |year=1994|pmid=7973169}}</ref> Sugu TB ni mbaya ya afya ya umma suala katika nchi nyingi zinazoendelea, kama tiba yake ni tena na inahitaji dawa ghali zaidi. MDR-TB hufafanuliwa kama upinzani kwa mbili ya ufanisi zaidi madawa ya TB ya mstari wa kwanza: rifampicin na isoniazidi. . [[Extensively drug-resistant tuberculosis| Sana sugu TB]] pia ni sugu kwa tatu au zaidi ya madarasa sita ya madawa ya mstari wa pili. .<ref name="MMWR2006">{{cite journal |title=Emergence of ''Mycobacterium tuberculosis'' with extensive resistance to second-line drugs—worldwide, 2000–2004 |journal=MMWR Morb Mortal Wkly Rep |volume=55 |issue=11 |pages=301–5 |year=2006|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5511a2.htm|pmid = 16557213 |author=Centers for Disease Control and Prevention (CDC)}}</ref> [[Totally drug-resistant tuberculosis| Kabisa sugu TB]], ambayo kwa mara ya kwanza aliona katika 2003 nchini Italia, lakini si sana taarifa mpaka 2012, ni sugu kwa madawa yote kwa sasa kutumika. <ref> {{cite web|title=Totally Resistant TB: Earliest Cases in Italy |url=http://www.wired.com/wiredscience/2012/01/tdrfirstitaly/|author=Maryn McKenna date=12 January 2012|accessdate=12 January 2012|publisher=[[Wired(magazine)|Wired]]}}</ref>

Mwendelezo na maambukizi ya TB na ugonjwa wazi ya TB hutokea wakati bacilli kushinda ulinzi mfumo wa kinga na kuanza kuzidisha. Katika ugonjwa wa TB ya msingi (baadhi 1-5% ya kesi), hii hutokea mara baada ya maambukizi ya awali. [219] Hata hivyo, katika matukio mengi ya, [[Latent tuberculosis| maambukizi sioonekana]] hutokea na hakuna dalili za wazi. <ref name=Robbins/> Hizi bacilli kulala kuzalisha kifua kikuu kazi katika% 5-10 ya kesi hizi sioonekana, mara nyingi miaka mingi baada ya kuambukizwa. <ref name=Pet2005/>

== Epidemolojia ==

[[FilePicha:Tuberculosis world map - DALY - WHO2004.svg|thumb|[[Age adjustment|Age-standardized]] death from tuberculosis per 100,000&nbsp;inhabitants in 2004.<ref>{{cite web|url=http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html |title=WHO Disease and injury country estimates |year=2004 |work=World Health Organization |accessdate=11 November 2009}}</ref>

Takribani theluthi moja ya idadi ya watu duniani imekuwa kuambukizwa na M. kifua kikuu, na maambukizi mapya ya kutokea kwa kiwango cha moja kwa pili kwa kiwango cha kimataifa. <ref name=WHO2012data/>Hata hivyo, wengi maambukizi na M. kifua kikuu wala kusababisha ugonjwa wa Kifua Kikuu, <ref name=CDC> {{cite web publisher= [[Centers for Disease Control]]|url=http://www.cdc.gov/tb/publications/factsheets/general/LTBIandActiveTB.htm|title=Fact Sheets: The Difference Between Latent TB Infection and Active TB Disease date=20 June 2011|accessdate=26 July 2011}}</ref> na 90-95% ya maambukizi ya kubaki bila dalili. <ref name=Book90/> Mwaka 2007, kulikuwa na wastani wa milioni 13.7 sugu kazi kesi. <ref name=WHO2009-Epidemiology/> Mwaka 2010, kulikuwa na milioni 8.8 mpya kesi ya TB kukutwa na vifo 1,450,000, zaidi ya haya yanayojitokeza katika [[Developing nation|nchi zinazoendelea]].<ref name=WHO2011/> Vifo hivi 1,450,000, kuhusu 0,350,000 kutokea katika wale wana ambukizwa pamoja na HIV. <ref name=WHO2011Control>{{cite web|title=GlobalTuberculosisControl2011|url=http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf|work=WorldHealthOrganization|accessdate=15 April 2012}}</ref> Kifua Kikuu ni ya pili zaidi ya vifo kutokana na ugonjwa kuambukiza (baada ya wale kutokana na HIV / UKIMWI).<ref name=ID10/>idadi kamili ya kesi kifua kikuu ("maambukizi") imekuwa ikipungua tangu 2005, wakati mpya kesi ("[[Incidence (epidemiolojia )|matukio]]") zimeshuka tangu 2002.<ref name=WHO2011/>China imepata maendeleo makubwa hasa, pamoja na kupunguza takriban 80% katika kiwango cha TB wake vifo kati ya 1990 na 2010.<ref name=WHO2011Control/> Kifua Kikuu ni ya kawaida zaidi katika nchi zinazoendelea; kuhusu 80% ya idadi ya watu katika nchi nyingi za Asia na Afrika mtihani chanya katika vipimo tuberculin, wakati tu 5-10% ya mtihani Marekani idadi chanya.<ref name=Robbins/> Matumaini ya kudhibiti ugonjwa huo kabisa wamekuwa kasi unyevunyevu kwa sababu ya mambo kadhaa, ikiwa ni pamoja na ugumu wa kuendeleza chanjo ufanisi, ghali na muda mwingi uchunguzi wa mchakato, umuhimu wa miezi mingi ya matibabu, ongezeko la maambukizi ya virusi-kuhusishwa kifua kikuu , na kuibuka wa kesi sugu katika miaka ya 1980.<ref name=Lancet11/>[[FilePicha:TB incidence.png|thumb|left|Annual number of new reported TB cases. Data from [[World Health Organization|WHO]]. <ref> {{cite web|author=WorldHealthOrganization|url=http://www.who.int/tb/publications/global_report/2008/annex_3/en/index.html|title=WHO report 2008: Global tuberculosis control|accessdate=13 April 2009}}</ref>]]

Katika 2007, nchi yenye kiwango cha juu zaidi ya makadirio ya matukio ya TB ilikuwa [[Swaziland]], na kesi 1,200 kwa kila watu 100,000. India ilikuwa kubwa jumla ya matukio, na wastani wa kesi 2.0 milioni mpya. <ref name=WHO2009-Epidemiology/> Katika nchi zilizoendelea, kifua kikuu ni. <ref name=WHO2009-Epidemiology/>chini ya kawaida na ni kupatikana hasa katika maeneo ya mijini. Viwango kila watu 100,000 katika maeneo mbalimbali ya dunia ambapo: Kimataifa 178, 332 Kusini, Amerika 36, Bahari ya Mashariki 173, Ulaya 63, Asia ya Kusini 278, na 139 Pacific Magharibi katika 2010 <ref name=WHO2011Control/> Nchini Canada na Australia, kifua kikuu ni mara nyingi zaidi ya kawaida kati ya [[Aboriginal peoples| Watu wa asili]],hasa katika maeneo ya kijijini.<ref>{{cite journal|last=FitzGerald|first=JM|coauthors=Wang,L,Elwood,RK|title=Tuberculosis: 13.Control of the disease among aboriginal people inCanada.|journal=CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne|date=2000 Feb 8|volume=162|issue=3|pages=351-5|pmid=10693593}}</ref><ref>{{cite book |author=Quah, Stella R.; Carrin, Guy; Buse, Kent; Kristian Heggenhougen |title=Health Systems Policy, Finance, andOrganization |publisher=AcademicPress |location=Boston |year=2009 |pages=424 |isbn=0123750873 |oclc= |url=http://books.google.ca/books?id=IEXUrc0tr1wC&pg=PA424}}</ref>Katika Marekani watu wa asili kuwa vifo vya mara tano zaidi kutoka TB.<ref>{{cite book |author= Anne-Emanuelle Birn |title= Textbook of International Health: Global Health in a Dynamic World |year=2009|pages=261 |isbn=9780199885213 |url=http://books.google.ca/books?id=2XBB4-eYGZIC&pg=PT261 |doi= |accessdate=}}</ref> matukio ya TB inatofautiana na umri Katika Afrika, kimsingi unaathiri vijana na watu wazima vijana. <ref> {{cite web|author=World Health Organization|url=http://www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf|title=Global Tuberculosis Control Report, 2006 – Annex 1 Profiles of high-burden countries format=PDF accessdate=13 October 2006|archiveurl=http://web.archive.org/20060716135331/www.who.int/tb/publications/global_report/2006/pdf/full_report_correctedversion.pdf|archivedate=2006-07-16}} </ref>Hata hivyo, katika nchi ambapo matukio viwango zimepungua kasi ( kama vile Marekani), TB ni ugonjwa wa watu hasa wakubwa na kinga iliyoathirika. <ref name=Robbins/><ref>{{cite web|author=CentersforDiseaseControlandPrevention|url=http://www.cdc.gov/nchstp/tb/pubs/slidesets/surv/surv2005/default.htm|title=2005SurveillanceSlideSet|date=12September2006|accessdate=13October2006}}</ref>.

== Historia ==

[[ImagePicha:Mummy at British Museum.jpg| thumb| Egyptian [[maiti]] katika [[Makumbusho ya Uingereza]] - kuoza lioathiriwa na kifua kikuu imekuwa kupatikana katika miiba ya [[Egyptian]] [[mummy=maiti]].]]

Kifua Kikuu imekuwepo kwa binadamu tangu zamani saa ya karibuni [[Zamani saa ya karibuni ]] .<ref name=Lancet11>{{cite journal|last=Lawn first=SD|coauthors=Zumla, AI|title=Tuberculosis journal=Lancet|date=2 July 2011|volume=378|issue=9785|pages=57–72|pmid=21420161|doi=10.1016/S0140-6736(10)62173-3}}</ref> Mwanzo zisizo na utata kutambua ya M. kifua kikuu inahusisha ushahidi wa ugonjwa huo katika mabaki ya bison tarehe na takriban 17,000 miaka iliyopita.<ref>{{cite journal |author=Rothschild BM |title=Mycobacterium tuberculosis complex DNA from an extinct bison dated 17,000 years before the present |journal=Clin. Infect. Dis. |volume=33 |issue=3 |pages=305–11 |year=2001|month=August |pmid=11438894 |doi=10.1086/321886 |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID001531|author-separator=, |author2=Martin LD |author3=Lev G |display-authors=3 |last4=Bercovier |first4=Helen |last5=Bar‐Gal|first5=Gila Kahila |last6=Greenblatt |first6=Charles |last7=Donoghue |first7=Helen |last8=Spigelman |first8=Mark|last9=Brittain |first9=David}}</ref> Hivyo, kama kifua kikuu asili katika mangombe, kisha kuhamishiwa kwa binadamu, au kama ni kuachana kutoka babu ya kawaida, sasa ni wazi. <ref>{{cite journal |author=Pearce-Duvet J |title=The origin of human pathogens: evaluating the role of agriculture and domestic animals in the evolution of human disease|journal=Biol Rev Camb Philos Soc |volume=81 |issue=3 |pages=369–82 |year=2006|pmid = 16672105|doi=10.1017/S1464793106007020}}</ref> kulinganisha [[gene]]s ya M. kifua kikuu tata (MTBC) kwa binadamu kwa MTBC katika wanyama unaonyesha binadamu hakuwa kupata MTBC kutoka kwa wanyama wakati wa kufuga wanyama kama ilivyoaminika hapo nyuma. Wote Matatizo ya bakteria kifua kikuu kushiriki babu ya kawaida, ambayo ingeweza kuambukizwa binadamu kama mapema kama [[Mapinduzi Neolithic]]. <ref>{{cite journal|last=Comas first=I coauthors=Gagneux, S|title=The past and future of tuberculosis research.|journal=PLoS pathogens date=2009 Oct|volume=5|issue=10|pages=e1000600|pmid=19855821}}</ref> Mabaki ya kiunzi kuonyesha prehistoric binadamu (4000 KK) [[Common Era|BC ]] ) alikuwa TB. Na watafiti wamegundua kuoza enye umbo katika miiba ya [[Misri ya Egypt]] [[ maiti|mummies]] kutoka BC 3000-2400.<ref>{{cite journal |author=Zink A, Sola C, Reischl U, Grabner W, Rastogi N, Wolf H, Nerlich A |title=Characterization of Mycobacterium tuberculosis Complex DNAs from Egyptian Mummies by Spoligotyping |journal=J Clin Microbiol |volume=41 |issue=1 |pages=359–67 |year=2003 |pmid=12517873|doi=10.1128/JCM.41.1.359-367.2003 |pmc=149558}}</ref> Phthisis ni neno la Kigiriki kwa ajili ya matumizi, mrefu zamani kwa ajili ya kifua kikuu cha mapafu; <ref>{{cite book|title=The Chambers Dictionary.|year=1998|publisher=Allied Chambers India Ltd.|location=New Delhi|isbn=978-81-86062-25-8|pages=352|url=http://books.google.ca/books?id=pz2ORay2HWoC&pg=RA1-PA352}}</ref> ] karibu 460 BC, [[Hippocrates]] kutambuliwa phthisis kama ugonjwa kuenea zaidi ya nyakati. Ilikuwa alisema kuhusisha homa na kukohoa ya damu, ambayo ilikuwa karibu daima mbaya. <ref>Hippocrates.[http://web.archive.org/web/20050211173218/http://classics.mit.edu/Hippocrates/aphorisms.mb.txt Aphorisms.] Accessed 7 October 2006. </ref> Masomo ya maumbile zinaonyesha TB alikuwepo katika [[Amerika]] kutoka BK mwaka 100. <ref>{{cite journal |author=Konomi N, Lebwohl E, Mowbray K, Tattersall I, Zhang D |title=Detection of Mycobacterial DNA in Andean Mummies |journal=J Clin Microbiol |volume=40 |issue=12 |pages=4738–40 |year=2002 |pmid=12454182|doi=10.1128/JCM.40.12.4738-4740.2002 |pmc=154635}}</ref>

Kabla ya [[ Mapinduzi ya Viwanda]], ngano nyingi zinazohusiana na kifua kikuu [[vampire]]s. Wakati mmoja wa familia walikufa kutokana na hilo, wanachama wengine walioambukizwa bila kupoteza afya yao polepole. Watu waliamini hii kulitokana na mtu awali na TB kuondoa maji maisha kutoka kwa wanachama wengine wa familia.<ref name=sledzik>{{cite journal |last=Sledzik |first=Paul S. |coauthors=Nicholas Bellantoni |month=June |year=1994 |title=Bioarcheological and biocultural evidence for the New England vampire folk belief |journal=American Journal of Physical Anthropology |volume=94 |issue=2 |pages=269–274|doi=10.1002/ajpa.1330940210 |url=http://www.ceev.net/biocultural.pdf |format=PDF|pmid=8085617 |issn=0002-9483}}</ref>

Ingawa aina ya mapafu kuhusishwa na[[tubercle (anatomia )|tubercles]] ilianzishwa kama patholojia na Dr Richard Morton katika 1689.<ref name="WhoNamedIt-Calmette">{{WhoNamedIt|doctor|2413|Léon Charles Albert Calmette}}</ref><ref name="MedHist1970-Trail">{{cite journal |author=Trail RR |title=Richard Morton (1637-1698) |journal=Med Hist |volume=14|issue=2 |pages=166–74 |year=1970 |month=April |pmid=4914685 |pmc=1034037 }}</ref> kutokana na aina ya dalili yake, TB ilikuwa si kutambuliwa kama ugonjwa mmoja hadi miaka ya 1820, na haikuitwa kifua kikuu mpaka 1839 na [[Johann Lukas Schönlein|J. L. Schönlein]].<ref>Zur Pathogenie der Impetigines. Auszug aus einer brieflichen Mitteilung an den Herausgeber. [Müller’s] ''Archiv für Anatomie, Physiologie und wissenschaftliche Medicin''. 1839, page 82.</ref> Katika miaka 1838-1845, Dk John Croghan, mmiliki wa of [[Pango Mammoth ]] , kuletwa idadi ya watu wenye kifua kikuu katika pango kwa matumaini ya kutibu ugonjwa na joto mara kwa mara na usafi wa hewa pango; walikufa ndani ya mwaka. <ref>[http://edition.cnn.com/2004/TRAVEL/DESTINATIONS/02/26/mammoth.cave.ap/index.html Kentucky: Mammoth Cave long on history.] ''[[CNN]]''. 27 February 2004. Accessed 8 October 2006.</ref> Hermann Brehmer kufunguliwa kwanza TB [[sanatorium]] katika 1859 katika [[Sokołowsko|Sokołowsko, Poland]].<ref name =sanatoria>{{cite journal |author=McCarthy OR |title=The key to the sanatoria |journal=J R Soc Med |volume=94 |issue=8 |pages=413–7 |year=2001 |month=August |pmid=11461990 |pmc=1281640|url=http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=11461990}}</ref>

[[ImagePicha: RobertKoch.jpg|upright|thumb|left|Dr. Robert Koch discovered the tuberculosis bacilli.]]

[[Albert Calmette]] na [[Camille Guérin]] mafanikio ya kwanza ya kweli mafanikio katika utoaji wa chanjo dhidi ya kifua kikuu katika 1906. kwa kutumia mnachuja ya ngombe kufikika kifua kikuu. Ilikuwa inaitwa ([[Bacillus Calmette-Guérin|bacillus of Calmette and Guérin]]) (BCG). Chanjo ya BCG mara ya kwanza kutumika juu ya binadamu katika 1921 nchini [[ Ufalansa]].<ref name=Bonah>{{cite journal |author=Bonah C|title=The 'experimental stable' of the BCG vaccine: safety, efficacy, proof, and standards, 1921–1933 |journal=Stud Hist Philos Biol Biomed Sci |volume=36 |issue=4 |pages=696–721 |year=2005 |pmid=16337557|doi=10.1016/j.shpsc.2005.09.003}}</ref> Lakini tu kupokea kukubalika kuenea katika [[United States|Marekani]], [[Uingereza]], and [[ Ujerumani]] na baada ya Vita Kuu ya II. <ref name=Comstock>{{cite journal |author=Comstock G |title=The International Tuberculosis Campaign: a pioneering venture in mass vaccination and research |journal=Clin Infect Dis |volume=19 |issue=3 |pages=528–40 |year=1994|pmid=7811874|doi=10.1093/clinids/19.3.528}}</ref>

Kifua Kikuu unasababishwa zaidi kuenea umma wasiwasi katika karne ya 19 na 20 mapema kama ugonjwa wa [[endemic (epidemiolojia )|ndwele]] maskini wa mijini. Katika 1815, moja katika vifo nne nchini Uingereza ni kutokana na "matumizi". By 1918, moja katika vifo sita katika Ufaransa alikuwa bado unasababishwa na TB. Baada ya kuamua ugonjwa huo kuenea katika miaka ya 1880, TB ilikuwa kuweka [[Katika orodha ya ugonjwa |liolazimu kujulishwa Ugonjwa]] katika Uingereza, kampeni walikuwa wameanza kuacha watu kutoka kutema katika maeneo ya umma, na maskini walioambukizwa walikuwa "moyo" kuingia [[sanatorium sanatoria]] ambayo inafanana magereza (sanatoria kwa ajili ya madarasa kati na juu inayotolewa huduma bora na matibabu ya mara kwa mara). <ref name =sanatoria/> Chochote faida ( kwa kusudi ) ya "hewa safi" na ajira katika sanatoria, hata chini ya hali bora, 50% ya wale waliokuwa wakiingia alikufa ndani ya miaka mitano (circa 1916).<ref name =sanatoria/>

Katika Ulaya, viwango vya ugonjwa wa kifua kikuu ulianza kupanda katika miaka ya 1600 mapema kwa ngazi kilele katika miaka ya 1800, wakati unasababishwa karibu 25% ya vifo vyote.<ref>{{cite book|last=Bloom|first=editor, Barry R.|title=Tuberculosis : pathogenesis, protection, and control|year=1994|publisher=ASM Press|location=Washington, D.C.|isbn=978-1-55581-072-6}}</ref> Vifo vya kisha ilipungua karibu 90% kwa miaka ya 1950.<ref>{{cite book|last=Persson|first=Sheryl|title=Smallpox, Syphilis and Salvation: Medical Breakthroughs That Changed the World|year=2010|publisher=ReadHowYouWant.com|isbn=978-1-4587-6712-7|pages=141|url=http://books.google.ca/books?id=-W7ch1d6JOoC&pg=PA141}}</ref> Maboresho katika afya ya umma alianza kwa kiasi kikubwa kupunguza viwango vya ugonjwa wa kifua kikuu hata kabla ya kuwasili kwa [[streptomycin] na kiviujasumu nyingine. Ingawa ugonjwa alibakia tishio kubwa kwa afya ya umma ambao vile. Wakati [[Medical Research Council (UK) |Medical Council Utafiti]] iliundwa katika Uingereza katika 1913, lengo yake ya awali ilikuwa kifua kikuu utafiti. <ref>{{cite book|last=editor|first=Caroline Hannaway,|title=Biomedicine in the twentieth century: practices, policies, and politics|year=2008|publisher=IOS Press|location=Amsterdam|isbn=978-1-58603-832-8|pages=233|url=http://books.google.ca/books?id=o5HBxyg5APIC&pg=PA233}}</ref>

India ilikuwa ya juu jumla ya idadi ya wagonjwa wa TB duniani kote katika 2010, kwa sehemu kutokana na usimamizi mbovu ugonjwa ndani ya sekta binafsi ya afya. Mipango kama vile [[ Programu ya Taifa ya Kifua Kikuu ]] karatasi ya kufikiria tena ni kusaidia kupunguza viwango vya TB miongoni mwa watu wanaopata huduma ya afya ya umma.<ref name="Bhargava">{{cite journal |author=Anurag Bhargava, Lancelot Pinto, Madhukar Pai |title=Mismanagement of tuberculosis in India: Causes, consequences, and the way forward |journal=Hypothesis|volume=9 |issue=1 |pages=e7 |year=2011 |url=http://www.hypothesisjournal.com/?p=989}}</ref><ref>{{cite journal last=Amdekar|first=Y|title=Changes in the management of tuberculosis.|journal=Indian journal of pediatrics|date=2009 Jul|volume=76|issue=7|pages=739-42|pmid=19693453}}</ref>

Chanjo ya BCG ina mapungufu, na utafiti wa kuendeleza chanjo ya TB mpya ni unaoendelea.<ref name=VacRes2011>{{cite journal last=Martín Montañés|first=C|coauthors=Gicquel, B|title=New tuberculosis vaccines. journal=Enfermedades infecciosas y microbiologia clinica|date=2011 Mar|volume=29 Suppl 1|pages=57–62|pmid=21420568|doi=10.1016/S0213-005X(11)70019-2}}</ref> idadi ya wagombea uwezekano ni sasa katika majaribio [[clinical trial| ya awamu ya I na II kliniki ]] .<ref name=VacRes2011/> Mbili mbinu kuu ni kuwa kutumika kujaribu kuboresha ufanisi wa chanjo zinapatikana. Moja inahusisha mbinu kuongeza chanjo subunit kwa BCG, wakati mkakati mwingine ni kujaribu kujenga mpya na bora chanjo hai. <ref name=VacRes2011/> [[ MVA85A]], mfano wa chanjo subunit, sasa katika majaribio nchini Afrika Kusini, ni msingi juu ya virusi vya vinasaba kufura ngozi.<ref name=Ibanga_2006>{{cite journal |author=Ibanga H, Brookes R, Hill P, Owiafe P, Fletcher H, Lienhardt C, Hill A, Adegbola R, McShane H |title=Early clinical trials with a new tuberculosis vaccine, MVA85A, in tuberculosis-endemic countries: issues in study design |journal=Lancet Infect Dis |volume=6 |issue=8|pages=522–8 |year=2006 |doi= 10.1016/S1473-3099(06)70552-7| pmid = 16870530}}</ref> Chanjo ni unaotarajiwa kuwa na jukumu muhimu katika matibabu ya wote fiche na ugonjwa hai.<ref>{{cite journal|author=Kaufmann SH|title=Future vaccination strategies against tuberculosis: Thinking outside the box|journal=Immunity|year=2010|volume=33|pages=567–77|pmid = 21029966|doi=10.1016/j.immuni.2010.09.015|issue=4}}</ref>

Kuhamasisha ugunduzi zaidi, watafiti na watunga sera ni kukuza mpya mifano ya kiuchumi ya maendeleo ya chanjo, ikiwa ni pamoja na zawadi, motisha ya kodi, na [[ahadi mapema Soko ]] .<ref>{{cite journal|author=Webber D, Kremer M|url=http://www.who.int/bulletin/archives/79(8)735.pdf |title=Stimulating Industrial R&D for Neglected Infectious Diseases: Economic Perspectives |journal=Bulletin of the World Health Organization|volume=79|issue=8|year=2001|pages=693–801}}</ref><ref>{{cite journal|author=Barder O, Kremer M, Williams H|url=http://www.bepress.com/ev/vol3/iss3/art1 |title=Advance Market Commitments: A Policy to Stimulate Investment in Vaccines for Neglected Diseases|journal=The Economists' Voice|volume=3|year=2006|issue=3|doi=10.2202/1553-3832.1144}}</ref> Idadi ya makundi, ikiwa ni pamoja na [[ Ushirikiano Stop TB ]] ,<ref>{{cite book|last=Economic|first=Department of|title=Achieving the global public health agenda : dialogues at the Economic and Social Council|year=2009|publisher=United Nations|location=New York|isbn=978-92-1-104596-3|pages=103|url=http://books.google.ca/books?id=VeF9dv74C4MC&pg=PA103|coauthors=Affairs, Social}}</ref> ] Afrika Kifua Initiative Chanjo, na the [[ Aeras TB Duniani Foundation Chanjo ]] , wanahusika na utafiti.<ref>{{cite book|last=Jong|first=[edited by] Jane N. Zuckerman, Elaine C.|title=Travelers' vaccines|year=2010|publisher=People's Medical Pub. House|location=Shelton, CT|isbn=978-1-60795-045-5|pages=319|url=http://books.google.ca/books?id=BKRpWFEy66wC&pg=PA319|edition=2nd ed.}}</ref> Kati ya hayo, Aeras TB Duniani Chanjo Foundation alipokea zawadi ya zaidi ya $ 280,000,000 (Marekani) kutoka kwa [[Bill na Melinda Gates Foundation]] kuendeleza na leseni ya chanjo dhidi ya kifua kikuu bora kwa ajili ya matumizi katika nchi mzigo mkubwa. <ref>{{Cite web last=Bill and Melinda Gates Foundation Announcement|title=Gates Foundation Commits $82.9 Million to Develop New Tuberculosis Vaccines|date=2004-02-12| url=http://www.globalhealth.org/news/article/4134}}</ref><ref>{{Cite web last=Nightingale|first=Katherine|title=Gates foundation gives US$280 million to fight TB|date=2007-09-19|url=http://www.scidev.net/en/news/gates-foundation-gives-us280-million-to-fight-tb.html}}</ref>

Mycobacteria kuambukiza wanyama mbalimbali, ikiwa ni pamoja na ndege,<ref>{{cite journal last=Shivaprasad|first=HL|coauthors=Palmieri, C|title=Pathology of mycobacteriosis in birds.|journal=The veterinary clinics of North America. Exotic animal practice date=2012 Jan volume=15|issue=1|pages=41-55, v-vi|pmid=22244112}}</ref>panya,<ref>{{cite journal last=Reavill|first=DR|coauthors=Schmidt, RE|title=Mycobacterial lesions in fish, amphibians, reptiles, rodents, lagomorphs, and ferrets with reference to animal models.|journal=The veterinary clinics of North America. Exotic animal practice date=2012 Jan volume=15|issue=1|pages=25-40, v|pmid=22244111}} </ref> na wanyama watambaao. <ref>{{cite journal last=Mitchell|first=MA|title=Mycobacterial infections in reptiles.|journal=The veterinary clinics of North America. Exotic animal practice date=2012 Jan volume=15|issue=1|pages=101-11, vii|pmid=22244116}} </ref> subspecies Mycobacterium kifua kikuu, ingawa, ni mara chache sasa katika wanyama wa porini. <ref>{{cite book|last=Wobeser|first=Gary A.|title=Essentials of disease in wild animals|year=2006|publisher=Blackwell Publ.|location=Ames, Iowa [u.a.]|isbn=978-0-8138-0589-4|pages=170|url=http://books.google.ca/books?id=JgyS6fxVasYC&pg=PA170|edition=1st ed.}}</ref> jitihada za kutokomeza kifua kikuu ng’ombe unasababishwa na “[[Bovis Mycobacterium ]] ” kutoka kwa ng'ombe na mifugo kulungu wa[[New Zealand]] New Zealand imekuwa na mafanikio.<ref>{{cite journal last=Ryan first=TJ|coauthors=Livingstone, PG, Ramsey, DS, de Lisle, GW, Nugent, G, Collins, DM, Buddle, BM|title=Advances in understanding disease epidemiology and implications for control and eradication of tuberculosis in livestock: the experience from New Zealand.|journal=Veterinary microbiology|date=2006 Feb 25|volume=112|issue=2-4|pages=211-9|pmid=16330161}}</ref> Jitihada katika Uingereza wamekuwa chini ya mafanikio.<ref>{{cite journal last=White|first=PC|coauthors=Böhm, M, Marion, G, Hutchings, MR|title=Control of bovine tuberculosis in British livestock: there is no 'silver bullet'.|journal=Trends in microbiology|date=2008 Sep|volume=16|issue=9|pages=420-7|pmid=18706814}}</ref><ref>{{cite journal last=Ward|first=AI|coauthors=Judge, J, Delahay, RJ|title=Farm husbandry and badger behaviour: opportunities to manage badger to cattle transmission of Mycobacterium bovis?|journal=Preventive veterinary medicine|date=2010 Jan 1|volume=93|issue=1|pages=2-10|pmid=19846226}}</ref>

== Rejea ==