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Lymph nodes-The neglected battlefield in tuberculosis.
Sharie Keanne C Ganchua1, Alexander G White1, Edwin C Klein2
1Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America.
Plos Pathogens
|August 14, 2020
Summary
Thoracic lymph nodes are common sites for extrapulmonary tuberculosis (TB) but are understudied. Research highlights their role in TB persistence, vaccine efficacy, and poor drug penetration, necessitating their inclusion in future TB studies.
Area of Science:
- Immunology
- Infectious Diseases
- Microbiology
Background:
- Thoracic lymph nodes are frequent sites of extrapulmonary tuberculosis (TB).
- Mycobacterium tuberculosis (Mtb) infection in lymph nodes remains understudied.
- Lymph nodes are crucial for adaptive immunity and serve as Mtb reservoirs.
Purpose of the Study:
- To highlight the understudied role of thoracic lymph nodes in TB pathogenesis.
- To emphasize the importance of lymph nodes in Mtb persistence and dissemination.
- To advocate for the inclusion of thoracic lymph nodes in TB vaccine and drug efficacy evaluations.
Main Methods:
- Review of existing literature on TB lymph node involvement.
- Analysis of Mtb's interaction with lymph node architecture.
- Comparison of drug and vaccine efficacy in preclinical models focusing on lymph nodes.
Main Results:
- Mtb infection disrupts lymph node architecture, impairing immune function.
- Successful TB vaccines may prevent Mtb spread to lymph nodes.
- Latent TB reactivation can originate in lymph nodes, leading to dissemination.
- Bacille Calmette-Guerin (BCG) vaccine efficacy might be enhanced by lymph node involvement.
- Drug penetration into lymph nodes is significantly poorer than into lung tissues or granulomas.
Conclusions:
- Thoracic lymph nodes are critical, yet overlooked, sites in TB infection and latency.
- Future TB vaccine and drug development must consider lymph node pharmacokinetics and pharmacodynamics.
- Evaluating TB interventions solely based on pulmonary outcomes may underestimate treatment efficacy.
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