**1. Introduction**

66 Current Topics in Tropical Medicine

Schneider, M. C., Romijn, P. C., Uieda, W., Tamayo, H., da Silva, D. F., Belotto, A., et al.

Schülein, R., Seubert, A., Gille, C., Lanz, C., Hansmann, Y., Piemont, Y., et al. (2001).

strategy of the emerging pathogen bartonella. J. Exp. Med. 193:1077-1086. Simmons, N. B. (2005). Order Chiroptera, p. 312-529. *In* D. E. Wilson and D. M. Reeder (ed.),

Stevenson, H., Bai, Y., Kosoy, M., Montenieri, J., Lowell, J., Chu, M., et al. (2003). Detection

Streicker, D. G., Turmelle, A. S., Vonhof, M. J., Kuzmin, I. V., McCracken, G. F., &

Tang, X. C., Zhang, J. X., Zhang, S. Y., Wang, P., Fan, X. H., Li, L. et al. (2006). Prevalence and genetic diversity of coronaviruses in bats from China. J. Virol. 80:7481-7490. Tea, A., Alexiou-Daniel, S., Papoutsi, A., Papa, A., & Antoniadis, A. (2004). *Bartonella* species

Telfer, S., Bown, K. J., Sekules, R., Begon, M., Hayden, T., & Birtles, R. (2005). Disruption of a

Turner, D. C., & Bateson, P. (1975).The vampire bat: a fi eld study in behavior and ecology.

Welch, D. F., Carroll, K. C., Hofmeister, E. K., Persing, D. H., Robison, D. A., Steigerwalt, A.

Weiss, E., & Dasch, G. (1982). Differential characteristics of strains of *Rochalimae: Rochalimae vinsonii* sp. nov., the Canadian vole agent. Int. J. Syst. Bacteriol. 32: 305-314. Williams, C. J. 2005. Bats as the reservoir for outbreaks of emerging infectious diseases.

Winoto, I. L., Goethert, H., Ibrahim, I. N., Yuniherlina, I., Stoops, C., Susanti, I., et al. (2005).

Ying, B., Kosoy, M., Maupin, G., Tsuchiya, K., & Gage, K. (2002). Genetic and ecological

*Bartonella* species in rodents and shrews in the greater Jakarta area. Southeast Asian

characteristics of *Bartonella* communities in rodents in southern China. Am. J. Trop.

host-parasite system following the introduction of an exotic host species.

G., et al. (1999). Isolation of a new subspecies, *Bartonella vinsonii* subsp. *arupensis* , from a cattle rancher: identity with isolates found in conjunction with *Borrelia burgdorferi* and *Babesia microti* among naturally infected mice. J. Clin. Microbiol. 37:

Sulkin, S. E., & Allen, R. (1974). Virus infections in bats. Monogr. Virol.8:1–103.

isolated from rodents, Greece. Emerg. Infect. Dis. 10: 963-964.

Baltimore: Johns Hopkins University Press; p. 1–7.

38:2943-2948.

40:329-337.

2598-2601.

doi:10.1126/science.1188836

Parasitology. 130:661-668.

Erup. Serveill. 10:E051110.4.

Med. Hyg. 66:622-627.

J. Trop. Med. Public Health 36:1523-1529.

doi:10.1590/S1020-49892009000300010

Hopkins University Press, Baltimore, Md.

antiflagellin antibodies in patients with lymphadenopathy. J. Clin. Microbiol.

(2009). Rabies transmitted by vampire bats to humans: an emerging zoonotic disease in Latin America? Rev. Panam. Salud. Publica. 25:260–269.

Invasion and persistent intracellular colonization of erythrocytes: a unique parasitic

Mammal species of the world: a taxonomic and geographic reference, 3rd ed. Johns

of novel *Bartonella* strains and *Yersinia pestis* in prairie dogs and their fleas (*Siphonaptera:* Ceratophyllidae and *Pulicidae*) using multiplex PCR. J. Med. Entomol.

Rupprecht, C. E. (2010). Host phylogeny constrains cross-species emergence and establishment of rabies virus in bats. Science. 329:676–379.

> Tuberculosis (TB) is an infectious disease caused by different species of *Mycobacteria*. Human disease is usually caused by *Mycobacterium tuberculosis*, also know as the Koch's bacilli, which can affect any organ or tissue in the body. Although this, pulmonary disease, with their particular hallmarks such as occurrence of cough with expectoration lasting more than 15 days, is the main corporal area affected by this mainly tropical pathogen (Rodríguez-Morales et al. 2008). In such cases, previous to a microbiological diagnosis, individuals in such state are so-called respiratory symptomatic.

> Besides those symptoms/signs, disease can be manifested with hemoptisis, fever, night sweating, general malaise, thoracic pain, anorexia and weight lost. This disease is still a significant public heal problem due to is highly transmissibility, but is highly potentially preventable and treatable condition (Curto et al. 2010, Dim et al. 2011, Orcau et al. 2011, Marais & Schaaf 2010, Glaziou et al. 2009). Even more, in the context of HIV and newer immunosuppressive conditions mycobacterial diseases emerge as public health threat in the World (Vargas et al. 2005).

> According to the World Health Organization (WHO), in 2010, there were 8.8 million (range, 8.5–9.2 million) incident cases of TB, 1.1 million (range, 0.9–1.2 million) deaths from TB among HIV-negative people and an additional 0.35 million (range, 0.32–0.39 million) deaths from HIV-associated TB. Important new findings at the global level are: a) the absolute number of TB cases has been falling since 2006 (rather than rising slowly as indicated in previous global reports); b) TB incidence rates have been falling since 2002 (two years earlier than previously suggested); c) Estimates of the number of deaths from TB each year have been revised downwards; d) In 2009 there were almost 10 million children who were orphans as a result of parental deaths caused by TB (World Health Organization 2011).

> Beyond its epidemiology, particularly mostly due to pulmonary disease, other important forms of disease represent also a significant burden in thee World. When the infection affects organ other than the lung is called extrapulmonary TB. The most common form of this disease is at the pleura, followed by the lymphatic nodes. Extrapulmonary TB includes

Social Networking in Tuberculosis: Experience in Colombia 69

the disease, which still represents a significant stigma in many communities in the World. Given this setting, TB approach is complex and requires not only medical but also psychological and especially sociological approaches in order to improve its management from a collective medicine perspective as well better acceptability by non-affected people surrounding infected individuals at their communities or neighborhoods. In this way, programs approaching taking all these considerations in count will benefit with better strategies that allow good interactions between social actors involve in the complex social matrix in which sometimes TB can be present at societies. Taking advantage from this, regular activities, such as proper diagnosis and treatment would be achieve in a more

This chapter will cover how using social networks in the context of tuberculosis control program would achieve a better management of cases at individual and at a collective level in a western area of Colombia, where TB is a highly prevalent condition and where available

Human societies can be regarded as large numbers of locally interacting agents, connected by a broad range of social and economic relationships. These relational ties are highly diverse in nature and can represent, e.g., the feeling a person has for another (friendship, enmity, love), communication, exchange of goods (trade), or behavioral interactions (cooperation or punishment). Each type of relation spans a social network of its own. A systemic understanding of a whole society can only be achieved by understanding these individual networks and how they influence and co-construct each other. The shape of one network influences the topologies of the others, as networks of one type may act as a

For instance, the network of communications poses constraints on the network of friendships, trading networks are usually constrained to positively connoted interactions such as trust, and networks representing hostile actions may serve as a catalyst for the network of punishments. A society is therefore characterized by the superposition of its constitutive socioeconomic networks, all defined on the same set of nodes. This superposition is usually called multiplex, multirelational, multimodal, or multivariate network (Szell et al. 2010). Summarizing, a social network is a social structure made up of individuals (or organizations) called "nodes", which are tied (connected) by one or more specific types of interdependency, such as friendship, kinship, common interest, financial exchange, dislike, sexual relationships, or relationships of

Understanding and modeling network structures have been a focus of attention in a number of diverse fields, including physics, biology, computer science, statistics, and social sciences. Applications of network analysis include friendship and social networks, marketing and recommender systems, the World Wide Web, disease models, and food webs, among others (Zhao et al. 2011). Social network analysis (SNA) is the study of structure. It involves relational datasets. That is, structure is derived from the regularities in the patterning of relationships among social entities, which might be people, groups, or organizations. Social network analysis is quantitative, but qualitative interpretation also its necessary. It has a long history in sociology and mathematics and it is creeping into health research as its analytical methods become more accessible with user friendly software (Hawe et al. 2004). SNA views social relationships in terms of network theory consisting of nodes and ties (also

efficient way (Murray et al. 2011, Santin & Navas 2011, Juniarti & Evans 2011).

constraint, an inhibitor, or a catalyst on networks of another type of relation.

beliefs, knowledge or prestige (Palinkas et al. 2011, Szell et al. 2010).

called edges, links, or connections).

**2. Social networking** 

resources for disease management and program are still limited in multiple aspects.

various manifestations according to the affected organ. Prognosis and time to develop disease also can vary according to the affected organ.

Disease can ranges a spectrum that can begin from a latent infection or reactivation slowly evolving into a focal or whole spread and involvement of multiple organs, which makes it difficult to diagnosis by clinicians and health care workers, who many times could not identify it timely (Castañeda-Hernández et al. 2012a). One of the most severe forms of extrapulmonary TB is the meningitis (TB meningitis), which occurs as a result of hematogenous spread of bacilli into the subarachnoid space. This is known as a complication of primary TB and may occur years later as an endogenous reactivation of a latent tuberculosis or as a result of exogenous reinfection (Glaziou et al. 2009, Hoek et al. 2011, Galimi 2011, Garcia-Rodriguez et al. 2011).

Tuberculosis is a complex disease in terms of the multiple factors that are involved in its occurrence and persistence in the human societies. In first place there are factors associated with the bacillus (viability, transmissibility and virulence), with the host as a biological individual (immune status, genetic susceptibility, duration and intensity of exposure) as well, at the bacillus-host interaction (place of affection, severity of illness).

At a second, clinical level, the occurrence of pulmonary tuberculosis undiagnosed or untreated, overcrowding, malnutrition, immunosuppresion from any cause (HIV infection, use of immunosuppressive drugs, diabetes, cancer, chronic renal failure, silicosis, alcoholism and drug addiction), are also important factors.

At community public health interventional level, protective factors include the BCG (Bacille Calmette Guerin) vaccine, applied in developing countries, which provides protection before exposure and prevent severe infection forms, especially in infants and young children, reaching up to 80% of protection against the development of forms of the disease such as meningeal and miliary TB (Garcia-Rodriguez et al. 2011, Garg 2010, Black et al. 2003, Francis et al. 2002, Arbelaez et al. 2000, Ginsberg 2000).

Additional to those clinical implications, changes in the susceptibility of the etiological agent to the therapy used drugs has imposed more challenges in the management of TB. The magnitude of problem with TB now lies in the fact that one third of the world population is infected by *Mycobacterium tuberculosis*. Even in the 21st century, TB kills more people than any other infective agent. This, then, occurs in part as a result of a progressive decrease in its susceptibility to anti-TB drugs or resistance emergence. Cases of resistant TB, defined by the recommendations of the World Health Organization (WHO) as primary, initial, acquired multidrug resistant (MDR-TB) or extensively drug resistant TB (XDR-TB) are emerging in different areas of the World.

The development of resistance TB may result from the administration of mono-therapy or inadequate combinations of anti-TB drugs. A possible role of health care workers in the development of multi drug-resistant TB is very important. Actually, multi drug-resistant TB is a direct consequence of mistakes in prescribing chemotherapy, provision of antituberculosis drugs, surveillance of the patient and decision-making regarding further treatment as well as in a wrong way of administration of anti-TB drugs. The problem of XDR-TB in the world has become very alarming. Only adequate treatment according to directly supervised short regiment for correctly categorized cases of TB can stop the escalation of MDR-TB or XDR-TB, which is actually, in large magnitude, a global threat in the 21st century (Torres et al. 2011, Solari et al. 2011, Chadha et al. 2011, Arenas-Suarez et al. 2010, Ferro et al. 2011, Martins 2011).

Another important issue in TB is the social component, related to a complex background and multiple interacting factors that internally and externally affect individuals affected by the disease, which still represents a significant stigma in many communities in the World. Given this setting, TB approach is complex and requires not only medical but also psychological and especially sociological approaches in order to improve its management from a collective medicine perspective as well better acceptability by non-affected people surrounding infected individuals at their communities or neighborhoods. In this way, programs approaching taking all these considerations in count will benefit with better strategies that allow good interactions between social actors involve in the complex social matrix in which sometimes TB can be present at societies. Taking advantage from this, regular activities, such as proper diagnosis and treatment would be achieve in a more efficient way (Murray et al. 2011, Santin & Navas 2011, Juniarti & Evans 2011).

This chapter will cover how using social networks in the context of tuberculosis control program would achieve a better management of cases at individual and at a collective level in a western area of Colombia, where TB is a highly prevalent condition and where available resources for disease management and program are still limited in multiple aspects.
