Tuberculosis I: a conceptual frame for the immunopathology of the disease

Maes, Hubert; Causse, Jean; Maes, Roland

doi:10.1054/mehy.1997.0698

Cited by 6 publications

(4 citation statements)

References 63 publications

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“…Heterodox views should be evaluated on their merits and not excluded on sentimental grounds: bad news is not necessary false. If publications on humoral responses are given credit, evaluated properly and integrated [42][43][44][45][46], the following conclusions are drawn:…”

Section: Resultsmentioning

confidence: 99%

A Critical Appraisal of the Ban on Serological Tests for Tuberculosis Usefulness of Serological Monitoring of Tuberculosis Antibodies during the Treatment of TB Patients

Maes¹

2016

Clin Microbiol

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In 2011, the WHO banned the use of serological tests for the detection of antibodies against mycobacteria. This ban rests on a meta-analysis that observed a disparity in accuracy and specificity of results reported in various studies using this technique. All the included results were either level II observational studies or level III expert opinions. The immense majority of studies on other aspects of TB, as microscopy and vaccine efficacy, also pertain to these levels and present the same spread of results. The WHO policy statement rests on incorrect and invalid evidence. The experts analysed a pool of published studies of widely divergent quality, using different serological markers, and drew thereupon conclusions on quality of the serological test itself instead of on the quality of the studies analysed. In addition, the authors of the meta-analysis report results that are sometimes incorrect, drew conclusions on incomplete data, removed publications from their study using dubious reasons, lumped together results that should have been analysed separately and finally failed to take into consideration the value of the golden diagnostic methods used today. I intend to prove that serology is a very useful complementary tool in the diagnostic and prognostic of mycobacterial infections and that, had the WHO based their analysis on the complete information available, they would have supported the use of some serological tools for the diagnosis of TB instead of banning them.

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Section: Resultsmentioning

confidence: 99%

A Critical Appraisal of the Ban on Serological Tests for Tuberculosis Usefulness of Serological Monitoring of Tuberculosis Antibodies during the Treatment of TB Patients

Maes¹

2016

Clin Microbiol

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“…Maes and colleagues has been conceptualized the human immune responses against mycobacteria into four different stages based on BCG vaccination and tuberculosis disease and treatment, initiated from innate response followed by intermingled innate and adaptive response against low molecular weight oligopeptiic and nonpeptidic, as muramyldipeptide and trehalose 6,6 dimycolate and high molecular weight nonpeptidic antigens such as lipoarabinomannan. The final response is directed against protein antigens (Maes et al, 1999 However, until now, any performance was not successful to show the, stable, consistent and acceptable sero-diagnostic efficacy with a sensitivity of at least more than 85% and a specificity of more than 95% and to replace the traditional sputum microscopy as a reliable diagnostic tool in different groups of tuberculosis patients including HIV-positive, -negative, extra-pulmonary tuberculosis or in pediatric tuberculosis detection. However, extensive study for evaluation of humoral immune responses in different stages of tuberculosis infection and disease and their association with the disease pathogenesis should be consider to clarify the variable antibody responses against different antigens.…”

Section: Discussionmentioning

confidence: 99%

Immunological Diagnosis of Active and Latent TB

Shiratori¹,

Saitoh²,

Siddiqi³

et al. 2012

Understanding Tuberculosis - Global Experiences and Innovative Approaches to the Diagnosis

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“…The tuberculosis disease is scientifically and medically complex [33][34][35][36]. The immune response against M. tuberculosis proceeds in four overlapping stages.…”

Section: The Specificity Of Bcg Antibodiesmentioning

confidence: 99%

“…The first line of defence against an invading pathogen is the production of the highly reactive nitric oxide by macrophages and other cells [33,34]. The antimicrobial properties of Nitric Oxide (NO) are well established since 1995 [53].…”

Section: Boosting Of the Immune Responsementioning

confidence: 99%

Can the Triumphant March of TB be Stopped? A Critical Appraisal of the Currently Applied Policy of Eradication

Maes¹

2016

Clin Microbiol

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The fight against TB is organized by International (WHO, International Union of Tuberculosis and Lung Diseases (UTLD) and National organizations (Ministries of Health). Their strategy is based on a "herd medicine" approach. The vaccine and the massive administration of four drugs (isoniazid, rifampicin, ethambutol and pyrazinamide-with streptomycin eventually added for the resistant cases) worldwide during decennia were expected to solve the TB problem. They did not because the means applied to fight the disease were not appropriate. The BCG vaccine is the only vaccine in use, yet it sometimes promotes TB multiplication instead of eradication; only four drugs were imposed by Standard Operating Procedures during decennia, of which some are immunodepressive and may, under some conditions, add to the immunodepressive activity of the pathogen and favour relapse; the diagnosis limited to the detection of the pathogen ignores the immune condition of the patients under treatment.The prognosis, diagnosis and treatment of tuberculosis can be improved. The BCG vaccine is iatrogenic and needs replacement; diagnostic tests based on the detection of the pathogen have their use but need to be completed with the detection of asymptomatic cases and the monitoring of the immune status of the treated patients with a sero-diagnostic test that detects unapparent infections and immune-depressed cases; the drugs used to fight TB must be re-evaluated and complemented by the application of immune-stimulating products to those refractory patients who show a need therefore. The continuing use of an iatrogenic vaccine and of immunodepressive drugs defeats the purpose.

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Tuberculosis I: a conceptual frame for the immunopathology of the disease

Cited by 6 publications

References 63 publications

A Critical Appraisal of the Ban on Serological Tests for Tuberculosis Usefulness of Serological Monitoring of Tuberculosis Antibodies during the Treatment of TB Patients

A Critical Appraisal of the Ban on Serological Tests for Tuberculosis Usefulness of Serological Monitoring of Tuberculosis Antibodies during the Treatment of TB Patients

Immunological Diagnosis of Active and Latent TB

Can the Triumphant March of TB be Stopped? A Critical Appraisal of the Currently Applied Policy of Eradication

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