HOST FACTORS FOR SUSCEPTIBILITY It is not every individual exposed to the Mycobacterium tuberculosis that gets infected with

the infection. Susceptibility to disease after infection by Mycobacterium tuberculosis is influenced by environmental and host factors (nature and nurture) A primary infection may heal, the host acquiring immunity in the process while in other cases, the primary infection may progress to produce extensive disease locally, or infection may be promulgated or disseminated to produce metastatic or miliary tuberculosis. In others, primary lesions that are apparently healed may subsequently deteriorate with reactivation of the disease. Those vital, influential and important host factors include: Age The role of age in the susceptibility to tuberculosis is unequivocal, since epidemiological data has shown that the population at the extreme of age are more affected (the children and the elderly), this is attributable to the fact that the immune system of the children is not fully developed and also to the progressive deterioration, degradation and retrogression of the immune system of the elderly due to senescence. Malnutrition It is not surprising to see that majority of patient developing the clinical features of pulmonary tuberculosis are people that are undernourished (malnourished) since malnutrition can have adverse, even devastating effects upon the antigen-specific arms of the immune system, as well as on many of the more generalized mechanisms used for host defense. Viral Infections Host defend is often crippled and incapacitated by viral infections like Human immune deficiency virus, which increases susceptibility to other infections like tuberculosis, this is further buttressed by the fact that most tuberculosis patients are HIV positive. Other factors that tend to incapacitate the immune system (innate and acquired), thereby increasing the susceptibility of an individual to the infection or culminating in the reactivation of a previously dormant infection include:

 Patients receiving chronic corticosteroid therapy for autoimmune diseases Chronic illnesses like diabetes mellitus Those on immunosuppressive therapy because of organ transplant and stem cell transplant Individuals receiving cancer chemotherapy Chronic lung disease is another significant risk factor with silicosis increasing the risk about 30-fold Those who smoke cigarettes and drink alcohol have nearly thrice the risk of TB than nonsmokers There is also a genetic susceptibility, for which overall importance remains undefined.

Community factors The community factors also play a role in the epidemiology of tuberculosis. Those at high risk thus include: people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (e.g. prisons and homeless shelters), medically underprivileged and resource-poor communities, high-risk ethnic minorities, children in close contact with high-risk category patients, and health care providers serving these patients. In conclusion both nature and nurture must be contributing to the risk of tuberculosis. If undue emphasis is put on inheritable factors, the humanitarian need to improve the lot of the poorest of the world who run the greatest risk of disease will be overlooked. On the other hand, an emphasis on nurture may well have contributed to the initial failure to detect and acknowledge the resurgence of the disease that has occurred in the developed countries in recent years and its threat to all levels of society. Source of infection Humans are the reservoir of the human strain (Mycobacterium tuberculosis) and patients with tuberculosis constitute the main source of infection. The reservoir of the bovine strain which can also affect humans is cattle, with infected milk and meat being the main source. With pasteurization of milk the incidence of the bovine tuberculosis has reduced drastically. It is only common in the northern part

of Nigeria where they ingest or consume raw milk from their cattle without pasteurization. Transmission When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0.5 to 5.0 m in diameter. A single sneeze can release up to 40,000 droplets. Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low (the inhalation of fewer than 10 bacteria may cause an infection). People with prolonged, frequent, or close contact with people with TB are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis may infect 1015 (or more) other people per year. Transmission should only occur from people with active TB those with latent infection are not thought to be contagious. The probability of transmission from one person to another depends upon several factors, including the number of infectious droplets expelled by the carrier, the effectiveness of ventilation, the duration of exposure, the virulence of the M. tuberculosis strain, the level of immunity in the uninfected person, and others. The cascade of personto-person spread can be circumvented by effectively segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others. If someone does become infected, it typically takes three to four weeks before the newly infected person becomes infectious enough to transmit the disease to others.