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B io Factsheet Number 193

The Biology of TB
Which of the following are True and which are False?
Typical Exam Question
• Keats, Chopin, Edgar Allan Poe, Robert Louis Stevenson, Franz
Table 1 shows the number of cases of tuberculosis in different
Kafka, King Tutankhamen and George Orwell all suffered from
regions of England between 2000 and 2005.
• The number of new cases of TB in 2005 exceeded 8 million Table 1
• 1.6 million people died worldwide in 2005 from TB
• TB has almost been eradicated in the UK Region Number of cases of tuberculosis
per 100,000 of the population
All true, except the last one
2000 2001 2002 2003 2004
This Factsheet summarises the key biological aspects of East Midlands 10.6 11.1 11.9 7.9 9.9
tuberculosis; West Midlands 13.7 13.1 14.9 15.0 16.2
• how it spreads North East 5.7 7.7 6.4 6.1 6.7
• how it affects the human body North West 10.0 10.0 9.4 9.0 9.3
• why it is on the increase South East 6.1 6.6 7.3 7.4 7.3
• the most recent efforts at developing a vaccine, and South West 4.6 4.0 4.8 4.5 5.3
• recent exam questions on TB
(a) Suggest why number of cases of tuberculosis has increased
Note: TB comes up on all exam boards in application questions in some regions more than others (2 ).

(b) How could each of the following have contributed to the

Tuberculosis is caused by the rod – shaped bacterium, overall increase?
Mycobacterium tuberculosis (i) an increase in antibiotic-resistant strains of
• It enters the body when infected Mycobacterium tuberculosis;
droplets from coughing or sneezing are (ii) an increase in the number of people with AIDS.
breathed in
(c) Suggest why the procedure is for people with TB to take a
• It can also enter the body when infected
mixture of three or four antibiotics for up to a year.
milk is ingested but pasteurisation and
sterilization now usually prevent this
method of transmission
(a) areas most affected are cities such as London, Birmingham
• It usually infects the lung/respiratory
and Leicester;
have immigrant communities from countries where TB still
• Phagocytes take in the bacteria by
persists e.g. Pakistan, Bangladesh and parts of Africa;
• A tissue mass called a granuloma forms. These are anaerobic (b) (i) people cannot be treated effectively/fewer people treated/
tubercles and contain dead bacteria and macrophages people infective for longer;
• After 3-8 weeks the infection has usually been controlled (ii) HIV suppresses patient’s immune systems/AIDS patients
and the lung tissue heals have weaker immune systems/ B-lymphocytes/helper T
• However, some of the bacteria may survive and breed inside cells not present
the macrophages
• They may lie dormant for years before attacking if and when (c) Different strains;
the immune system is weakened Some of which are resistant to a particular antibiotic;
• The bacteria then gradually destroy lung tissue Bacterium can remain hidden within lungs and act as a
• Symptoms include fever, weight loss, persistent coughing, reservoir of infection;
chest pain, the coughing up of blood and the build up of Less chance of resistance developing if several antibiotics
fluid in the pleural cavity used;
• The bacterium can infect the lymph nodes, bones and gut

Cases of tuberculosis increased by 10% in 2005. This is likely to be Clinical trials have now begun on the first new TB vaccine for 80
a result of the bacteria becoming increasingly resistant to antibiotics years. If successful, it is expected to be in GP’s surgeries by 2015
and to increasing air travel which is helping its spread. when it would be used as a booster for the (presently abandoned)
childhood BCG injection. This would give long-lasting immunity
through adulthood.

193 The Biology of TB Bio Factsheet

Typical Exam Question Explain how to prepare a bacterial lawn on an agar plate.
The graph shows information about the number of reported cases Learn these simple points:
of tuberculosis in the UK during the period 1920 to 1990. • place a small drop of culture on the sterile agar surface
• using aseptic technique
Number of reported cases per year (thousands

80 • use a sterile spreader to distribute/spread the culture

• evenly over the surface of the agar gel
Tuberculosis vaccination The antibiotic diffuses from the discs into the agar. The clear areas
60 introduced show where the antibiotic has killed the bacterium. From the diagram
we can see that antibiotic X is the most effective antibiotic at
50 inhibiting bacterial growth. But in reality, it has been antibiotic Z
40 that has been used most extensively. Table 2 shows why this has
been the case.
Table 2
Antibiotic Method of Cost per Recommended Total
10 administration dose number of cost
to a patient doses
1950 1920
1960 1970 1980 1990 1930 1940 V Tablet £0.36 90 £32.40
Year W Tablet £0.92 90 £82.80
The graph shows how successful vaccination against tuberculosis X Injection £18.00 15 £270.00
has been. However, it was not only vaccination that was Y Tablet £0.76 60 £45.60
responsible for the decline in the number of Z Tablet £6.00 12 £72.00
reported cases of tuberculosis.
Question. Give one piece of evidence from the graph to support Why use Z rather than X?
this statement. • less expensive per dose
• less expensive per course of treatment
Pretty obviously, the number of reported cases was falling before
• don’t need to take as many doses
vaccination was introduced. This was a result of factors such as:
• X is an injectable drug, so you would need to go to the doctors/
• Better housing conditions / other social reason e.g. diet
not be able to administer it yourself
• Better awareness of disease / improved medical care
• Z is a tablet, so you can take it yourself/ more likely to remember
• Fewer susceptible people / more immune
to take a tablet than want to go for an injection
• Availability of antibiotics post circa 1940;
The search for new antibiotics
The vaccine has taken a long time to develop because the bacterium One of the reasons scientists wish to conserve wild plant species is
is adept at hiding inside cells and avoiding antibodies. The approach that they might just contain substances that exert powerful
has been to use recombinant viruses that contain genes coding for antimicrobial properties. This becomes more important as resistance
a simple protein from the bacteria. The altered viruses enter the to our current antibiotics spreads. Extracts from the bark of a South
body, release the protein and then die. The protein is then easily American tree have been used as a treatment for tooth decay for
detected by the immune system which generates millions of T cells many years. To test whether this extract could be an effective
to attack it. Thus, if the bacteria then enter the body, the T cells are antibiotic, the growth of Mycobacterium tuberculosis in the
ready. presence of the extract was studied.
Combining knowledge of the theory with practical skills
Often, examiners will use questions on diseases, immunity and Typical Exam Question
vaccination to test candidates’ understanding of practical Describe a technique that you could use to measure the effects
procedures. of an antibiotic on the growth of bacteria. (6)
Question: Tuberculosis is caused by a bacterium. Antibiotics may Note the number of marks available here –you cannot get away
be used to kill bacteria. with the sparse details of the previous agar plate
The diagram below shows the results of an antibiotic assay against
an unknown bacterium. Here is the markscheme
clear zone Set up agar plates;
antibiotic disc Lawning/spreading with the bacteria;
Ensure that all equipment is sterile;
Description of aseptic technique;
V Set up wells or discs with the antibiotic
Use different concentrations of the antibiotic;
Incubate at safe temperature with plates closed;
bacterial lawn W Measure area cleared of bacteria;

193 The Biology of TB Bio Factsheet

The study involved counting the number of living Mycobacterium

cells after growth in a range of concentrations of the extract. The Typical Exam Question
results are shown in the graph (Fig 1)below. The BCG vaccine consists of Mycobacterium bovis. The
bacterium is injected into the body to stimulate active immunity
Fig 1
against tuberculosis (TB). TB is caused by Mycobacterium
tuberculosis, a bacterium that is closely related to M. bovis.
(a) What is meant by active immunity?.
Another common bacterium, Mycobacterium fortuitum is
harmless and often found in soil. In a study to compare the effects
200 of different Mycobacterium species, mice were infected with
tuberculosis /cells µm-3
Living Mycobactreium

Mycobacterium as shown in the diagram. Enough time was

allowed between injections for an immune response to develop.
Bacterium speices Treatment A Treatment B Treatment C
100 injected

M. fortuitum
0 1 2 3 4 5 6 7
concentration of extract /mgdm-3

In order to compare the effectiveness of the extract with other

antibiotics, the minimum inhibitory concentration (MIC) was
calculated. This is the minimum concentration that will reduce
bacterial growth by 90%. mouse dies mouse mouse dies
of TB survives of TB
Question Use the information in Fig 1 to find the MIC for this
extract. Show your working. (b) Explain why the mouse died of TB after treatment A, but the
mouse used for treatment B did not die of TB.
Answer 10% = 20; 4.3mg dm-3
(c) The BCG vaccine needs the M. bovis cells to grow and divide
Question Explain why this extract would not make an effective in order to provide protection. Suggest reasons why the BCG
antibiotic against Mycobacterium. vaccine in treatment C failed to protect the mouse against
Answer. Even the highest concentration of extract did not kill all
the bacteria, suggesting that some of them have already (d) M. fortuitum often infects wounds in young children. Suggest
developed resistance. Surviving bacteria will pass on the alleles one possible consequence of this in later life.
that confer resistance – which will then spread.
(a) Response of the body’s immune system / making antibodies;
The BCG vaccine To foreign antigen / organism / bacterium / pathogen / virus ;
The BCG vaccine contains a live but weakened form of
Mycobacterium bovis (the vaccine is known as BCG because the (b) M. bovis antigens similar to tuberculosis / M. fortuitum not
bacterial strain used is called Bacillus Calmette-Guerin). The vaccine similar ;
stimulates the body’s immune response to produce antibodies which No (secondary response / memory cells to) tuberculosis in A
remain in the body to fight any actual M. bovis that enter the body / no immunity /converse ;
– active immunity.
(c) Immunity to M. fortuitum prevents M. bovis growing and
The BCG vaccine is now only given to high risk groups - infants dividing ;
under one year of age living in areas where the incidence of TB is 40 M. fortuitum immunises against M. bovis / eq. ;
cases per 100,000 people or higher, infants under one year of age No stimulation of immune response to TB antigens ;
whose parents or grandparents were born in a country with an M. fortuitum causes antibody production against M. bovis ;
incidence of TB of 40 cases per 100,000 people or higher, and new
immigrants from countries with a high incidence of TB who have (d) BCG won’t protect against TB / more likely to get TB ;
not already been vaccinated.

This Factsheet was researched and written by Kevin Byrne.
Curriculum Press, Bank House, 105 King Street, Wellington, Shropshire, TF1 1NU.
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form or by any other means, without the prior permission of the publisher. ISSN 1351-5136