romikgosai/squad_modified huggingface dataset:
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.

Questions and answers:
['
Q: Which lobes of the lungs are more often affected by TB?
A: upper lung lobes', "
Q: What symptom will result if TB infection causes a Rasmussen's aneurysm?
A: massive bleeding", "
Q: What percentage of tuberculosis infections don't ever manifest in symptoms of the disease?
A: 25%", "
Q: If TB becomes chronic, what lasting effect might it have on the lung's upper lobes?
A: scarring", '
Q: Approximately what percentage of active TB cases affect the lungs?
A: 90%']
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.

Questions and answers:
["
Q: What's the medical term for TB when it spreads from the lungs to other parts of the body?
A: extrapulmonary tuberculosis", '
Q: At least what percentage of HIV-positive patients who contract TB will experience extrapulmonary infection?
A: 50%', '
Q: What\'s the other name for "disseminated tuberculosis"?
A: miliary tuberculosis', '
Q: Along with people with diminished immune function, like HIV patients, what group of people is more likely to develop extrapulmonary TB?
A: young children', '
Q: If TB infection spreads to the central nervous system, what is it called?
A: tuberculous meningitis']
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.

Questions and answers:
['
Q: The uniqueness of Mycobacterium tuberculosis is due to its high level of what type of molecule?
A: lipid', '
Q: Is the division rate of the TB bacterium fast or slow relative to other bacteria?
A: slow', '
Q: In nature, what "helper" does the MTB bacterium require to grow?
A: a host organism', '
Q: How long is the period between division of MTB cells?
A: 16 to 20 hours', '
Q: How much time does it take most bacteria to divide?
A: less than an hour']
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.

Questions and answers:
['
Q: What\'s another word for "sputum"?
A: phlegm', "
Q: One of the two standard acid-fast staining techniques is the Kinyoun stain; what's the other?
A: Ziehl–Neelsen stain", '
Q: What color will acid-fast bacilli become when stained?
A: bright red', "
Q: What's the term for bacillus that can be exposed to acidic solutions without losing their stains?
A: acid-fast", "
Q: If a scientist didn't want to use an acid-fast staining technique, what type of microscopy could they use instead?
A: fluorescence"]
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.

Questions and answers:
['
Q: Which mycobacterium that causes TB can often be found in unpasteurized milk?
A: M. bovis', '
Q: Which one of the tuberculosis mycobacteria is associated with the Horn of Africa?
A: M. canetti', '
Q: Which of the four TB-causing bacteria do scientists think might be more common than we know?
A: M. microti', '
Q: What bacterium has the name of the country it affects most in its name?
A: M. africanum']
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.

Questions and answers:
["
Q: If you're around someone with active TB, what's the chance you'll contract it expressed as a percentage?
A: 22%", '
Q: Left untreated, about how many people could contract tuberculosis from an active TB patient in a year?
A: 10–15', '
Q: About how long will a TB patient receiving effective treatment stay contagious?
A: two weeks', "
Q: If you contracted tuberculosis today, what's the estimated gestation period before you could spread the infection to others?
A: three to four weeks", '
Q: What term is interchangeable with "active" when talking about tuberculosis infection?
A: overt']
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.

Questions and answers:
['
Q: What specific part of the lungs marks the start of tuberculosis infection?
A: pulmonary alveoli', "
Q: What's the process by which macrophages try to get rid of the TB bacterium?
A: phagocytosis", '
Q: What do you get when you combine a lysosome and a phagosome?
A: a phagolysosome', '
Q: What does the M. tuberculosis bacterium have that protects it from being affected by toxins?
A: mycolic acid capsule', '
Q: What vesicle is the temporary holding room for the M. tuberculosis bacterium during phagocytosis?
A: phagosome']
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.

Questions and answers:
['
Q: What two-word phrase is used for the main part of the lungs infected by TB?
A: Ghon focus', "
Q: If the lungs are infected by TB via bloodstream, what's the type of focus?
A: Simon focus", '
Q: In what general area of the lungs is SImon focus usually located?
A: the top', '
Q: What is the term that describes a blood-borne infection, like TB when it travels through the blood to the kidneys or brain?
A: hematogenous', "
Q: Four areas of the body are usually safe from TB infection, including skeletal muscles, heart, and thyroid; what's the fourth?
A: pancreas"]
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.

Questions and answers:
['
Q: What specific type of disease is TB?
A: granulomatous inflammatory', '
Q: What type of cells gather around infected macrophages in a person infected with TB?
A: lymphocytes', '
Q: What type of cell forms when macrophages clump together trying to kill off the TB infection?
A: multinucleated', "
Q: What natural defensive response is hindered by cells in granulomas that can't send antigen to lymphocytes?
A: immune response", "
Q: What's the technical term for abnormal cell death?
A: necrosis"]
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.

Questions and answers:
['
Q: What process replaces tissue damaged by TB?
A: scarring', "
Q: What material can sometimes be expelled by coughing if the cavities it's stored in connect to bronchi?
A: caseous necrotic material", '
Q: What type of bacteria-attacking medicine will treat tuberculosis?
A: antibiotics', '
Q: Are the bacteria in caseous necrotic material living or dead?
A: living']
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.

Questions and answers:
["
Q: Is active TB difficult or easy to diagnose by patients' symptoms alone?
A: difficult", '
Q: If a patient has some symptoms associated with TB, after what time period should tuberculosis be diagnostically considered?
A: two weeks', '
Q: What part of the body would be X-rayed to check for TB?
A: chest', '
Q: What sign of TB infection would a lab be looking for in a sputum culture?
A: acid-fast bacilli', "
Q: Along with interferon-y release essays, what other tests aren't useful in TB diagnosis in developing countries?
A: tuberculin skin tests"]
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.

Questions and answers:
['
Q: What result might someone who has received a TB vaccination get from the Mantoux test?
A: false-positive', '
Q: What liquid would you need from a patient to perform IGRAs?
A: blood', '
Q: In combination with skin tests, are IGRAs associated with an increase or decrease in sensitivity?
A: increase', '
Q: Which test has fewer false positives: IGRAs or the Mantoux skin test?
A: IGRAs', '
Q: What does "IGRAs" stand for?
A: Interferon gamma release assays']
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.

Questions and answers:
['
Q: For about how long does full immunity from the TB vaccine last?
A: ten years', '
Q: What percentage of kids in the whole world get the BCG vaccine?
A: 90%', '
Q: Is TB common or uncommon in the United States?
A: uncommon', '
Q: In addition to the U.S. and Canada, what European country sees very few tuberculosis infections?
A: the United Kingdom', '
Q: What segment of the population gets the TB vaccine in countries like Canada with a very low incidence of infection?
A: high risk']
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.

Questions and answers:
['
Q: What group heads up the Global Plan to Stop Tuberculosis?
A: Stop TB Partnership', '
Q: In what year did the WHO say tuberculosis was a "global health emergency"?
A: 1993', '
Q: How many lives did the Stop TB Partnership vow to save in the nine years between its start and 2015?
A: 14 million', "
Q: Drug-resistant TB is one of the barriers to success of the Stop TB Partnership's initiative; what's the other other?
A: HIV-associated tuberculosis", '
Q: What organization created a system to classify various types of TB?
A: American Thoracic Society']
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.

Questions and answers:
['
Q: What part of the mycobacterial cell makes tuberculosis more difficult to treat?
A: wall', "
Q: Isoniazid is one of the two most popular drugs for TB treatment; what's the other one?
A: rifampicin", '
Q: What complication does the use of combinations of antibiotics for active TB prevent?
A: antibiotic resistance', "
Q: What's the three-word name for the method where a health care worker watches their patient take their medication?
A: Directly observed therapy", '
Q: What organization recommends directly observed therapy to make sure people take their antibiotics correctly?
A: WHO']
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.

Questions and answers:
["
Q: If a person has TB that's resistant to rifampicin and isoniazid, which type of the disease do they have?
A: MDR-TB", '
Q: What\'s the minimum number of second-line medication classes your TB would have to resist to make it count as "extensively drug-resistant"?
A: three', '
Q: In what country was the first case of totally drug-resistant tuberculosis?
A: Italy', "
Q: What's the only antibiotic that might be effective against totally drug-resistant TB?
A: Bedaquiline", '
Q: Cases of totally drug-resistant TB have been found in what country in addition to Italy and India?
A: Iran']
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.

Questions and answers:
['
Q: As immunosuppression goes up in tuberculosis cases, what risk rises with it? 
A: reactivation', '
Q: What disease has a similar relationship as TB does between reactivation and immunosuppression?
A: HIV', "
Q: If you'd been diagnosed with tuberculosis in 1995, how great a chance would you have faced of dying from it?
A: 8%", '
Q: In what year did the risk of dying from TB reach half what it was in 1995?
A: 2008', '
Q: New studies have found that half of reactivation cases of tuberculosis might actually be due to what other "re-" word?
A: reinfection']
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.

Questions and answers:
['
Q: At any given time, about how much of all the people in the world has M. tuberculosis?
A: one-third', '
Q: Approximately how many active TB cases were there in 2012?
A: 8.6 million', '
Q: How many patients were diagnosed with tuberculosis in 2010?
A: 8.8 million', '
Q: About how many people died in 2010 carrying both HIV and TB?
A: 0.35 million', "
Q: What percentage of the world's total population gets infected with tuberculosis every year?
A: 1%"]