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Free Content Viewpoint: Scientific dogmas, paradoxes and mysteries of latent Mycobacterium tuberculosis infection

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Summary Worldwide, there are nearly 10 million new cases of active TB and 1.8 million associated deaths every year. WHO estimates that one-third of the world’s population is infected with , forming a huge latent global reservoir. This renders the prospect of ever eliminating from the human race almost impossible. Several controversial issues regarding host-pathogen interactions and existing prevention and eradication strategies for latent infections need to be critically re-examined. In this viewpoint, widely held assumptions on latency and isoniazid monotherapy and chemoprophylaxis are challenged. We highlight the need for future research to resolve these issues and to develop evidence-based strategies for better understanding of equilibrium and escape of in the human body, eventually leading to global recommendations for elimination of the latent state through informed policy and practice. Until such strategies and policies are realized, WHO and TB experts will have to settle for global TB control rather than eradication.

Dans le monde, il ya près de 10 millions de nouveaux cas de tuberculose (TB) active et 1,8 millions de personnes en meurent chaque année, ce qui en fait l’une des plus importantes causes de décès. L’OMS estime qu’un tiers de la population mondiale est infecté par Mycobacterium tuberculosis (Mtb), formant ainsi un énorme réservoir mondial de Mtb. Ceci rend la perspective de l’élimination de Mtb de la race humaine presque impossible. Plusieurs questions controversées concernant les interactions hôte/pathogène et les stratégies de prévention et d’éradication des infections latentes de Mtb doivent être réexaminées de façon critique. Dans ce point de vue, les hypothèses largement répandues sur la latence de Mtb et la monothérapie/chimioprophylaxie à l’isoniazide sont contestées. Nous soulignons le besoin de futures recherches nécessaires pour résoudre ces problèmes et pour élaborer des stratégies fondées sur des preuves pour une meilleure compréhension de l’équilibre et de l’évasion de Mtb dans le corps humain, afin d’aboutir éventuellement à des recommandations globales pour l’élimination de l’état latent de Mtbà travers des politiques et des pratiques éclairées. Jusqu’à ce que ces stratégies et politiques soient réalisées, l’OMS et les experts de la TB devront se contenter du contrôle mondial de la TB plutôt que de son éradication.

Keywords: MDR/XDR-TB; Mycobacterium tuberculosis; TB MDR/UR; immunologie; immunology; inmunología; isoniazid; isoniazida; isoniazide; latence; latencia; latency; preventive therapy; re-activation; reactivación; réactivation; terapia preventiva; traitement préventif; tuberculose; tuberculosis; tuberculosis multirresistente y extremadamente resistente (MDR/XDR-TB)

Document Type: Research Article


Affiliations: 1:  Department of Infection, University College London Medical School, London, UK 2:  Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden 3:  University of Zambia-University College London Medical School (UNZA-UCLMS) Project, University Teaching Hospital, Lusaka, Zambia 4:  Global Alliance for TB Drug Development, New York, NY, USA 5:  Lung Institute, University of Cape Town, Cape Town, South Africa 6:  Department for Infectious Diseases and Tropical Medicine, Klinlikum of the University of Munich, Munich, Germany

Publication date: 2011-01-01

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