Current Concepts in the Management of Tuberculosis

Abstract

E ffective medical therapy for tuberculosis (TB) has existed for more than half a century, yet TB remains among the most pressing public health issues of our day. Tuberculosis is, in part, a disease of poverty. 1 The fact that it remains the eighth leading cause of death in the world speaks to the challenges facing practitioners and public health officials as they try to control a disease that is so entwined in the cultural and economic fabric of society. Challenges to effective solutions include lack of access to diagnosis and treatment, the frequent coexistence of epidemics of TB and human immunodeficiency virus (HIV), and the Tuberculosis (TB) poses a serious threat to public health throughout the world but disproportionately afflicts low-income nations. Persons in close contact with a patient with active pulmonary TB and those from endemic regions of the world are at highest risk of primary infection, whereas patients with compromised immune systems are at highest risk of reactivation of latent TB infection (LTBI). Tuberculosis can affect any organ system. Clinical manifestations vary accordingly but often include fever, night sweats, and weight loss. Positive results on either a tuberculin skin test or an interferon-γ release assay in the absence of active TB establish a diagnosis of LTBI. A combination of epidemiological, clinical, radiographic, microbiological, and histopathologic features is used to establish the diagnosis of active TB. Patients with suspected active pulmonary TB should submit 3 sputum specimens for acidfast bacilli smears and culture, with nucleic acid amplification testing performed on at least 1 specimen. For patients with LTBI, treatment with isoniazid for 9 months is preferred. Patients with active TB should be treated with multiple agents to achieve bacterial clearance, to reduce the risk of transmission, and to prevent the emergence of drug resistance. Directly observed therapy is recommended for the treatment of active TB. Health care professionals should collaborate, when possible, with local and state public health departments to care for patients with TB. Patients with drug-resistant TB or coinfection with human immunodeficiency virus should be treated in collaboration with TB specialists. Public health measures to prevent the spread of TB include appropriate respiratory isolation of patients with active pulmonary TB, contact investigation, and reduction of the LTBI burden. Proc. 2011;86(4):348-361 AFB = acid-fast bacilli; BCG = bacille Calmette-Guérin; CFP-10 = culture filtrate protein 10; DOT = directly observed therapy; EMB = ethambutol; ESAT-6 = early-secreted antigenic target 6; HIV = human immuno deficiency virus; IFN-γ = interferon-γ; IGRA = IFN-γ release assay; INH = isoniazid; LTBI = latent TBI; MDR-TB = multidrug-resistant TB; NAA = nucleic acid amplification; PZA = pyrazinamide; RIF = rifampin; TB = tuberculosis; TBI = TB infection; TST = tuberculin skin test; XDR-TB = extensively drug-resistant TB Mayo Clin

In vitro and In vivo antimycobacterial, hepatoprotective and immunomodulatory activity of Euclea natalensis and its mode of action

“…The time required to treat TB can range from 6-9 months. This time duration not only increases the risk of a patient infecting more individuals but also increases the risk of the patient developing drug-induced hepatic damage (Sia and Wieland, 2011). Secondly, during tuberculosis infection, an imbalance between the T-helper cell 1 (Th1) and T-helper cell 2 (Th2) human immune responses exist, where it has been shown that an increase in the Th1 response could potentially be used as an immune therapy for active TB infections (Wong et al, 2013).…”

GeneXpert MTB/RIF Sputum MTB Detection and Human Immunodeficiency Virus Seroprevalence among Patients with Presumptive Pulmonary Tuberculosis at a New Teaching Hospital in North-Central Nigeria

“…nations (WHO, 2015;Mesfin et al, 2015;Muvunyi et al, 2010;Nwadike et al, 2013;Sia et al, 2011). Historically, the scourge of PTB declined in the late 70s especially in developed countries until the advent of HIV which significantly increased its global incidence and altered its presentation consequently posing major clinical and laboratory diagnostic challenges especially in the resource-constrained nations.…”

The Impact of Tuberculosis among Immigrants: Epidemiology and Strategies of Control in High-Income Countries—Current Data and Literature Review

“…However, only 22% of countries worldwide routinely perform cultures and DST, and only 48% of the 46 countries in the WHO Africa region have ever undertaken a drug-resistance survey [4,73]. Moreover, DST is often too expensive, especially in high-burden countries, and in many settings it is neglected because of the lack of SLD [73,74]. In general, treatment for MDR-TB can extend up to 2 years after microbiologic culture conversion and relies on more toxic, less efficacious second-or third-line agents, many of which are even more scarce than frontline drugs in affected areas [75].…”