[Tuberculosis in the 21st century].

Area of Science:

• Infectious Diseases
• Immunology
• Public Health

Context:

• Tuberculosis (TB) poses a significant global health challenge, disproportionately impacting developing countries co-afflicted by HIV.
• In industrialized nations, TB primarily affects immigrants, the immunocompromised, and the elderly.
• Tumor necrosis factor-alpha (TNF-alpha) antagonists are emerging as critical risk factors for TB development.

Purpose:

• To review the current landscape of tuberculosis, including risk factors, diagnostic challenges, and treatment strategies.
• To highlight the need for improved diagnostic sensitivity and novel therapeutic agents for active and latent TB.
• To address the complexities of TB management in HIV-positive patients, including immune reconstitution inflammatory syndrome.

Summary:

• Despite advances, TB diagnosis remains challenging, with existing nucleic acid-based techniques lacking sufficient sensitivity.
• Isoniazid and rifampicin are standard treatments for active TB, though new drugs are under evaluation.
• Latent TB treatment primarily uses isoniazid, with ongoing efforts to enhance patient adherence and explore new immunologic diagnostic methods.

Impact:

• Improved screening and control guidelines are being implemented, particularly concerning TNF-alpha antagonist use.
• Advancements in immunologic methods and new drug development are crucial for combating TB effectively.
• Better understanding and management of TB in vulnerable populations, including HIV co-infected individuals, are essential for global health.