Tuberculosis

qas: question: What bacterium causes tuberculosis infection?
answers: text: Mycobacterium tuberculosis
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question: What primary body part is affected by tuberculosis?
answers: text: lungs
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question: Roughly, what percentage of latent tuberculosis infections result in active tuberculosis?
answers: text: 10%
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question: What name has been used to refer to tuberculosis because of associated weight loss?
answers: text: consumption
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question: Along with cough, weight loss, and night sweats, what's the fourth classic symptom of the disease?
answers: text: fever
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question: What disease is caused by TB?
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question: What percentage of infections do not have symptoms?
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question: What was consumption originally called?
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question: What is an infection with symptoms called?
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question: What percentage of patients with latent TB die?
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question: How much of the entire population of the planet is estimated to be carrying tuberculosis?
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question: For about how long does full immunity from the TB vaccine last?
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question: What year was the Medical Research Council created?
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context: Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those infected. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. The historical term "consumption" came about due to the weight loss. Infection of other organs can cause a wide range of symptoms.

qas: question: How much of the entire population of the planet is estimated to be carrying tuberculosis?
answers: text: One-third
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question: How many cases of tuberculosis were active over the course of 2014?
answers: text: 9.6 million
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question: In 2014, how many people died from TB?
answers: text: 1.5 million
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question: Does the majority of fatalities from TB occur in developing countries or industrialized nations?
answers: text: developing countries
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question: Has TB infection increased or decreased worldwide since the start of the 21st century?
answers: text: decreased
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question: What percentage of deaths worldwide died from TB in 2014?
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question: How many people died from TB in 2000?
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question: How many new cases of TB occurred in 2014?
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question: When did deaths begin increasing?
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question: Which Asian country has an 80% infection rate?
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question: When was Wyoming discovered?
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question: What did Britain try to get people to stop doing to reduce the spread of TB in public?
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question: What event is celebrated on March 24th to recognize the test for latent TB?
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context: One-third of the world's population is thought to be infected with TB. New infections occur in about 1% of the population each year. In 2014, there were 9.6 million cases of active TB which resulted in 1.5 million deaths. More than 95% of deaths occurred in developing countries. The number of new cases each year has decreased since 2000. About 80% of people in many Asian and African countries test positive while 5–10% of people in the United States population tests positive by the tuberculin test. Tuberculosis has been present in humans since ancient times.

qas: question: Which lobes of the lungs are more often affected by TB?
answers: text: upper lung lobes
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question: What symptom will result if TB infection causes a Rasmussen's aneurysm?
answers: text: massive bleeding
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question: What percentage of tuberculosis infections don't ever manifest in symptoms of the disease?
answers: text: 25%
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question: If TB becomes chronic, what lasting effect might it have on the lung's upper lobes?
answers: text: scarring
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question: Approximately what percentage of active TB cases affect the lungs?
answers: text: 90%
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question: What percentage of cases include chest pain?
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question: What is it called when people have symptoms?
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question: What percentage of cases erode into the pulmonary artery?
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question: What kind of aneurysm does chest pain in TB patients sometimes result in?
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question: What are lower lobes in the lungs often more affected by?
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question: What type of cells gather around infected macrophages in a person infected with TB?
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question: What color is Auramine-rhodamine staining?
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question: What member of leadership at the Global Fund to Fight AIDS, Tuberculosis and Malaria called TB a "pandemic"?
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context: If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases). Symptoms may include chest pain and a prolonged cough producing sputum. About 25% of people may not have any symptoms (i.e. they remain "asymptomatic"). Occasionally, people may cough up blood in small amounts, and in very rare cases, the infection may erode into the pulmonary artery or a Rasmussen's aneurysm, resulting in massive bleeding. Tuberculosis may become a chronic illness and cause extensive scarring in the upper lobes of the lungs. The upper lung lobes are more frequently affected by tuberculosis than the lower ones. The reason for this difference is not clear. It may be due either to better air flow, or to poor lymph drainage within the upper lungs.

qas: question: What's the medical term for TB when it spreads from the lungs to other parts of the body?
answers: text: extrapulmonary tuberculosis
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question: At least what percentage of HIV-positive patients who contract TB will experience extrapulmonary infection?
answers: text: 50%
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question: Along with people with diminished immune function, like HIV patients, what group of people is more likely to develop extrapulmonary TB?
answers: text: young children
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question: If TB infection spreads to the central nervous system, what is it called?
answers: text: tuberculous meningitis
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question: What's the other name for "disseminated tuberculosis"?
answers: text: miliary tuberculosis
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question: What percentage of young children get Extrapulmonary TB?
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question: What does a tuberculous ulcer result in?
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question: What does disseminated tuberculosis look like?
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question: What is another name for osseous tuberculosis?
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question: What percentage of HIV positive cases also get Military TB?
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question: Who have been performing studies on the relationship between stigma and mortality?
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question: What incorrect result may someone who has not gotten the TB vaccination get?
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question: What organization recommends directly observed therapy to make sure people take their antibiotics correctly?
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context: In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as "extrapulmonary tuberculosis". Extrapulmonary TB occurs more commonly in immunosuppressed persons and young children. In those with HIV, this occurs in more than 50% of cases. Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis), and the bones and joints (in Pott disease of the spine), among others. When it spreads to the bones, it is also known as "osseous tuberculosis", a form of osteomyelitis. Sometimes, bursting of a tubercular abscess through skin results in tuberculous ulcer. An ulcer originating from nearby infected lymph nodes is painless, slowly enlarging and has an appearance of "wash leather". A potentially more serious, widespread form of TB is called "disseminated tuberculosis", also known as miliary tuberculosis. Miliary TB makes up about 10% of extrapulmonary cases.

qas: question: The uniqueness of Mycobacterium tuberculosis is due to its high level of what type of molecule?
answers: text: lipid
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question: Is the division rate of the TB bacterium fast or slow relative to other bacteria?
answers: text: slow
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question: In nature, what "helper" does the MTB bacterium require to grow?
answers: text: a host organism
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question: How long is the period between division of MTB cells?
answers: text: 16 to 20 hours
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question: How much time does it take most bacteria to divide?
answers: text: less than an hour
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question: What is the main cause of Mycobacterium tuberculosis?
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question: How long can a Gram stain last?
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question: What grows outside of the cells of a host organism?
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question: How often do lipids divide?
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question: What divides faster than other bacteria?
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question: How many chronic cases of TB were there total in 2012?
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question: What vesicle is the temporary holding room for the M. tuberculosis bacterium during phagocytosis?
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question: How many deaths out of every six in France during 1918 were attributed to tuberculosis?
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context: The main cause of TB is Mycobacterium tuberculosis, a small, aerobic, nonmotile bacillus. The high lipid content of this pathogen accounts for many of its unique clinical characteristics. It divides every 16 to 20 hours, which is an extremely slow rate compared with other bacteria, which usually divide in less than an hour. Mycobacteria have an outer membrane lipid bilayer. If a Gram stain is performed, MTB either stains very weakly "Gram-positive" or does not retain dye as a result of the high lipid and mycolic acid content of its cell wall. MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the laboratory.

qas: question: What's another word for "sputum"?
answers: text: phlegm
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question: One of the two standard acid-fast staining techniques is the Kinyoun stain; what's the other?
answers: text: Ziehl–Neelsen stain
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question: What color will acid-fast bacilli become when stained?
answers: text: bright red
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question: What's the term for bacillus that can be exposed to acidic solutions without losing their stains?
answers: text: acid-fast
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question: If a scientist didn't want to use an acid-fast staining technique, what type of microscopy could they use instead?
answers: text: fluorescence
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question: What is another name for an expectorated sample?
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question: What removes all stains from MTB?
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question: What is another name for the Kinyoun stain?
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question: What become blue when stained?
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question: What color is Auramine-rhodamine staining?
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question: When did HIV-associated tuberculosis become more common?
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question: What is low-quality medication an example of a lack of?
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question: What liquid would you need from a patient to perform IGRAs?
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context: Using histological stains on expectorated samples from phlegm (also called "sputum"), scientists can identify MTB under a microscope. Since MTB retains certain stains even after being treated with acidic solution, it is classified as an acid-fast bacillus. The most common acid-fast staining techniques are the Ziehl–Neelsen stain and the Kinyoun stain, which dye acid-fast bacilli a bright red that stands out against a blue background. Auramine-rhodamine staining and fluorescence microscopy are also used.

qas: question: Which mycobacterium that causes TB can often be found in unpasteurized milk?
answers: text: M. bovis
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question: Which one of the tuberculosis mycobacteria is associated with the Horn of Africa?
answers: text: M. canetti
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question: Which of the four TB-causing bacteria do scientists think might be more common than we know?
answers: text: M. microti
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question: What bacterium has the name of the country it affects most in its name?
answers: text: M. africanum
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question: How many M. tuberculosis complexes are there?
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question: Which parts of Africa is M. africanum most common in?
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question: African emigrants are not likely to get what disease in the Horn of Africa?
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question: What form of tuberculosis has pasteurized milk caused?
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question: Which bacterium has likely been overestimated?
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question: What sign of TB infection would a lab be looking for in a sputum culture?
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question: What grows outside of the cells of a host organism?
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question: New studies have found that half of reactivation cases of tuberculosis might actually be due to what other "re-" word?
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context: The M. tuberculosis complex (MTBC) includes four other TB-causing mycobacteria: M. bovis, M. africanum, M. canetti, and M. microti. M. africanum is not widespread, but it is a significant cause of tuberculosis in parts of Africa. M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has almost completely eliminated this as a public health problem in developed countries. M. canetti is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants. M. microti is also rare and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated.

qas: question: If you're around someone with active TB, what's the chance you'll contract it expressed as a percentage?
answers: text: 22%
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question: Left untreated, about how many people could contract tuberculosis from an active TB patient in a year?
answers: text: 10–15
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question: About how long will a TB patient receiving effective treatment stay contagious?
answers: text: two weeks
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question: If you contracted tuberculosis today, what's the estimated gestation period before you could spread the infection to others?
answers: text: three to four weeks
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question: What term is interchangeable with "active" when talking about tuberculosis infection?
answers: text: overt
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question: What is the infection rate for people not in close contact with TB?
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question: How many people does a person whose TB is being treated infect per year?
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question: Which type of TB is more infectious than active TB?
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question: Uninfected people are treated with what regimens?
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question: How long is someone contagious if they are recently infected?
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question: In what decade was TB's communicability finally realized?
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question: Who started World Tuberculosis Day?
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question: Education about TB seems to decrease the stigma of the disease and lead to what other positive effect?
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context: 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 10–15 (or more) other people per year. Transmission should occur from only 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 person-to-person spread can be circumvented by 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.

qas: question: What specific part of the lungs marks the start of tuberculosis infection?
answers: text: pulmonary alveoli
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question: What's the process by which macrophages try to get rid of the TB bacterium?
answers: text: phagocytosis
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question: What do you get when you combine a lysosome and a phagosome?
answers: text: a phagolysosome
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question: What does the M. tuberculosis bacterium have that protects it from being affected by toxins?
answers: text: mycolic acid capsule
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question: What vesicle is the temporary holding room for the M. tuberculosis bacterium during phagocytosis?
answers: text: phagosome
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question: What replicates inside the pulmonary alveoli?
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question: What begins when the endosomes reach the pulmonary alveoli?
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question: What do the bacterium identify?
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question: What envelopes the macrophage?
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question: What does the combination of a lysosome and a phagolysosome create?
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question: How much greater is the mortality rate from TB for racial and ethnic minorities?
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question: When tuberculosis was at its worst in Europe, what percentage of deaths was TB-related?
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question: How are people with AIDS perceived?
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context: TB infection begins when the mycobacteria reach the pulmonary alveoli, where they invade and replicate within endosomes of alveolar macrophages. Macrophages identify the bacterium as foreign and attempt to eliminate it by phagocytosis. During this process, the bacterium is enveloped by the macrophage and stored temporarily in a membrane-bound vesicle called a phagosome. The phagosome then combines with a lysosome to create a phagolysosome. In the phagolysosome, the cell attempts to use reactive oxygen species and acid to kill the bacterium. However, M. tuberculosis has a thick, waxy mycolic acid capsule that protects it from these toxic substances. M. tuberculosis is able to reproduce inside the macrophage and will eventually kill the immune cell.

qas: question: What two-word phrase is used for the main part of the lungs infected by TB?
answers: text: Ghon focus
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question: If the lungs are infected by TB via bloodstream, what's the type of focus?
answers: text: Simon focus
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question: In what general area of the lungs is SImon focus usually located?
answers: text: the top
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question: What is the term that describes a blood-borne infection, like TB when it travels through the blood to the kidneys or brain?
answers: text: hematogenous
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question: Four areas of the body are usually safe from TB infection, including skeletal muscles, heart, and thyroid; what's the fourth?
answers: text: pancreas
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question: What is the section of lung not affected by TB called?
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question: What is another name for Ghon focus?
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question: What is type of transmission is found in the lungs?
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question: Where are the peripheral lymph nodes?
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question: What disease often affects the heart, skeletal muscles, pancreas, or thyroid?
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question: Is the division rate of the TB bacterium fast or slow relative to other bacteria?
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question: What is low-quality medication an example of a lack of?
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question: What's the only antibiotic that might be effective against totally drug-resistant TB?
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context: The primary site of infection in the lungs, known as the "Ghon focus", is generally located in either the upper part of the lower lobe, or the lower part of the upper lobe. Tuberculosis of the lungs may also occur via infection from the blood stream. This is known as a Simon focus and is typically found in the top of the lung. This hematogenous transmission can also spread infection to more distant sites, such as peripheral lymph nodes, the kidneys, the brain, and the bones. All parts of the body can be affected by the disease, though for unknown reasons it rarely affects the heart, skeletal muscles, pancreas, or thyroid.

qas: question: What specific type of disease is TB?
answers: text: granulomatous inflammatory
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question: What type of cells gather around infected macrophages in a person infected with TB?
answers: text: lymphocytes
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question: What type of cell forms when macrophages clump together trying to kill off the TB infection?
answers: text: multinucleated
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question: What's the technical term for abnormal cell death?
answers: text: necrosis
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question: What natural defensive response is hindered by cells in granulomas that can't send antigen to lymphocytes?
answers: text: immune response
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question: What surrounds the lymphocytes?
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question: What do infected macrophages form?
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question: What is used by bacteria to destroy the host's immune system?
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question: Which cells serve as antigen to lymphocytes?
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question: What is the texture of cheese called?
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question: What's another word for "sputum"?
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question: What year was Koch awarded a Nobel Prize?
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question: Which test has fewer false positives: IGRAs or the Mantoux skin test?
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context: Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages, T lymphocytes, B lymphocytes, and fibroblasts aggregate to form granulomas, with lymphocytes surrounding the infected macrophages. When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system. However, more recent evidence suggests that the bacteria use the granulomas to avoid destruction by the host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death (necrosis) in the center of tubercles. To the naked eye, this has the texture of soft, white cheese and is termed caseous necrosis.

qas: question: What process replaces tissue damaged by TB?
answers: text: scarring
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question: What material can sometimes be expelled by coughing if the cavities it's stored in connect to bronchi?
answers: text: caseous necrotic material
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question: What type of bacteria-attacking medicine will treat tuberculosis?
answers: text: antibiotics
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question: Are the bacteria in caseous necrotic material living or dead?
answers: text: living
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question: What replaces scarring?
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question: What is affected tissue filled with?
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question: What do cavities join with in the waning period?
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question: What medicine treats scar tissue?
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question: What joins with air passages to prevent material from being coughed up?
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question: What kind of cultures test for HIV?
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question: What surrounds the lymphocytes?
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question: If a patient has some symptoms associated with TB, after what time period should tuberculosis be diagnostically considered?
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context: In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages bronchi and this material can be coughed up. It contains living bacteria, so can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.

qas: question: Is active TB difficult or easy to diagnose by patients' symptoms alone?
answers: text: difficult
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question: If a patient has some symptoms associated with TB, after what time period should tuberculosis be diagnostically considered?
answers: text: two weeks
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question: What part of the body would be X-rayed to check for TB?
answers: text: chest
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question: What sign of TB infection would a lab be looking for in a sputum culture?
answers: text: acid-fast bacilli
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question: Along with interferon-y release essays, what other tests aren't useful in TB diagnosis in developing countries?
answers: text: tuberculin skin tests
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question: What is usually diagnosed using just signs and symptoms?
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question: How long do symptoms in someone who is immunosuppressed last?
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question: What kind of cultures test for HIV?
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question: What kind of tests are common in developing countries?
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question: What type of bacilli do interferon-y release assays look for?
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question: What population segment in China struggles to get follow-up care for TB infection?
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question: How often do lipids divide?
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question: What organization brought antibiotics to Britain?
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context: Diagnosing active tuberculosis based only on signs and symptoms is difficult, as is diagnosing the disease in those who are immunosuppressed. A diagnosis of TB should, however, be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation. Interferon-γ release assays and tuberculin skin tests are of little use in the developing world. IGRA have similar limitations in those with HIV.

qas: question: What result might someone who has received a TB vaccination get from the Mantoux test?
answers: text: false-positive
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question: What does "IGRAs" stand for?
answers: text: Interferon gamma release assays
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question: In combination with skin tests, are IGRAs associated with an increase or decrease in sensitivity?
answers: text: increase
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question: Which test has fewer false positives: IGRAs or the Mantoux skin test?
answers: text: IGRAs
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question: What liquid would you need from a patient to perform IGRAs?
answers: text: blood
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question: What is used to test for sarcoidosis?
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question: What incorrect result may someone who has not gotten the TB vaccination get?
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question: What environmental substance are IGRAs affected by?
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question: What has more false-positives than the Mantoux tuberculin test?
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question: What drug in the running to treat multi drug resistant TB has already gotten FDA approval?
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question: About how much had the death rate from TB been reduced in Europe by the midpoint of the 20th century?
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question: What remedy did Koch win a Nobel prize for?
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context: The Mantoux tuberculin skin test is often used to screen people at high risk for TB. Those who have been previously immunized may have a false-positive test result. The test may be falsely negative in those with sarcoidosis, Hodgkin's lymphoma, malnutrition, and most notably, active tuberculosis. Interferon gamma release assays (IGRAs), on a blood sample, are recommended in those who are positive to the Mantoux test. These are not affected by immunization or most environmental mycobacteria, so they generate fewer false-positive results. However, they are affected by M. szulgai, M. marinum, and M. kansasii. IGRAs may increase sensitivity when used in addition to the skin test, but may be less sensitive than the skin test when used alone.

qas: question: For about how long does full immunity from the TB vaccine last?
answers: text: ten years
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question: What percentage of kids in the whole world get the BCG vaccine?
answers: text: 90%
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question: Is TB common or uncommon in the United States?
answers: text: uncommon
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question: In addition to the U.S. and Canada, what European country sees very few tuberculosis infections?
answers: text: the United Kingdom
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question: What segment of the population gets the TB vaccine in countries like Canada with a very low incidence of infection?
answers: text: high risk
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question: What percentage of children have TB?
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question: What disease is common in the UK?
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question: How long do you have to wait to get the TB vaccine?
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question: What is not given to high risk people?
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question: Which three countries have a high risk of tuberculosis?
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question: What drug in the running to treat multi drug resistant TB has already gotten FDA approval?
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question: When was Wyoming discovered?
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question: Who gifted Stop TB Partnership a large amount of money for improving vaccinations?
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context: It is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated. The immunity it induces decreases after about ten years. As tuberculosis is uncommon in most of Canada, the United Kingdom, and the United States, BCG is administered only to those people at high risk. Part of the reasoning against the use of the vaccine is that it makes the tuberculin skin test falsely positive, reducing the test's use in screening. A number of new vaccines are currently in development.

qas: question: What group heads up the Global Plan to Stop Tuberculosis?
answers: text: Stop TB Partnership
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question: In what year did the WHO say tuberculosis was a "global health emergency"?
answers: text: 1993
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question: How many lives did the Stop TB Partnership vow to save in the nine years between its start and 2015?
answers: text: 14 million
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question: Drug-resistant TB is one of the barriers to success of the Stop TB Partnership's initiative; what's the other other?
answers: text: HIV-associated tuberculosis
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question: What organization created a system to classify various types of TB?
answers: text: American Thoracic Society
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question: What did the World Health Organization create in 2006?
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question: How many lives has Stop TB Partnership saved?
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question: When was the World Health Organization founded?
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question: Who developed the classification of HIV-associated TB?
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question: When was the tuberculosis classification system created?
is_impossible: yes

question: For about how long does full immunity from the TB vaccine last?
is_impossible: yes

question: Which gene was concluded to come from animals?
is_impossible: yes

question: When tuberculosis was at its worst in Europe, what percentage of deaths was TB-related?
is_impossible: yes
context: The World Health Organization declared TB a "global health emergency" in 1993, and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between its launch and 2015. A number of targets they have set are not likely to be achieved by 2015, mostly due to the increase in HIV-associated tuberculosis and the emergence of multiple drug-resistant tuberculosis. A tuberculosis classification system developed by the American Thoracic Society is used primarily in public health programs.

qas: question: What part of the mycobacterial cell makes tuberculosis more difficult to treat?
answers: text: wall
is_impossible: no

question: Isoniazid is one of the two most popular drugs for TB treatment; what's the other one?
answers: text: rifampicin
is_impossible: no

question: What complication does the use of combinations of antibiotics for active TB prevent?
answers: text: antibiotic resistance
is_impossible: no

question: What's the three-word name for the method where a health care worker watches their patient take their medication?
answers: text: Directly observed therapy
is_impossible: no

question: What organization recommends directly observed therapy to make sure people take their antibiotics correctly?
answers: text: WHO
is_impossible: no

question: What is used to kill antibiotics?
is_impossible: yes

question: The chemical composition of what wall makes TB easy to treat?
is_impossible: yes

question: Which two drugs are used simultaneously to treat latent TB?
is_impossible: yes

question: How long are antibiotics ineffective?
is_impossible: yes

question: What health care provider watches the person take their medications?
is_impossible: yes

question: What percentage of kids in the whole world get the BCG vaccine?
is_impossible: yes

question: What do cavities join with in the waning period?
is_impossible: yes

question: Approximately how many active TB cases were there in 2012?
is_impossible: yes
context: Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective. The two antibiotics most commonly used are isoniazid and rifampicin, and treatments can be prolonged, taking several months. Latent TB treatment usually employs a single antibiotic, while active TB disease is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance. People with latent infections are also treated to prevent them from progressing to active TB disease later in life. Directly observed therapy, i.e., having a health care provider watch the person take their medications, is recommended by the WHO in an effort to reduce the number of people not appropriately taking antibiotics. The evidence to support this practice over people simply taking their medications independently is poor. Methods to remind people of the importance of treatment do, however, appear effective.

qas: question: If a person has TB that's resistant to rifampicin and isoniazid, which type of the disease do they have?
answers: text: MDR-TB
is_impossible: no

question: What's the minimum number of second-line medication classes your TB would have to resist to make it count as "extensively drug-resistant"?
answers: text: three
is_impossible: no

question: In what country was the first case of totally drug-resistant tuberculosis?
answers: text: Italy
is_impossible: no

question: What's the only antibiotic that might be effective against totally drug-resistant TB?
answers: text: Bedaquiline
is_impossible: no

question: Cases of totally drug-resistant TB have been found in what country in addition to Italy and India?
answers: text: Iran
is_impossible: no

question: Someone who is not susceptible to MTP develops what?
is_impossible: yes

question: What is low-quality medication an example of a lack of?
is_impossible: yes

question: What was first reported in Iran?
is_impossible: yes

question: When was MDR-TB first observed?
is_impossible: yes

question: Where was bedaquiline created?
is_impossible: yes

question: Who gave the Bill and Melinda Gates Foundation $280 mil?
is_impossible: yes

question: What material can sometimes be expelled by coughing if the cavities it's stored in connect to bronchi?
is_impossible: yes

question: What health care provider watches the person take their medications?
is_impossible: yes
context: Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible MTB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication. Drug-resistant TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs. Totally drug-resistant TB is resistant to all currently used drugs. It was first observed in 2003 in Italy, but not widely reported until 2012, and has also been found in Iran and India. Bedaquiline is tentatively supported for use in multiple drug-resistant TB.

qas: question: As immunosuppression goes up in tuberculosis cases, what risk rises with it? 
answers: text: reactivation
is_impossible: no

question: What disease has a similar relationship as TB does between reactivation and immunosuppression?
answers: text: HIV
is_impossible: no

question: If you'd been diagnosed with tuberculosis in 1995, how great a chance would you have faced of dying from it?
answers: text: 8%
is_impossible: no

question: In what year did the risk of dying from TB reach half what it was in 1995?
answers: text: 2008
is_impossible: no

question: New studies have found that half of reactivation cases of tuberculosis might actually be due to what other "re-" word?
answers: text: reinfection
is_impossible: no

question: Reactivation is caused by what disease?
is_impossible: yes

question: What is the risk of reactivation in someone who only has M. tuberculosis?
is_impossible: yes

question: What was the chance of death from HIV in 2008?
is_impossible: yes

question: When did scientists begin to suspect reinfection was worse than previously thought?
is_impossible: yes

question: What methods have recent studies used to examine HIV strains?
is_impossible: yes

question: When was Wyoming discovered?
is_impossible: yes

question: What is another name for an expectorated sample?
is_impossible: yes

question: What percentage of the world's total population gets infected with tuberculosis every year?
is_impossible: yes
context: The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year. Studies using DNA fingerprinting of M. tuberculosis strains have shown reinfection contributes more substantially to recurrent TB than previously thought, with estimates that it might account for more than 50% of reactivated cases in areas where TB is common. The chance of death from a case of tuberculosis is about 4% as of 2008, down from 8% in 1995.

qas: question: At any given time, about how much of all the people in the world has M. tuberculosis?
answers: text: one-third
is_impossible: no

question: Approximately how many active TB cases were there in 2012?
answers: text: 8.6 million
is_impossible: no

question: How many patients were diagnosed with tuberculosis in 2010?
answers: text: 8.8 million
is_impossible: no

question: About how many people died in 2010 carrying both HIV and TB?
answers: text: 0.35 million
is_impossible: no

question: What percentage of the world's total population gets infected with tuberculosis every year?
answers: text: 1%
is_impossible: no

question: How many people died from TB in 2012?
is_impossible: yes

question: What percentage of TB deaths result in death?
is_impossible: yes

question: How many people died in developing countries from TB?
is_impossible: yes

question: What percentage of the population is infected by HIV each year?
is_impossible: yes

question: How many chronic cases of TB were there total in 2012?
is_impossible: yes

question: What percentage of the world's total population gets infected with tuberculosis every year?
is_impossible: yes

question: Out of every 100,000 people in Swaziland in 2007, how many were infected with tuberculosis?
is_impossible: yes

question: How long can a Gram stain last?
is_impossible: yes
context: Roughly one-third of the world's population has been infected with M. tuberculosis, with new infections occurring in about 1% of the population each year. However, most infections with M. tuberculosis do not cause TB disease, and 90–95% of infections remain asymptomatic. In 2012, an estimated 8.6 million chronic cases were active. In 2010, 8.8 million new cases of TB were diagnosed, and 1.20–1.45 million deaths occurred, most of these occurring in developing countries. Of these 1.45 million deaths, about 0.35 million occur in those also infected with HIV.

qas: question: What infectious disease causes more deaths than tuberculosis?
answers: text: HIV/AIDS
is_impossible: no

question: When did new cases of TB infection start going down?
answers: text: 2002
is_impossible: no

question: What country has had the most success reducing the TB mortality rate?
answers: text: China
is_impossible: no

question: In what decade did some strains of drug-resistant TB start showing up?
answers: text: 1980s
is_impossible: no

question: How much did China reduce its rate of death from TB in the 20 years leading up to 2010?
answers: text: 80%
is_impossible: no

question: What infections disease causes more deaths than HIV?
is_impossible: yes

question: How much has the US reduced its TB mortality rate by?
is_impossible: yes

question: What country has reduced its HIV mortality rate the most?
is_impossible: yes

question: When did HIV-associated tuberculosis become more common?
is_impossible: yes

question: Which named country tests positive for TB in about 80% of its population?
is_impossible: yes

question: What result might someone who has received a TB vaccination get from the Mantoux test?
is_impossible: yes

question: What species have we definitively traced the origin of TB to?
is_impossible: yes

question: Who started World Tuberculosis Day?
is_impossible: yes
context: Tuberculosis is the second-most common cause of death from infectious disease (after those due to HIV/AIDS). The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002. China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010. The number of new cases has declined by 17% between 2004–2014. Tuberculosis is more common in developing countries; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the US population test positive. Hopes of totally controlling the disease have been dramatically dampened because of a number of factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.

qas: question: Out of every 100,000 people in Swaziland in 2007, how many were infected with tuberculosis?
answers: text: 1,200
is_impossible: no

question: What country had a record-setting 2 million new cases of TB in 2007?
answers: text: India
is_impossible: no

question: What people in Australia and Canada have a much higher risk of TB infection than other residents?
answers: text: aboriginal
is_impossible: no

question: What indigenous people in the U.S. are five times more likely to die from TB?
answers: text: Native Americans
is_impossible: no

question: What percentage of TB cases in America are diagnosed in minority groups?
answers: text: 84%
is_impossible: no

question: What percentage of TB cases worldwide are minorities?
is_impossible: yes

question: How many new cases in millions did Swaziland have in 2007?
is_impossible: yes

question: What is mostly found in remote areas in developed countries?
is_impossible: yes

question: What was the rate of TB cases per 100,000 people in Swaziland in 2010?
is_impossible: yes

question: How much greater is the mortality rate from TB for racial and ethnic minorities?
is_impossible: yes

question: What is low-quality medication an example of a lack of?
is_impossible: yes

question: How many chronic cases of TB were there total in 2012?
is_impossible: yes

question: In what country was the first case of totally drug-resistant tuberculosis?
is_impossible: yes
context: In 2007, the country with the highest estimated incidence rate of TB was Swaziland, with 1,200 cases per 100,000 people. India had the largest total incidence, with an estimated 2.0 million new cases. In developed countries, tuberculosis is less common and is found mainly in urban areas. Rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139 in 2010. In Canada and Australia, tuberculosis is many times more common among the aboriginal peoples, especially in remote areas. In the United States Native Americans have a fivefold greater mortality from TB, and racial and ethnic minorities accounted for 84% of all reported TB cases.

qas: question: What animal was found with 17,000-year-old damage from tuberculosis?
answers: text: bison
is_impossible: no

question: What does MTBC stand for?
answers: text: M. tuberculosis complex
is_impossible: no

question: During what time period do some scientist believe the first human could have contracted TB from an ancestor they shared with animals?
answers: text: Neolithic Revolution
is_impossible: no

question: In which U.S. state was the oldest definitive evidence of TB found?
answers: text: Wyoming
is_impossible: no

question: When was Wyoming discovered?
is_impossible: yes

question: Which gene was concluded to come from animals?
is_impossible: yes

question: What period did the bison live in?
is_impossible: yes

question: What did animals get TB from?
is_impossible: yes

question: What species have we definitively traced the origin of TB to?
is_impossible: yes

question: What member of leadership at the Global Fund to Fight AIDS, Tuberculosis and Malaria called TB a "pandemic"?
is_impossible: yes

question: Along with interferon-y release essays, what other tests aren't useful in TB diagnosis in developing countries?
is_impossible: yes

question: What year was Koch awarded a Nobel Prize?
is_impossible: yes
context: Tuberculosis has been present in humans since antiquity. The earliest unambiguous detection of M. tuberculosis involves evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago. However, whether tuberculosis originated in bovines, then was transferred to humans, or whether it diverged from a common ancestor, is currently unclear. A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as was previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans as early as the Neolithic Revolution.

qas: question: Who discovered M. tuberculosis?
answers: text: Robert Koch
is_impossible: no

question: What year was Koch awarded a Nobel Prize?
answers: text: 1905
is_impossible: no

question: Koch's conviction that human and bovine strains of TB were unrelated meant more people were exposed by drinking what?
answers: text: milk
is_impossible: no

question: What did Koch call the ineffective treatment for TB he came up with in 1890?
answers: text: tuberculin
is_impossible: no

question: What event is celebrated on March 24th to recognize the test for latent TB?
answers: text: World Tuberculosis Day
is_impossible: no

question: Who started World Tuberculosis Day?
is_impossible: yes

question: What did Koch believe was similar to bovine tuberculosis?
is_impossible: yes

question: What year did World Tuberculosis Day start?
is_impossible: yes

question: What remedy did Koch win a Nobel prize for?
is_impossible: yes

question: When did Koch describe the connection between TB and infected milk?
is_impossible: yes

question: When were deaths from TB in England reduced to one in six?
is_impossible: yes

question: At least what percentage of HIV-positive patients who contract TB will experience extrapulmonary infection?
is_impossible: yes

question: What percentage of deaths were caused by TB in the 1950s?
is_impossible: yes
context: The bacillus causing tuberculosis, M. tuberculosis, was identified and described on 24 March 1882 by Robert Koch. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. Koch did not believe the bovine (cattle) and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. Later, the risk of transmission from this source was dramatically reduced by the invention of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". While it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. The World Tuberculosis Day was established on 24 March for this reason.

qas: question: What was tuberculosis called in 19th-century England?
answers: text: consumption
is_impossible: no

question: How many deaths out of every six in France during 1918 were attributed to tuberculosis?
answers: text: one
is_impossible: no

question: In what decade was TB's communicability finally realized?
answers: text: 1880s
is_impossible: no

question: What did Britain try to get people to stop doing to reduce the spread of TB in public?
answers: text: spitting
is_impossible: no

question: What were the "treatment" facilities for poor people with TB in the early 1900s called?
answers: text: sanatoria
is_impossible: no

question: How many deaths in France were caused by TB in 1815?
is_impossible: yes

question: When were deaths from TB in England reduced to one in six?
is_impossible: yes

question: When did France put TB on the notifiable disease list?
is_impossible: yes

question: What percent of people who contracted TB died?
is_impossible: yes

question: Where did poor people get excellent healthcare?
is_impossible: yes

question: Which type of TB is more infectious than active TB?
is_impossible: yes

question: What vaccine are researchers trying to improve on?
is_impossible: yes

question: What are lower lobes in the lungs often more affected by?
is_impossible: yes
context: Tuberculosis caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, one in six deaths in France was still caused by TB. After TB was determined to be contagious, in the 1880s, it was put on a notifiable disease list in Britain; campaigns were started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons (the sanatoria for the middle and upper classes offered excellent care and constant medical attention). Whatever the (purported) benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years (circa 1916).

qas: question: When did the incidence of TB in Europe reach its highest point?
answers: text: 1800s
is_impossible: no

question: When tuberculosis was at its worst in Europe, what percentage of deaths was TB-related?
answers: text: 25%
is_impossible: no

question: What British health organization made tuberculosis its top priority at its start?
answers: text: Medical Research Council
is_impossible: no

question: What year was the Medical Research Council created?
answers: text: 1913
is_impossible: no

question: About how much had the death rate from TB been reduced in Europe by the midpoint of the 20th century?
answers: text: 90%
is_impossible: no

question: What percentage of deaths were caused by TB in the 1950s?
is_impossible: yes

question: What reduced rates of mortality in the 1950s?
is_impossible: yes

question: What organization brought antibiotics to Britain?
is_impossible: yes

question: What year did streptomycin arrive?
is_impossible: yes

question: What material can sometimes be expelled by coughing if the cavities it's stored in connect to bronchi?
is_impossible: yes

question: If you're around someone with active TB, what's the chance you'll contract it expressed as a percentage?
is_impossible: yes

question: What was the chance of death from HIV in 2008?
is_impossible: yes
context: In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths. By the 1950s, mortality had decreased nearly 90%. Improvements in public health began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat to public health such that when the Medical Research Council was formed in Britain in 1913, its initial focus was tuberculosis research.

qas: question: What member of leadership at the Global Fund to Fight AIDS, Tuberculosis and Malaria called TB a "pandemic"?
answers: text: Mark Dybul
is_impossible: no

question: What country covers treatment for tuberculosis for its citizens?
answers: text: Brazil
is_impossible: no

question: What organization said some countries might be spending as much as $150 billion each year on TB?
answers: text: World Bank
is_impossible: no

question: What population segment in China struggles to get follow-up care for TB infection?
answers: text: rural migrants
is_impossible: no

question: What do some people think we need more of to prevent for-profit providers of TB treatment from over-prescribing?
answers: text: regulations
is_impossible: no

question: At least what percentage of HIV-positive patients who contract TB will experience extrapulmonary infection?
is_impossible: yes

question: If the lungs are infected by TB via bloodstream, what's the type of focus?
is_impossible: yes

question: What percentage of cases erode into the pulmonary artery?
is_impossible: yes
context: Slow progress has led to frustration, expressed by executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it." Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government, although adherence is often sketchy. Commercial treatment-providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations. The government of Brazil provides universal TB-care, which reduces this problem. Conversely, falling rates of TB-infection may not relate to the number of programs directed at reducing infection rates, but may be tied to increased level of education, income and health of the population. Costs of the disease, as calculated by the World Bank in 2009 may exceed 150 billion USD per year in "high burden" countries. Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250M rural migrants in China.

qas: question: What groups might help tuberculosis patients share with and support each other?
answers: text: TB clubs
is_impossible: no

question: Education about TB seems to decrease the stigma of the disease and lead to what other positive effect?
answers: text: increasing treatment adherence
is_impossible: no

question: What do some people say is even worse than the effects of tuberculosis itself?
answers: text: the stigma
is_impossible: no

question: What group of people can add to the TB stigma by treating patients as troublesome or unwanted?
answers: text: healthcare providers
is_impossible: no

question: As recently as what year were there no studies on how TB mortality is connected to stigma?
answers: text: 2010
is_impossible: no

question: When did studies begin linking mortality to stigma?
is_impossible: yes

question: What have studies claimed are worse than the stigma?
is_impossible: yes

question: How are people with AIDS perceived?
is_impossible: yes

question: What will stigma reduction result in in regards to understanding?
is_impossible: yes

question: Who have been performing studies on the relationship between stigma and mortality?
is_impossible: yes

question: How many people died from TB in 2000?
is_impossible: yes

question: What is mostly found in remote areas in developed countries?
is_impossible: yes

question: Which bacterium has likely been overestimated?
is_impossible: yes
context: One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling. Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence. Despite this, studies on relationship between reduced stigma and mortality are lacking as of 2010, and similar efforts to decrease stigma surrounding AIDS have been minimally effective. Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable. A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.

qas: question: What vaccine are researchers trying to improve on?
answers: text: BCG
is_impossible: no

question: What phase of clinical trials have some new vaccine options reached?
answers: text: I and II
is_impossible: no

question: What does one option propose adding to the existing BCG vaccine? 
answers: text: subunit vaccine
is_impossible: no

question: What's the name of the subunit vaccine being studied in South Africa?
answers: text: MVA85A
is_impossible: no

question: What genetically modified virus was used to develop MVA85A?
answers: text: vaccinia
is_impossible: no

question: What candidate is in phase I and II?
is_impossible: yes

question: What is added to a subunit vaccine?
is_impossible: yes

question: Where is BCG in trials?
is_impossible: yes

question: How many main limitations does the BCG vaccine have?
is_impossible: yes

question: What virus is BCG based on?
is_impossible: yes

question: If TB infection spreads to the central nervous system, what is it called?
is_impossible: yes

question: How are people with AIDS perceived?
is_impossible: yes

question: What population segment in China struggles to get follow-up care for TB infection?
is_impossible: yes
context: The BCG vaccine has limitations, and research to develop new TB vaccines is ongoing. A number of potential candidates are currently in phase I and II clinical trials. Two main approaches are being used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines. MVA85A, an example of a subunit vaccine, currently in trials in South Africa, is based on a genetically modified vaccinia virus. Vaccines are hoped to play a significant role in treatment of both latent and active disease.

qas: question: What organization did the Bill and Melinda Gates Foundation donate $280 million to?
answers: text: Aeras Global TB Vaccine Foundation
is_impossible: no

question: Policymakers believe tax incentives, market commitments, and what third incentive will speed up vaccine development?
answers: text: prizes
is_impossible: no

question: What group with the initials SATVI is researching TB vaccines?
answers: text: South African Tuberculosis Vaccine Initiative
is_impossible: no

question: What nonprofit tuberculosis research foundation has a verb in its name?
answers: text: Stop TB Partnership
is_impossible: no

question: Who gave the Bill and Melinda Gates Foundation $280 mil?
is_impossible: yes

question: What is the prize for vaccine development set at?
is_impossible: yes

question: Who gifted Stop TB Partnership a large amount of money for improving vaccinations?
is_impossible: yes

question: Where is Stop TB Partnership working?
is_impossible: yes

question: If the lungs are infected by TB via bloodstream, what's the type of focus?
is_impossible: yes

question: Which parts of Africa is M. africanum most common in?
is_impossible: yes

question: How much did China reduce its rate of death from TB in the 20 years leading up to 2010?
is_impossible: yes
context: To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development, including prizes, tax incentives, and advance market commitments. A number of groups, including the Stop TB Partnership, the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research. Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280 million (US) from the Bill and Melinda Gates Foundation to develop and license an improved vaccine against tuberculosis for use in high burden countries.

qas: question: What drug in the running to treat multi drug resistant TB has already gotten FDA approval?
answers: text: Bedaquiline
is_impossible: no

question: What year did the U.S. Food and Drug Administration approve bedaquiline?
answers: text: 2012
is_impossible: no

question: Despite FDA approval, how much more likely to die are patients who take bedaquiline in addition to the standard TB regimen?
answers: text: five times
is_impossible: no

question: Opposition to the use of bedaquiline think what providers were influenced by a connection with the drug company?
answers: text: physicians
is_impossible: no

question: What type of publication has put out articles questioning bedaquiline's safety?
answers: text: medical journal
is_impossible: no

question: What are the names of the multi-drug resistant strains of tuberculosis?
is_impossible: yes

question: When did delamind receive FDA approval?
is_impossible: yes

question: What happens to the death rate for people taking delamind?
is_impossible: yes

question: What is delamind taken alongside of?
is_impossible: yes

question: Who approved the drug delamanid?
is_impossible: yes

question: Who started World Tuberculosis Day?
is_impossible: yes

question: What result might someone who has received a TB vaccination get from the Mantoux test?
is_impossible: yes

question: If you're around someone with active TB, what's the chance you'll contract it expressed as a percentage?
is_impossible: yes
context: A number of medications are being studied for multi drug resistant tuberculosis including: bedaquiline and delamanid. Bedaquiline received U.S. Food and Drug Administration (FDA) approval in late 2012. The safety and effectiveness of these new agents are still uncertain, because they are based on the results of a relatively small studies. However, existing data suggest that patients taking bedaquiline in addition to standard TB therapy are five times more likely to die than those without the new drug, which has resulted in medical journal articles raising health policy questions about why the FDA approved the drug and whether financial ties to the company making bedaquiline influenced physicians' support for its use