Tuberculosis seems set on defying concerted efforts to treat it successfully with powerful drugs, turning the clock back to the 1930s, warn the editors of the journal Thorax in a special themed issue of the journal to mark World TB day on March 24, and published today.
During the 1930s, dedicated sanitaria and invasive surgery were commonly prescribed for those with the infection - usually caused by Mycobacterium tuberculosis, which the editors describe as “the most successful human pathogen of all time.”
TB often lies dormant with no symptoms, but in a proportion of cases, becomes active, predominantly attacking the lungs. But it can also affect the bones and nervous system, and if left untreated can be fatal. The infection is developing increasing resistance around the world to the powerful drugs currently used to treat it.
“Whatever we may have once optimistically thought, TB remains with death, taxes and political chicanery as being inevitable, unavoidable and deeply unpleasant,” write co-editors, Andy Bush and Ian Pavord. “It shows every sign of weathering the storm and superb randomised controlled trials, to emerge in ever-increasingly drug-resistant forms, potentially turning the clock back to the 1930s,” they say.
“This edition of Thorax, coinciding with world TB day, is themed to recognise the ongoing sinister successes of Mycobacterium tuberculosis, unarguably the most successful human pathogen of all time,” they conclude.
The issue contains international research papers, looking at a broad range of issues, from the risk of TB after seroconversion to HIV infection, to the impact of ethnicity on the pattern of disease.
• The ability of new single step and cost effective tests to eradicate the need for chest X-ray screens for newly arrived immigrants to the UK, who account for 70 percent of TB reported infections in the UK.
• The vulnerability of patients with diabetes to more severe TB infection and a higher probability of unsuccessful treatment.
• A 16-fold increase in non-tuberculous mycobacterial (NTM) infection among patients with chronic obstructive pulmonary disease (COPD) treated with steroids: 1 in 3 people with NTM die within three years of contracting the infection.
• The ability of childhood BCG vaccination against latent TB to last for decades afterwards, resolving some of the doubts about its long-term impact.
• The cost effectiveness of automatically treating young children in close contact with an infected adult, without testing them, in a bid to curb the spread of the infection.
Thorax is one of more than 40 specialist titles published by BMJ Group. The title is co-owned with the British Thoracic Society.