Center for Tuberculosis Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Center for Tuberculosis Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Lancet Infect Dis. 2020 Jun;20(6):e117-e128. doi: 10.1016/S1473-3099(20)30148-1. Epub 2020 May 5.
Tuberculosis continues to be a major threat to global health. Cavitation is a dangerous consequence of pulmonary tuberculosis associated with poor outcomes, treatment relapse, higher transmission rates, and development of drug resistance. However, in the antibiotic era, cavities are often identified as the most extreme outcome of treatment failure and are one of the least-studied aspects of tuberculosis. We review the epidemiology, clinical features, and concurrent standards of care for individuals with cavitary tuberculosis. We also discuss developments in the understanding of tuberculosis cavities as dynamic physical and biochemical structures that interface the host response with a unique mycobacterial niche to drive tuberculosis-associated morbidity and transmission. Advances in preclinical models and non-invasive imaging can provide valuable insights into the drivers of cavitation. These insights will guide the development of specific pharmacological interventions to prevent cavitation and improve lung function for individuals with tuberculosis.
结核病仍然是全球健康的主要威胁。空洞是与不良结局、治疗复发、更高的传播率和耐药性发展相关的肺结核的一种危险后果。然而，在抗生素时代，空洞通常被认为是治疗失败的最极端结果，也是结核病研究最少的方面之一。我们回顾了空洞性肺结核的流行病学、临床特征和现行的护理标准。我们还讨论了对结核空洞作为动态物理和生化结构的理解的进展，这些结构将宿主反应与独特的分枝杆菌小生境联系起来，从而导致与结核病相关的发病率和传播。临床前模型和非侵入性成像技术的进步可以为空洞形成的驱动因素提供有价值的见解。这些见解将指导预防空洞和改善肺结核患者肺功能的特定药物干预措施的开发。
