Department of Infection, University College London Medical School, London, UK.
Trop Med Int Health. 2011 Jan;16(1):79-83. doi: 10.1111/j.1365-3156.2010.02665.x.
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 Mycobacterium tuberculosis (Mtb), forming a huge latent Mtb global reservoir. This renders the prospect of ever eliminating Mtb from the human race almost impossible. Several controversial issues regarding host-pathogen interactions and existing prevention and eradication strategies for latent Mtb infections need to be critically re-examined. In this viewpoint, widely held assumptions on Mtb 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 Mtb in the human body, eventually leading to global recommendations for elimination of the latent Mtb 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.
全球每年有近 1000 万例活动性结核病和 180 万人与之相关的死亡。世卫组织估计，全球有三分之一的人口感染了结核分枝杆菌（Mtb），形成了一个巨大的潜伏 Mtb 全球储存库。这使得从人类中彻底消除 Mtb 的前景几乎不可能实现。宿主-病原体相互作用以及现有的潜伏 Mtb 感染预防和根除策略方面存在一些有争议的问题，需要进行批判性地重新审查。在本观点中，对 Mtb 潜伏期和异烟肼单药治疗和化学预防的广泛假设提出了挑战。我们强调需要进行未来的研究来解决这些问题，并制定基于证据的策略，以更好地了解 Mtb 在人体内的平衡和逃逸，最终为消除潜伏 Mtb 状态提出知情的政策和实践建议。在这些策略和政策实现之前，世卫组织和结核病专家将不得不满足于全球结核病控制而不是根除。
