Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection

Author:

Drain Paul K.123ORCID,Bajema Kristina L.2,Dowdy David4,Dheda Keertan5,Naidoo Kogieleum67,Schumacher Samuel G.8,Ma Shuyi19,Meermeier Erin10,Lewinsohn David M.10,Sherman David R.19

Affiliation:

1. Department of Global Health, University of Washington, Seattle, Washington, USA

2. Department of Medicine, University of Washington, Seattle, Washington, USA

3. Department of Epidemiology, University of Washington, Seattle, Washington, USA

4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

5. University of Cape Town, Cape Town, South Africa

6. Centre for the AIDS Programme of Research in Africa, Durban, South Africa

7. South African Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa

8. Foundation for Innovative New Diagnostics, Geneva, Switzerland

9. Center for Infectious Disease Research, Seattle, Washington, USA

10. Oregon Health and Science University, Portland, Oregon, USA

Abstract

SUMMARY Tuberculosis (TB) is the leading infectious cause of mortality worldwide, due in part to a limited understanding of its clinical pathogenic spectrum of infection and disease. Historically, scientific research, diagnostic testing, and drug treatment have focused on addressing one of two disease states: latent TB infection or active TB disease. Recent research has clearly demonstrated that human TB infection, from latent infection to active disease, exists within a continuous spectrum of metabolic bacterial activity and antagonistic immunological responses. This revised understanding leads us to propose two additional clinical states: incipient and subclinical TB. The recognition of incipient and subclinical TB, which helps divide latent and active TB along the clinical disease spectrum, provides opportunities for the development of diagnostic and therapeutic interventions to prevent progression to active TB disease and transmission of TB bacilli. In this report, we review the current understanding of the pathogenesis, immunology, clinical epidemiology, diagnosis, treatment, and prevention of both incipient and subclinical TB, two emerging clinical states of an ancient bacterium.

Publisher

American Society for Microbiology

Subject

Infectious Diseases,Microbiology (medical),Public Health, Environmental and Occupational Health,General Immunology and Microbiology,Epidemiology

Reference249 articles.

1. World Health Organization. 2016. Global tuberculosis report. World Health Organization, Geneva, Switzerland.

2. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling

3. World Health Organization. 2014. The end TB strategy. World Health Organization, Geneva, Switzerland.

4. Tuberculosis

5. Heterogeneity in tuberculosis

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