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Antibiotic Resistance in a Russian Prison

Playing with the Spread of Tuberculosis


Christian Angeles
Ayala School of Biological Sciences
University of California, Irvine
Isabella Villano

San Joaquin High School
Andrea C. Nicholas
Department of Neurobiology and Behavior
University of California, Irvine


In this case study, students will have the opportunity to model the spread of tuberculosis and development of antibiotic resistance in a hypothetical prison environment. After reading a brief handout and viewing a short video, students play a simulation game by first identifying a group of prison inmates represented by index cards. The placement of the cards will influence how drug resistance spreads from one inmate to another. Using a dice roll to mimic random probability of infection and antibiotic misuse, students then track the development of resistance to four specific antibiotics, determined by selection of playing card suit. Opportunity for release or transfer on inmates from one facility to another introduces a further level of complexity, allowing students to study resistance spread. This activity was originally designed for a section of an upper-division biology course about antibiotic resistance, but it would also be appropriate for lower-division undergraduate and high school biology courses discussing antibiotic use.


  • Identify how TB spreads through populations.
  • List the risk factors associated with TB infection.
  • Describe certain populations and geographic regions most prone to TB infections or outbreaks.
  • Understand the role of institutions (e.g., prisons) on the spread of infections and development of an outbreak.
  • Discuss the concept of immunity and previous exposure as important factors in infection success.
  • Acknowledge the impact of incorrect use or overuse of antibiotic treatments on the development of drug resistance in bacteria.
  • Elaborate on ways of identifying and preventing potential antibiotic resistant strains of bacteria from spreading.
  • Describe common misconceptions regarding the nature of antibiotic resistance.
  • Justify the emerging concerns regarding antibiotic resistance and how such resistance may change our ability to treat infectious diseases.


tuberculosis; MDR-TB; antibiotic resistance; antibiotics; antibiotic misuse; drug resistant bacteria; suberbugs; bacterial resistance; bacterial disease; bacteria; disease spread; outbreak

Topical Areas

N/A, Ethics, Policy issues, Regulatory issues, Social issues, Social justice issues

Educational Level

High school, Undergraduate lower division, Undergraduate upper division, General public & informal education



Type / Methods

Analysis (Issues), Discussion, Role-Play



Subject Headings

Biology (General)  |   Epidemiology  |   Medicine (General)  |   Pharmacy / Pharmacology  |   Physiology  |   Public Health  |   Science (General)  |   Science Education  |  

Date Posted


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The following video(s) are recommended for use in association with this case study.

  • Nothing to Sneeze At “Science
    Although we all know that sneezes and coughs transmit infections, little research had been done to model how they work. Lydia Bourouiba and John Bush of MIT’s Applied Mathematics Lab used high speed cameras and fluid mechanics to reveal why we’ve grossly underestimated how far sneezes and coughs transmit infections in enclosed spaces. Created by: Science Friday. Produced by: Luke Groskin. Running Time: 5:04 min. Date: May 1, 2014.


Hadizat Anaza
Energized for Stem Inc
This was a well-made case, the students were engaged and I was able to reinforce the topic of pesticide resistance from environmental science.