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Journal Article Review Ppublish 47 citations

PubMed: 35339424 DOI: 10.1016/j.ebiom.2022.103928

Mind the gap - Managing tuberculosis across the disease spectrum.

EBioMedicine 78:103928

Authors: Hanif Esmail, Liana Macpherson, Anna K Coussens, Rein M G J Houben

Affiliations

  • MRC Clinical Trials Unit at University College London, UK; Institute for Global Health, University College London, UK; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa.
  • MRC Clinical Trials Unit at University College London, UK.
  • Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa; Infectious Diseases and Immune Defense Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; Department of Medical Biology, University of Melbourne, Parkville, Australia.
  • TB Modelling Group, TB Centre, London School of Hygiene and Tropical Medicine, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK.

Abstract

We currently have a binomial approach to managing tuberculosis. Those with active disease, ideally confirmed microbiologically, are treated with a standard 6-month, multi-drug regimen and those with latent infection and no evidence of disease with shorter, one or two drug regimens. Clinicians frequently encounter patients that fall between these two management pathways with some but not all features of disease and this will occur more often with the increasing emphasis on chest X-ray-based systematic screening. The view of tuberculosis as a spectrum of disease states is being increasingly recognised and is leading to new diagnostic approaches for early disease. However, the 6-month regimen for treating disease was driven by the duration required to treat the most extensive forms of pulmonary TB and shorter durations appear sufficient for less extensive disease. It is time undertake clinical trials to better define the optimal treatment for tuberculosis across the disease spectrum.

MeSH

Infections, Tuberculosis, Therapeutics, Biomedical Research

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