Department of Pulmonary Diseases & Tuberculosis, University Medical Center Groningen, University of Groningen, the Netherlands.
Curr Pharm Des. 2011;17(27):2853-62. doi: 10.2174/138161211797470228.
Humans have always lived with tubercle bacilli. Host susceptibility both inherited and acquired determines whether an individual infected with Mycobacterium tuberculosis will eventually fall ill and develop tuberculosis (TB). After infection with M. tuberculosis, a latent TB infection may ensue reflected by immune recognition of specific antigenic epitopes expressed by M. tuberculosis the Region of Difference 1 proteins ESAT-6 and CFP-10 leading to interferon gamma release in vitro. Multi-Drug-Resistant TB has emerged as an enormous infectious threat in certain regions in the world, and the Acquired immunodeficiency by co-infection with HIV has accelerated the TB epidemic even further. A paradoxical response or Immune Response Inflammatory Syndrome in the context of treatment of HIV co-infection - is an increased inflammatory reaction during effective reduction in the bacterial load. This should be differentiated from treatment failure. A huge challenge is to develop novel markers that can differentiate paradoxical responses from treatment failure. We discuss the role of protection of vaccines especially BCG, iron metabolism and the role of vitamin D.
人类一直与结核分枝杆菌共存。宿主的易感性既包括遗传因素，也包括后天获得的因素，这决定了个体在感染结核分枝杆菌后是否最终会患病并发展为结核病（TB）。在感染结核分枝杆菌后，可能会发生潜伏性结核感染，这反映了机体对结核分枝杆菌差异区域 1 蛋白 ESAT-6 和 CFP-10 表达的特定抗原表位的免疫识别，导致体外干扰素γ的释放。多药耐药结核病已成为世界某些地区的巨大感染威胁，而 HIV 合并感染导致的获得性免疫缺陷加速了结核病的流行。在 HIV 合并感染的治疗中，一种矛盾的反应或免疫反应炎症综合征是指在有效降低细菌负荷的同时，炎症反应增加。这应与治疗失败相区别。一个巨大的挑战是开发新的标志物，以区分矛盾反应和治疗失败。我们讨论了疫苗（特别是卡介苗）、铁代谢和维生素 D 作用的保护作用。
