So here goes.
So where do I begin?

How about from the end! I thought I'd fill you in on some of the work I'm doing down in Peru this year. This will be installment number 1, maybe the duller part: Combatting Consumption. I'll keep you on the edge of your seat waiting for part 2, Sex in the Peruvian City.

About this time last year, I spent a month in Peru doing some sexually transmitted disesae work (you'll learn more about this next week) and was offered a job to return for this year. Though I accepted the job, I have known for a whlie that I may not stay in the STD field forever (it's got some incredibly interesting elements of social and hard science, but ultimately I don't feel like it's my niche for a variety of reasons). There is a lot of good work go on in Peru, so I approaced some people at my school to learn about what was going on down here. There is a big research team led by a physician named Robert Gilman, who has been sweating it out in Peru for almost 30 years researching everything from childhood diarrhea to tuberculosis. One of his middle-managers, is now my boss down here - Carlton Evans, a charming English guy from Imperial College in England. We had a meeting last spring about possible projects and the rest is history, present, and future.

Tuberculosis is caused by a bacteria, called Mycobacterium tuberculosis. It is estimated that 1/3 of the world's population is infected with the bacteria. Generally speaking, tuberculosis takes two forms: 1) latent infection, in which people have a dormant form of bacteria in their lungs and 2) active infection where the bacteria actively reproduces in the lungs (most commonly, but can be in just about any tissue in the body) and causes symptoms: cough, fever, weight loss (which is why it was called consumption), and others depending on what other parts of the body are invovled. Overall, for healthy people - risk of advancing from latent to active infection is about 10% over a lifetime (but for HIV positive people it is about 10% per year). Despite recent advances in TB care (giving people medications face to face over 6-9 months to make sure they are cured), active TB rates and mortality due to TB are on the rise mostly due to the AIDS epidemic and emergence of new forms of TB that are resistant to medications. It is thought that the new cases are not due to increased transmission of TB, but instead due to activation of latent disease among those with AIDS.

TB is a disease that is relatively hard to diagnose. 90% of TB cases are diagnosed by smearing spit from a patient on a slide and looking at it under a microscope with stains specific for the bacteria (sputum microscopy). Unfortunately, this technique only finds TB in patients who really have it in about 30-50% of the time. The bacteria also grows very slowly (6-8 weeks by standard methods), so culturing a sample of someone's spit takes time, and can be expensive in poor settings. The group I am working with has developed a new culture method that takes about 15 days. It is pretty exciting, but still lacks all the requirements for efficient use worldwide.

I have been involved in two major projects here. The first is testing this new culture test on samples from the pleura, or sack around the lung, to see if it is better than standard methods to diagnose TB infection in this site. That study which was run by a Peruvian doctor here named Marco Tovar, has been completed and I just today submitted my manuscript today for publication. I am attaching that article to this email

The second, and more interesting project, is trying to improve the ability of diagnosing TB by use of a microscope. The main problems with all culture methods is that they require weeks to diagnose and incubators and centrifuges and other expensive equipment that poor places cannot afford. It is these same poor places where the terrible effects of TB are the greatest. We are trying to develop a simple and cheat method to increase the sensitivity of sputum microscopy from 30% versus culture to hopefully 80 or 90%. We are doing this by trying to filter the spit, catching the tb in filters, and looking at the more concentred sample under a microscope. This is in the beginning stages (I have been able to concentrate the bacteria on filters - which has been published many times since the 1940s, but like all things in TB, the wheel is constantly being reinvented), but am still working to make it a funcional tool and test it on larger numbers of specimens. I hope to be able to get there and design a study that will take place after I leave in May. If we can get it to work, the hope is that it will be used in poor resource setting as a simple technique to increase the detection of TB so we can treat more cases earlier and prevent further spread and mortality of the disease. A lofty goal (perhaps unrealistic), but it gets me out of bed in the morning!