TUBERCULOSIS: MEDICO-LEGAL ASPECTS

Abstract

Tuberculosis is a diffusive infectious disease whose typical behavior differentiates it from other infectious diseases spread by human-to-human transmission (flu, chicken pox, cholera, etc.) which follow a classically epidemic pattern. Indeed, in the presence of a known source of Koch bacilli capable of spreading them by air, not all exposed individuals inhale the bacteria, not all those who inhale them absorb them, not all those who absorb them are unable to eliminate them, not all who are able to eliminate them do so using delayed hypersensitivity, not all those who react with delayed hypersensitivity suffer lasting tissue damage (among other things, minor), not all who suffer tissue damage have anatomical sequelae, not all those who have anatomical sequelae, however minimal, become carriers of bacilli in the latent period.

The vast majority (90-95%) of the latter – which are in any case a portion, not the totality of those exposed – remain asymptomatic throughout their lives and never develop active tuberculosis.

Based on these biological characteristics and the legal concepts of “epidemic” and “disease,” it becomes highly problematic, if not impossible, to assert both that tuberculosis can cause events of sufficient magnitude to be associated with the crime of “epidemic,” and that the mere diagnosis of a latent tuberculosis infection is sufficient to assume the presence of an illness legally prosecutable in criminal proceedings or a disability prosecutable in civil proceedings.

Further, clinically apparent tuberculosis is a temporarily—in some cases permanently—disabling condition, and in certain work environments, even with the difficulties caused by the lack of available effective diagnostic tools and the insidious behavior of the disease in the early stages, it appears appropriate to engage in targeted monitoring, also for the early identification of persons who may become ill.