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Update on tuberculosis - 2005
March 01, 2006A reduction in tuberculosis (TB) incidence, prevalence and death rate can be achieved by 2015 in most parts of the world, with the greatest challenges occurring in Africa and Eastern Europe, according to a projection by the Stop TB Department of the World Health Organization.
This assessment appears in the first issue for March 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Tuberculosis is a contagious, potentially fatal infection primarily caused by the airborne bacterium Mycobacterium tuberculosis. Factors that contribute to the spread of TB, particularly in developing nations, include: overcrowding and unsanitary living conditions in urban areas, homeless shelters and prisons; the emergence of multi-drug resistant disease strains; and the spread of HIV and AIDS, which weaken the human immune system and make infection more likely.
Wing Wai Yew, M.B., of the Tuberculosis and Chest Unit at Grantham Hospital in Hong Kong, China, and a colleague examine the worldwide state of TB epidemiology, diagnosis and treatment as shown through research results published during 2005.
"In sub-Saharan Africa, tuberculosis remains the top cause of HIV-related mortality," said Dr. Yew. "The incidence of tuberculosis in adults receiving highly active anti-retroviral therapy is lower than in untreated HIV-infected adults, but still higher than among HIV-negative adults."
Another study cited by the authors highlights the importance of recent infection with M. tuberculosis in an area with high HIV prevalence, as shown by the situation in northern Malawi in Africa. "The proportion of (TB) strains found to be clustered [here] was among the highest in the world," noted the report.
In a study of South African gold miners, TB incidence doubled within the first year of HIV infection.
For detection of possible TB infection, the U.S. Food and Drug Administration has approved a new interferon-gamma blood test. It is currently evaluating the enzyme-linked immunospot (ELISPOT) assay, which has already been approved in Europe.
"The ELISPOT appears to be at least as sensitive as the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection in contacts of patients with tuberculosis and is likely to be more specific than the TST in bacilli Calmette-Guérin (BCG) vaccine," said Dr. Yew.
(The BCG vaccine, which is not 100 percent effective, is used most often in developing countries.)
The most common antibiotics used to treat TB are isoniazid, rifampin, pyrazinamide, streptomycin and ethambutol. "Rifampin has a well-documented interaction with some highly active antiretroviral agents, especially HIV protease inhibitors," said Dr. Yew.
He noted that an alternate member of the rifamycin class called rifabutin has much less effect against the antiretroviral agents. "Thus, rifabutin-based therapy appears to be a better choice for HIV tuberculosis," he added.
However, another research study showed that rifabutin therapy for advanced HIV-related tuberculosis, while well-tolerated, could be associated with a high risk for either failure or relapse in the presence of significant immunosuppressive therapy.
In other research, a group of investigators concluded that lower plasma concentrations of rifabutin, and perhaps isoniazid, were associated with relapse in TB patients with HIV who received only twice-weekly antituberculosis therapy.
Finally, in animal studies, moxifloxacin, a drug with a long half-life that has potent bactericidal and sterilizing powers, has produced a stable cure, without relapse, in a mouse model of tuberculosis.
American Thoracic Society
Wing Wai Yew, M.B., of the Tuberculosis and Chest Unit at Grantham Hospital in Hong Kong, China, and a colleague examine the worldwide state of TB epidemiology, diagnosis and treatment as shown through research results published during 2005.
"In sub-Saharan Africa, tuberculosis remains the top cause of HIV-related mortality," said Dr. Yew. "The incidence of tuberculosis in adults receiving highly active anti-retroviral therapy is lower than in untreated HIV-infected adults, but still higher than among HIV-negative adults."
Another study cited by the authors highlights the importance of recent infection with M. tuberculosis in an area with high HIV prevalence, as shown by the situation in northern Malawi in Africa. "The proportion of (TB) strains found to be clustered [here] was among the highest in the world," noted the report.
In a study of South African gold miners, TB incidence doubled within the first year of HIV infection.
For detection of possible TB infection, the U.S. Food and Drug Administration has approved a new interferon-gamma blood test. It is currently evaluating the enzyme-linked immunospot (ELISPOT) assay, which has already been approved in Europe.
"The ELISPOT appears to be at least as sensitive as the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection in contacts of patients with tuberculosis and is likely to be more specific than the TST in bacilli Calmette-Guérin (BCG) vaccine," said Dr. Yew.
(The BCG vaccine, which is not 100 percent effective, is used most often in developing countries.)
The most common antibiotics used to treat TB are isoniazid, rifampin, pyrazinamide, streptomycin and ethambutol. "Rifampin has a well-documented interaction with some highly active antiretroviral agents, especially HIV protease inhibitors," said Dr. Yew.
He noted that an alternate member of the rifamycin class called rifabutin has much less effect against the antiretroviral agents. "Thus, rifabutin-based therapy appears to be a better choice for HIV tuberculosis," he added.
However, another research study showed that rifabutin therapy for advanced HIV-related tuberculosis, while well-tolerated, could be associated with a high risk for either failure or relapse in the presence of significant immunosuppressive therapy.
In other research, a group of investigators concluded that lower plasma concentrations of rifabutin, and perhaps isoniazid, were associated with relapse in TB patients with HIV who received only twice-weekly antituberculosis therapy.
Finally, in animal studies, moxifloxacin, a drug with a long half-life that has potent bactericidal and sterilizing powers, has produced a stable cure, without relapse, in a mouse model of tuberculosis.
American Thoracic Society
Tuberculosis Current Events and Tuberculosis News RSSStudy reveals why certain drug combinations backfire
Combination drug therapy has become a staple for treating many infections. For instance, doctors treat extensively drug resistant forms of tuberculosis with one drug that breaks down the pathogen's protective barriers and opens the door for another to deliver the deathblow.
Drug industry, nonprofits join forces to fight world's neglected diseases
Drug companies and nonprofit organizations are joining forces to develop new drugs and vaccines to target so-called "neglected" diseases that claim millions of lives in the developing world each year.
U.S. and European Experts Applaud Creation of New Transatlantic Task Force on Global Antibiotic Resistance Threat
Experts on both sides of the Atlantic applaud President Barack Obama and Swedish Prime Minister Fredrik Reinfeldt, representing the European Union (EU) Presidency, for establishing a transatlantic task force to address antibiotic resistance, an urgent and growing problem that threatens patient safety and public health worldwide.
1930s drug slows tumor growth
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There's a speed limit to the pace of evolution, Penn biologists say
Researchers at the University of Pennsylvania have developed a theoretical model that informs the understanding of evolution and determines how quickly an organism will evolve using a catalogue of "evolutionary speed limits."
Cell phones become handheld tools for global development
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Will genomics help prevent the next pandemic?
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Exon-skipping drug prevents muscle wasting, maintains muscle function in dystrophin deficient mice
An exon skipping PPMO has demonstrated dramatic effects in the prevention and treatment of severely affected, dystrophin and utrophin-deficient mice, preventing severe deterioration of the treated animals and extending their lifespan.
Scientists take step toward simple and portable tuberculosis tests for developing world
Two billion people worldwide carry the pathogen that causes tuberculosis (TB), and most of them do not even know they are infected. This is because some 90 percent of people with TB have "latent" infections. They have no symptoms, they can't spread the disease to others and the bug remains dormant in their lungs -- often for years.
High mortality rates may explain small body size
A new study suggests that high mortality rates in small-bodied people, commonly known as pygmies, may be part of the reason for their small stature.
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