The ongoing challenge of latent tuberculosis
Identifieur interne : 001998 ( Main/Exploration ); précédent : 001997; suivant : 001999The ongoing challenge of latent tuberculosis
Auteurs : H. Esmail [Royaume-Uni, Afrique du Sud] ; C. E. Barry [États-Unis] ; D. B. Young [Royaume-Uni] ; R. J. Wilkinson [Royaume-Uni, Afrique du Sud]Source :
- Philosophical Transactions of the Royal Society B: Biological Sciences [ 0962-8436 ] ; 2014.
Abstract
The global health community has set itself the task of eliminating tuberculosis (TB) as a public health problem by 2050. Although progress has been made in global TB control, the current decline in incidence of 2% yr−1 is far from the rate needed to achieve this. If we are to succeed in this endeavour, new strategies to reduce the reservoir of latently infected persons (from which new cases arise) would be advantageous. However, ascertainment of the extent and risk posed by this group is poor. The current diagnostics tests (tuberculin skin test and interferon-gamma release assays) poorly predict who will develop active disease and the therapeutic options available are not optimal for the scale of the intervention that may be required. In this article, we outline a basis for our current understanding of latent TB and highlight areas where innovation leading to development of novel diagnostic tests, drug regimens and vaccines may assist progress. We argue that the pool of individuals at high risk of progression may be significantly smaller than the 2.33 billion thought to be immune sensitized by
Url:
DOI: 10.1098/rstb.2013.0437
PubMed: 24821923
PubMed Central: 4024230
Affiliations:
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Esmail</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Imperial College</institution>,<addr-line>London W2 1PG</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine</addr-line>,<institution>University of Cape Town</institution>,<addr-line>Observatory 7925</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Barry, C E" sort="Barry, C E" uniqKey="Barry C" first="C. E." last="Barry">C. E. 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Esmail</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Imperial College</institution>,<addr-line>London W2 1PG</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine</addr-line>,<institution>University of Cape Town</institution>,<addr-line>Observatory 7925</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Barry, C E" sort="Barry, C E" uniqKey="Barry C" first="C. E." last="Barry">C. E. Barry</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Tuberculosis Research Section</addr-line>,<institution>NIAID, NIH</institution>,<addr-line>Bethesda, MD 20892</addr-line>,<country>USA</country></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Young, D B" sort="Young, D B" uniqKey="Young D" first="D. B." last="Young">D. B. Young</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Imperial College</institution>,<addr-line>London W2 1PG</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af4"><institution>MRC National Institute for Medical Research</institution>,<addr-line>London NW7 1AA</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Wilkinson, R J" sort="Wilkinson, R J" uniqKey="Wilkinson R" first="R. J." last="Wilkinson">R. J. Wilkinson</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>Department of Medicine</addr-line>,<institution>Imperial College</institution>,<addr-line>London W2 1PG</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af2"><addr-line>Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine</addr-line>,<institution>University of Cape Town</institution>,<addr-line>Observatory 7925</addr-line>,<country>South Africa</country></nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="af4"><institution>MRC National Institute for Medical Research</institution>,<addr-line>London NW7 1AA</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Philosophical Transactions of the Royal Society B: Biological Sciences</title><idno type="ISSN">0962-8436</idno><idno type="eISSN">1471-2970</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The global health community has set itself the task of eliminating tuberculosis (TB) as a public health problem by 2050. Although progress has been made in global TB control, the current decline in incidence of 2% yr<sup>−1</sup> is far from the rate needed to achieve this. If we are to succeed in this endeavour, new strategies to reduce the reservoir of latently infected persons (from which new cases arise) would be advantageous. However, ascertainment of the extent and risk posed by this group is poor. The current diagnostics tests (tuberculin skin test and interferon-gamma release assays) poorly predict who will develop active disease and the therapeutic options available are not optimal for the scale of the intervention that may be required. In this article, we outline a basis for our current understanding of latent TB and highlight areas where innovation leading to development of novel diagnostic tests, drug regimens and vaccines may assist progress. We argue that the pool of individuals at high risk of progression may be significantly smaller than the 2.33 billion thought to be immune sensitized by <italic>Mycobacterium tuberculosis</italic> and that identifying and targeting this group will be an important strategy in the road to elimination.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gagneux, S" uniqKey="Gagneux S">S Gagneux</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Comas, I" uniqKey="Comas I">I Comas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wirth, T" uniqKey="Wirth T">T Wirth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Blaser, Mj" uniqKey="Blaser M">MJ Blaser</name></author><author><name sortKey="Kirschner, D" uniqKey="Kirschner D">D Kirschner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hershberg, R" 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Cardona</name></author><author><name sortKey="Costa, J" uniqKey="Costa J">J Costa</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Afrique du Sud</li><li>Royaume-Uni</li><li>États-Unis</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Esmail, H" sort="Esmail, H" uniqKey="Esmail H" first="H." last="Esmail">H. Esmail</name></noRegion><name sortKey="Wilkinson, R J" sort="Wilkinson, R J" uniqKey="Wilkinson R" first="R. J." last="Wilkinson">R. J. Wilkinson</name><name sortKey="Wilkinson, R J" sort="Wilkinson, R J" uniqKey="Wilkinson R" first="R. J." last="Wilkinson">R. J. Wilkinson</name><name sortKey="Young, D B" sort="Young, D B" uniqKey="Young D" first="D. B." last="Young">D. B. Young</name><name sortKey="Young, D B" sort="Young, D B" uniqKey="Young D" first="D. B." last="Young">D. B. Young</name></country><country name="Afrique du Sud"><noRegion><name sortKey="Esmail, H" sort="Esmail, H" uniqKey="Esmail H" first="H." last="Esmail">H. Esmail</name></noRegion><name sortKey="Wilkinson, R J" sort="Wilkinson, R J" uniqKey="Wilkinson R" first="R. J." last="Wilkinson">R. J. Wilkinson</name></country><country name="États-Unis"><noRegion><name sortKey="Barry, C E" sort="Barry, C E" uniqKey="Barry C" first="C. E." last="Barry">C. E. 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