Tuberculosis: where are we?

Tuberculosis is the ninth leading cause of death worldwide and the leading cause of death from a single infectious agent, ranking above HIV/AIDS. The BRICS countries (i.e., Brazil, Russia, India, China, and South Africa) account for 53% of all tuberculosis cases in the world. In 2016, there were an estimated 1.3 million tuberculosis deaths among HIV-negative individuals and an additional 374,000 deaths among HIV-positive individuals. An estimated 10.4 million people (adults, 90%; males, 65%; and people living with HIV, 10%) fell ill with tuberculosis (i.e., were incident cases) in 2016. Drug-resistant tuberculosis is a persistent threat, a total of 490,000 cases of multidrug-resistant tuberculosis having occurred in 2016, with an additional 110,000 cases of rifampin-resistant, isoniazid-susceptible tuberculosis.¹

The World Health Assembly, convened annually by the World Health Organization, passed a resolution approving with full support the new post-2015 Global TB Strategy with its ambitious targets. The strategy is aimed at ending the global tuberculosis epidemic, with targets to reduce tuberculosis deaths by 90% and to cut new cases by 90% between 2015 and 2035.¹

It has been estimated that two thirds of all incident tuberculosis cases worldwide are notified to national tuberculosis control programs and reported to the World Health Organization; strengthening and expansion of the existing network of diagnostic facilities are required in order to guarantee universal access to early and accurate diagnosis of tuberculosis.²

An accurate diagnosis of active tuberculosis is a prerequisite for any successful tuberculosis control program: at the individual level, a patient who has tuberculosis and goes undiagnosed remains infectious to others, being at risk of dying, whereas a patient who does not have tuberculosis and is misdiagnosed as having tuberculosis is unnecessarily exposed to potentially toxic drugs, and scarce public health resources are wasted.³ In addition, only a fraction of the estimated cases of multidrug-resistant tuberculosis have a laboratory-confirmed diagnosis. Adequate capacity to diagnose all cases of drug-resistant tuberculosis is essential to make further progress in global tuberculosis care and control.² Therefore, the tuberculosis control strategy should ensure provision of services for early diagnosis and proper treatment of all forms of tuberculosis affecting people of all ages.^2,4 New, safer, affordable, and more effective drugs allowing treatment regimens that are shorter in duration and easier to administer are key to improving treatment outcomes of drug-resistant tuberculosis.⁵

A search of the recent literature reveals one review focusing on tuberculosis treatment and presenting current evidence on this fundamental aspect of tuberculosis control,⁶ as well as a worldwide survey of the current use and acceptability of novel diagnostic tests for active tuberculosis.⁷⁾ In addition to contributing to individual case management, such studies contribute to developing updated local guidelines and local health care policies, especially in countries with a significant burden of the disease, such as Brazil.

REFERENCES

• ¹
  World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization; 2017.
• ²
  World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: World Health Organization; 2013.
• ³
  Drobniewski F, Nikolayevskyy V, Balabanova Y, Bang D, Papaventsis D. Diagnosis of tuberculosis and drug resistance: what can new tools bring us? Int J Tuberc Lung Dis. 2012;16(7):860-70. https://doi.org/10.5588/ijtld.12.0180
  » https://doi.org/10.5588/ijtld.12.0180
• ⁴
  Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017;64(2):e1-e33. https://doi.org/10.1093/cid/ciw694
  » https://doi.org/10.1093/cid/ciw694
• ⁵
  World Health Organization. Treatment of tuberculosis: guidelines for treatment of drug-susceptible tuberculosis and patient care (2017 update). Geneva: World Health Organization; 2017.
• ⁶
  Rabahi MF, Silva Júnior JLRD, Ferreira ACG, Tannus-Silva DGS, Conde MB. Tuberculosis treatment. J Bras Pneumol. 2017;43(6):472-486. https://doi.org/10.1590/s1806-37562016000000388
  » https://doi.org/10.1590/s1806-37562016000000388
• ⁷
  Amicosante M, D'Ambrosio L, Munoz M, Mello FCQ, Tebruegge M, Chegou NN, et al. Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey. J Bras Pneumol. 2017;43(5):380-392. https://doi.org/10.1590/s1806-37562017000000219
  » https://doi.org/10.1590/s1806-37562017000000219

Publication Dates

• Publication in this collection
  Mar-Apr 2018