Permutations of time and place in tuberculosis

被引:32
作者
Elkington, Paul T. [1 ]
Friedland, Jon S. [2 ]
机构
[1] Univ Southampton, Clin & Expt Sci Acad Unit, Fac Med, Southampton SO16 1YD, Hants, England
[2] Univ London Imperial Coll Sci Technol & Med, Infect Dis & Immun, London SW7 2AZ, England
基金
英国医学研究理事会; 英国惠康基金;
关键词
PULMONARY TUBERCULOSIS; MYCOBACTERIUM-TUBERCULOSIS; IMMUNITY; LUNG; PATHOGENESIS; REACTIVATION; CHILDHOOD; INFECTION; DISCOVERY; NECROSIS;
D O I
10.1016/S1473-3099(15)00135-8
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Tuberculosis remains a global health pandemic. The current depiction of the Mycobacterium tuberculosis life cycle proposes that airborne bacilli are inhaled and phagocytosed by alveolar macrophages, resulting in the formation of a granuloma that ruptures into the airways to reinitiate the infectious cycle. However, this widely proposed model overlooks the fact, established 100 years ago, that the initial site of M tuberculosis implantation is in the lower zones of the lungs, whereas infectious cavitary pulmonary disease develops at the lung apices. The immunological events at these two pulmonary locations are different cavitation only occurs in the apices and not in the bases. Yet the current conceptual model of tuberculosis renders the immunology of these two temporally and spatially separated events identical. One key consequence is that prevention of primary childhood tuberculosis at the lung bases is regarded as adequate immunological protection, but extensive evidence shows that greater immunity could predispose to immunopathology and transmission at the lung apex. A much greater understanding of time and place in the immunopathological mechanisms underlying human tuberculosis is needed before further pre-exposure vaccination trials can be done.
引用
收藏
页码:1357 / 1360
页数:4
相关论文
共 49 条
[41]   Safety and efficacy of MVA85A, a new tuberculosis vaccine, in infants previously vaccinated with BCG: a randomised, placebo-controlled phase 2b trial [J].
Tameris, Michele D. ;
Hatherill, Mark ;
Landry, Bernard S. ;
Scriba, Thomas J. ;
Snowden, Margaret Ann ;
Lockhart, Stephen ;
Shea, Jacqueline E. ;
McClain, J. Bruce ;
Hussey, Gregory D. ;
Hanekom, Willem A. ;
Mahomed, Hassan ;
McShane, Helen .
LANCET, 2013, 381 (9871) :1021-1028
[42]   Pulmonary necrosis resulting from DNA vaccination against tuberculosis [J].
Taylor, JL ;
Turner, OC ;
Basaraba, RJ ;
Belisle, JT ;
Huygen, K ;
Orme, IM .
INFECTION AND IMMUNITY, 2003, 71 (04) :2192-2198
[43]   Doxycycline and HIV Infection Suppress Tuberculosis-induced Matrix Metalloproteinases [J].
Walker, Naomi F. ;
Clark, Simon O. ;
Oni, Tolu ;
Andreu, Nuria ;
Tezera, Liku ;
Singh, Shivani ;
Saraiva, Luisa ;
Pedersen, Bernadette ;
Kelly, Dominic L. ;
Tree, Julia A. ;
D'Armiento, Jeanine M. ;
Meintjes, Graeme ;
Mauri, Francesco A. ;
Williams, Ann ;
Wilkinson, Robert J. ;
Friedland, Jon S. ;
Elkington, Paul T. .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2012, 185 (09) :989-997
[44]   Tuberculosis biomarkers discovery: developments, needs, and challenges [J].
Wallis, Robert S. ;
Kim, Peter ;
Cole, Stewart ;
Hanna, Debra ;
Andrade, Bruno B. ;
Maeurer, Markus ;
Schito, Marco ;
Zumla, Alimuddin .
LANCET INFECTIOUS DISEASES, 2013, 13 (04) :362-372
[45]   Persistent Latent Tuberculosis Reactivation Risk in United States Immigrants [J].
Walter, Nicholas D. ;
Painter, John ;
Parker, Matthew ;
Lowenthal, Phillip ;
Flood, Jennifer ;
Fu, Yunxin ;
Asis, Redentor ;
Reves, Randall .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2014, 189 (01) :88-95
[46]   Identifying dynamic tuberculosis case-finding policies for HIV/TB coepidemics [J].
Yaesoubi, Reza ;
Cohen, Ted .
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 2013, 110 (23) :9457-9462
[47]  
YAMAMURA Y, 1974, AM REV RESPIR DIS, V109, P594
[48]  
Yoder MA, 2004, CURR SCI INDIA, V86, P74
[49]   Animal models of tuberculosis [J].
Young, Douglas .
EUROPEAN JOURNAL OF IMMUNOLOGY, 2009, 39 (08) :2011-2014