Richard van Altena, Sridevi Duggirala, Matthias I. P.Groschel and Tjip S. van der Werf Pages 2853 - 2862 ( 10 )
Humans have always lived with tubercle bacilli. Host susceptibility – both inherited and acquired – determines whether an individual infected with Mycobacterium tuberculosis will eventually fall ill and develop tuberculosis (TB). After infection with M. tuberculosis, a latent TB infection may ensue reflected by immune recognition of specific antigenic epitopes expressed by M. tuberculosis – the Region of Difference 1 proteins ESAT-6 and CFP-10 leading to interferon gamma release in vitro. Multi-Drug-Resistant TB has emerged as an enormous infectious threat in certain regions in the world, and the Acquired immunodeficiency by co-infection with HIV has accelerated the TB epidemic even further. A paradoxical response – or Immune Response Inflammatory Syndrome in the context of treatment of HIV co-infection - is an increased inflammatory reaction during effective reduction in the bacterial load. This should be differentiated from treatment failure. A huge challenge is to develop novel markers that can differentiate paradoxical responses from treatment failure. We discuss the role of protection of vaccines – especially BCG, iron metabolism and the role of vitamin D.
Mycobacterium tuberculosis,immune response,interferon gamma,BCG,vitamin D,iron,immune response inflammatory syndrome,Multi-Drug Resistant TB (MDR-TB),sputum smear microscopy,Mycobactin
, , , Dept Pulmonary Diseases&Tuberculosis, University Medical Center Groningen, University of Groningen PO Box 30001 9700RB Groningen the Netherlands.