Abstract

General Background: Infectious diseases continue to pose a significant global health challenge, with malaria, plague, and tuberculosis contributing to high morbidity and mortality rates. Globalization has further accelerated their spread across borders. Specific Background: Despite medical advancements, these diseases persist due to factors such as drug resistance, high transmission rates, and regional endemicity. Pulmonary tuberculosis, in particular, remains a major concern due to its chronic nature and multidrug resistance. Knowledge Gap: Comparative studies classifying these diseases based on severity, epidemiological impact, and treatment response remain limited, making it difficult to prioritize intervention strategies effectively. Aims: This study classifies malaria, plague, and pulmonary tuberculosis using global health data to assess their epidemiological burden and treatment response. Results: Pulmonary tuberculosis presents the greatest long-term threat due to its resistance patterns. Plague, while acutely lethal, is highly treatable with timely antibiotics. Malaria remains a significant burden but is manageable with appropriate interventions. Novelty: This study integrates statistical analyses of mortality rates, transmission dynamics, and drug resistance patterns to provide a comparative classification of these diseases. Implications: Findings emphasize the necessity of early diagnosis, targeted drug development, and strengthened surveillance to enhance global infectious disease control efforts.

Highlights:

1. Infectious diseases remain a global challenge due to transmission and drug resistance.
2. Tuberculosis is persistent, plague is acutely lethal, malaria burdens endemic regions.
3. Targeted interventions, early diagnosis, and drug development are crucial for control.

Keywords : Malaria, plague, tuberculosis, epidemiology, response to treatment and burden of disease

Introduction

Malaria, plague, and tuberculosis are among the most historically significant infectious diseases. While malaria is caused by the parasite Plasmodium [1], plague is caused by the bacterium Yersinia pestis, and tuberculosis is caused by the bacterium Mycobacterium tuberculosis [2]. The severity, epidemiological impact, and response to treatment of these diseases vary widely. Understanding these differences is essential for prioritizing public health interventions. According to the 2022 World Health Organization report, malaria killed more than 600,000 people that year, a death toll that has not improved significantly since 2015 [3]. In addition, drug-resistant parasites and insecticide-resistant mosquitoes are spreading throughout Africa and other regions, further complicating control efforts [4].

Tuberculosis (TB) remains a leading cause of death from infectious diseases, and is among the top 15 causes of death worldwide. According to the 2022 U.S. Centers for Disease Control and Prevention (CDC) report, an estimated 7.5 million people were diagnosed with TB that year, an increase from 2021 [5]. There were an estimated 1.3 million deaths from TB in 2022, including approximately 167,000 deaths among people living with HIV [6]. However, diagnosing TB remains a major challenge; in 2022, only 63% of people treated for TB had a microbiological test confirming the diagnosis [4].

On the other hand, the bacteria responsible for the plague, Yersinia pestis, has had a profound impact on human history. This bacteria has emerged as one of the most devastating diseases, causing numerous epidemics and millions of deaths. Plague has caused the greatest horrors around the world, especially through the three great pandemics that have struck humanity [7].

Methods

This study is based on data from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and the Global Burden of Disease (GBD) reports. The analysis includes:

Death rate per 100,000 population.

Infection and transmission rates.

Case fatality rate (CFR).

Response to treatment, as measured by drug efficacy and resistance patterns [4];[8].

Statistical tools such as Excel and SPSS were used to process the data, and graphs were created using GraphPad Prism [9]; [10].

Results and Discussion

3.1 Epidemiological ranking

Malaria has the highest incidence rate among infectious diseases, but has a relatively low mortality rate due to improved availability of treatment and prevention interventions such as insecticide-treated bed nets and antimalarial drugs [1].

On the other hand, plague is considered a rare disease in modern times due to the availability of effective antibiotics, such as streptomycin and doxycycline. However, plague has a significantly high mortality rate if not treated promptly and effectively [2].

Tuberculosis (TB) remains one of the most challenging diseases globally, with the spread of multidrug-resistant (MDR-TB) strains and latent infection affecting nearly a quarter of the world’s population. An estimated 10.6 million people fell ill with TB in 2022, with significant gaps in diagnosis and treatment [11].

3.2 Severity and pathogenesis

Plague

Prevalence and risk:

Plague is one of the most rapidly spreading infectious diseases, especially in its pneumonic form, which can be transmitted via respiratory droplets. If untreated, mortality rates are 90–100% in pneumonic plague and 30–60% in bubonic plague [7].

History: Plague has caused three major pandemics throughout history, including the Black Death in the 14th century, which killed an estimated 50 million people in Europe [6].

Treatment: Plague can be prevented and treated with antibiotics such as streptomycin and doxycycline, but treatment must begin early to avoid fatal complications [6].

Malaria

Distribution: Malaria mainly affects tropical and subtropical regions, with a high concentration in sub-Saharan Africa, where it accounts for about 95% of global cases and deaths [10].

Symptoms and complications: The Plasmodium parasite multiplies in the liver and red blood cells, leading to symptoms such as fever, anemia, and organ damage in severe cases.

Treatment and prevention: Key interventions include insecticide-treated bed nets, indoor spraying, and antimalarial drugs such as artemisinin. However, drug and insecticide resistance in mosquitoes pose increasing challenges [12].

Pulmonary tuberculosis

Prevalence: TB affects approximately 10.6 million people annually, with the highest incidence rates in Southeast Asia and Africa [4].Complications :

Tuberculosis leads to chronic complications such as lung damage, respiratory failure, and death if left untreated. Latent tuberculosis It poses a great risk, as it can become active at any time .

Complications: TB leads to chronic complications such as lung damage, respiratory failure, and death if left untreated. Latent TB also poses a significant risk, as it can become active at any time.

Challenges: Multidrug-resistant tuberculosis (MDR-TB) is one of the biggest challenges, requiring longer and more expensive treatment with lower success rates. In addition, human immunodeficiency virus (HIV) makes TB treatment even more complicated, as many patients suffer from co-infection [8].

3.3 Response to treatment and drug resistance

Plague: Best response due to low resistance rates:

Response to treatment: Plague has an excellent response to antibiotic treatment, as the bacteria Yersinia pestis remain sensitive to common drugs such as streptomycin and doxycycline. Rates of antibiotic resistance are very low, making treatment effective if started early [2]

Challenges: The main challenge is rapid diagnosis and immediate treatment, especially in remote areas where health infrastructure is limited [9].

Malaria: Drug resistance on the rise, especially in Southeast Asia

Drug resistance: Malaria is experiencing an increase in drug resistance, especially in the Greater Mekong region (Southeast Asia), where strains of the Plasmodium parasite have emerged that are resistant to artemisinin, the main ingredient in the most effective treatments [1].

Interventions: WHO and other health organizations are working to strengthen surveillance and research new drugs, as well as improve prevention strategies such as insecticide-treated bednets [13].

Pulmonary tuberculosis: the most resistant disease and requires multiple treatments for long periods

Drug resistance: TB is one of the most drug-resistant diseases, with multidrug-resistant (MDR-TB) and even extensively drug-resistant (XDR-TB) strains emerging. These strains require more complex treatments, including the use of dangerous drugs with severe side effects [10].

Treatment duration: Treatment for regular TB requires at least 6 months, while treatment for multidrug-resistant TB can last 18-24 months, with much lower success rates [11].

Challenges: The main challenges include difficulty in diagnosis, high cost of treatment, and severe side effects of medications, which make adherence to treatment difficult [12].

Malaria

Environmental area: tropical regions, where environmental conditions are suitable for the breeding of mosquitoes that transmit the disease [13].

Mortality rate: 12%, reflecting the seriousness of the disease especially in areas with weak health systems.

Infection rate: 80 cases per 100,000 people, indicating its widespread prevalence in endemic areas.

Global prevalence: 229.0 million cases per year, making it one of the most widespread infectious diseases [14].

Treatment success: 90%, indicating the effectiveness of available drugs such as artemisinin-based combination therapy.

Drug resistance: 40%, raising concerns about the development of drug resistance and the need to develop new drugs [15].

Plague

Endemic area: Limited (local) areas, where the disease is prevalent in certain human or animal populations.

Mortality rate: 60% if untreated, making it a very serious disease.

Infection rate: 15 cases per 100,000 people, reflecting its relative rarity.

Global prevalence: 0.002 million cases per year, indicating its rarity compared to other diseases.

Treatment success: 95% with early diagnosis and use of antibiotics such as streptomycin [16]

Drug resistance: 5%, indicating that current drugs are effective in most cases.

Pulmonary tuberculosis

Environment: Global, with the disease occurring worldwide, especially in areas with high population density and weak health systems.

Mortality rate: 30%, reflecting the seriousness of the disease, especially in cases of drug-resistant infections.

Infection rate: 50 cases per 100,000 people, indicating its widespread prevalence.

Global prevalence: 10.0 million cases per year, making it one of the leading causes of death from infectious diseases [17].

Treatment success: 60%, reflecting the challenges associated with treatment, especially in cases of drug-resistant tuberculosis.

Drug resistance: 70%, indicating high rates of drug resistance and the need to develop new treatments [18].

Figure 1.shows a graph comparing the death rates between three diseases: malaria, plague, and tuberculosis.

Figure 2.shows a graph comparing the levels of drug resistance for three diseases: malaria, plague, and tuberculosis.

Conclusion

This study classified malaria, plague and pulmonary tuberculosis based on their severity, epidemiological impact and response to treatment.

Pulmonary tuberculosis poses the greatest long-term threat due to multidrug-resistant tuberculosis.

Plague is the most rapidly fatal but effectively treatable disease.

Malaria remains a widespread burden but can be largely controlled with appropriate treatment.

Efforts should focus on early diagnosis, drug development and surveillance to control these infectious diseases.

References

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