This investigative case module was prepared as part of a BioQUEST faculty development workshop entitled Faculty Workshop: Implementing Investigative Cases and Technology in Biology and Chemistry at Center for Science Education in August 2004. The cases, resources, and implementation strategies were developed by participants for use with their own students. We invite you to adopt and adapt the following materials.

The BioQUEST Curriculum Consortium is committed to the reform of undergraduate biology instruction through an emphasis on engaging students in realistic scientific practices. This approach is sometimes characterized as an inquiry driven approach and is captured in BioQUEST's three P's (problem-posing, problem-solving, and peer-persuasion). As part of this workshop groups of faculty were encouraged to initiate innovative curricular projects. We are sharing these works in progress in the hope that they will stimulate further exploration, collaboration and development. Please see the following links for additional information:

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Investigative Cases
The Case: Tuberculosis Today

Part 1.

December 1974. Paul comes into the emergency room, coughing and weak. He's been coughing for what seems like ages. He can't eat; he can't sleep. He's lost weight, and sometimes, he coughs blood. The resident who examines him sends Paul down the hall for an x-ray. Sure enough, tuberculosis. Paul, a panicked look in his eye, says, "My aunt had that. They sent her away to an institution, and she never got better. What's going to happen to me?"

"Don't worry, sir," says the resident. Antibiotics have changed all that. You'll get a prescription and we'll recheck you in about four weeks. Keep taking the prescription for six months."

Part 2.

June 1998. David is very worried about his health. He's been sick for several weeks, coughing and weak. He decides to go to the urgent care center in his neighborhood. After a number of tests and a chest x-ray, the doctor comes into his room to tell him that he has tuberculosis.

Below is a picture of a lung x-ray showing symptoms of TB. Source:

David sighs. "That's good news, right? I was afraid I had AIDS or something. I just need some pills, right?" The doctor shakes her head. Well, it's not quite that simple, she says."

Part 3.

August 1998. David comes into the clinic to take his weekly medicines. His nurse, Victor, greets him in the waiting room with a stern look. "David, you missed your appointment last week and we couldn't reach you at home or at work. We've been through this already. You can't stop taking your medicine just because you're not coughing anymore." David looks sheepish and promises to continue coming to the clinic to take his medication.

Case Author:
Julie Bartley State University of West Georgia

Case Analysis

Probable Issues:

What is tuberculosis?

How many people get TB every year?

How are antibiotics are used to combat bacterial diseases such as tuberculosis?

Bacteria can become resistant to antibiotics.

How do bacteria acquire resistance?

How does improper or proper use of antibiotics contribute to antibiotic resistance?

Is the process of acquiring resistance related to natural selection?

How does natural selection affect disease management?

How does the behavior of individual patients affect the incidence of antibiotic resistance and the spread of the disease?

Option: Include a know / need to know chart like the one below:

What do you know?
What do you need to know?

Learning Goals



Conduct research using the Internet to discover information about tuberculosis and medical treatment options.

Describe these treatment options.

Evaluate underlying causes of antibiotic resistance.

Persuade others of the scientific validity of a particular public health policy.


Antibiotic resistance occurs over human timescales.

Development of antibiotic resistant follows the principles of natural selection.

Effective public policy in disease management should consider evolutionary processes.

Education of individual patients is a critical component of managing this disease.



Investigations and Activities

Locate informative websites that address TB treatment and/or antibiotic resistance. Complete worksheets that explore these topics.

Simulate the evolution of antibiotic resistance in the presence of an antibiotic. Describe the effect of variables such as mutation rate, growth rate, and antibiotic treatment.

Investigate current public health policy that specifically addresses evolution of antibiotic resistance. Persuade patients that compliance with treatment plans is important.



Internet sources:

1. US Food and Drug Administration website on antibiotic resistance.

2. CDC's Tuberculosis Site.

History of TB in Sweden

Print Sources:

1. Map of TB occurrences in the US in 1980 and 1995.

2. Textbook for Course: Palumbi, S. 1999. The Evolution Explosion.

3. Graphs showing proportion of antibiotic-resistant and multi-drug resistance TB in infected populations.

Modeling Software:

1. Evolution of bacterial resistance model

Students will usually obtain additional references or resources
to help answer or explore their questions.

Special Data Items

Below is a world map showing TB deaths worldwide, by region. Source: Johns Hopkins Center for Tuberculosis Research

The cartoon below shows the course of TB infection within a population. Source: State Government of Victoria, Department of Health Services

The graph below gives epidemiological data for the State of Victoria (Australia). Source: State Government of Victoria, Department of Health Services

1. TB_cartoon.jpg
2. TB_cases_victoria.gif
3. TB_deathmap.gif
4. tb_disease_progress.gif
5. TB_xray.jpg


Student Products

Worksheet describing the current status of drug-resistant TB.

Worksheet describing current treatment options for patients with TB, including special treatment for immune-compromised patients.

Group work:

Based on the microbial evolution simulation, describe the effects of the following variables: mutation rate, growth rate, incomplete antibiotic treatment

Create an information pamphlet for TB patients and their families.

Engage in a public policy debate regarding issues of freedom versus public welfare as it applies to TB management.

Note that students will choose either the pamphlet or the debate.

Assessment and Evaluation Plan

Peer evaluation of group work and debate

Worksheet completion: Did students investigate several resources? Is the information reported complete and accurate?

Results of modeling experiment - does the student demonstrate an understanding of the relative importance of the relevant variables?

Pamphlet - is the information presented both comprehensible and accurate? Is it targeted toward the correct audience (patients and their families)?

Exam questions - multiple choice and short-answer questions assessing understanding of various aspects of this project, including assessing an appreciation of the complexities of public health policy.



This case will be implemented over several class periods:

Week 1: Part 1 of the case along with antibiotic resistance and treatment options worksheets.

Week 2: Part 2 of case; resistance simulation.

Week 3: Part 3 of case; public policy worksheet

Week 4: Debate on public policy OR pamphlets due

Course name:
What Do You Know About Darwinian Evolution?
Likely sequence in syllabus:
Introduce second part of course (evolution today)
Time during term:
Weeks 4-8
4 weeks
Lecture course; work done both in and out of class
Students in course:
Collaborative elements:
Group work to create models, pamphlets and debate elements
Additional notes:



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