Tuberculosis in Adults and Children
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SPRINGER BRIEFS IN PUBLIC HEALTH Dorothee Heemskerk Maxine Caws Ben Marais Jeremy Farrar Tuberculosis in Adults and Children 123 SpringerBriefs in Public Health SpringerBriefs in Public Health present concise summaries of cutting-edge research and practical applications from across the entire field of public health, with contributions from medicine, bioethics, health economics, public policy, biostatis- tics, and sociology. The focus of the series is to highlight current topics in public health of interest to a global audience, including health care policy; social determinants of health; health issues in developing countries; new research methods; chronic and infectious disease epidemics; and innovative health interventions. Featuring compact volumes of 50 to 125 pages, the series covers a range of content from professional to academic. 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More information about this series at http://www.springer.com/series/10138 Dorothee Heemskerk • Maxine Caws Ben Marais • Jeremy Farrar Tuberculosis in Adults and Children Dorothee Heemskerk Ben Marais Tuberculosis (TB) Group Paediatrics and Child Health Oxford University Clinical Research Unit The Children’s Hospital at Westmead Ho Chi Minh City Sydney Vietnam Australia Maxine Caws Jeremy Farrar School of Clinical Sciences Gibbs Building Liverpool School of Tropical Medicine WellcomeTrust Liverpool London UK UK ISSN 2192-3698 ISSN 2192-3701 (electronic) SpringerBriefs in Public Health ISBN 978-3-319-19131-7 ISBN 978-3-319-19132-4 (eBook) DOI 10.1007/978-3-319-19132-4 Library of Congress Control Number: 2015943842 Springer Cham Heidelberg New York Dordrecht London © The Author(s) 2015. The book is published with open access at SpringerLink.com. Open Access This book is distributed under the terms of the Creative Commons Attribution Noncom- mercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. All commercial rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publi- cation does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer International Publishing AG Switzerland is part of Springer Science+Business Media (www.springer.com) Preface This monograph is written for healthcare workers in any setting who are faced with the complex care for patients with tuberculosis. Prevention, diagnosis and treatment of tuberculosis are fraught with challenges that are often reflective of problems in society as a whole. Significant progress has been made since the millennium; Global TB incidence has been reduced, access to rapid molecular diagnosis for both TB and drug resistance has been scaled up, and two new TB drugs have been approved in Europe and the USA. However, major political and socio-economic obstacles remain in the translation of these and other advances into equitable TB healthcare access for all. Access to information on developments in TB care is one such barrier, and by summarizing the most recent advances in disease epidemiol- ogy, scientific achievements in treatment and diagnosis and current recommenda- tions for all forms of tuberculosis, we hope to improve the dissemination of access to the latest evidence base for the care of individuals with tuberculosis. v Contents 1 Epidemiology ........................................ 1 1.1 Tuberculosis in History . 1 1.2 Pathogen . 2 1.3 Epidemiology. 4 1.4 Prognosis . 7 2 Pathogenesis......................................... 9 2.1 Transmission . 9 2.2 The Innate Immune Response . 10 2.3 The Adaptive Immune Reponse . 12 2.4 The Complex Role of TNF and Its Genetic Control . 12 2.5 The Tuberculoma . 13 2.6 Vitamin D and the Immune Response . 14 2.6.1 Vitamin D Metabolism . 14 2.6.2 Antimicrobial Effects of Vitamin D . 15 2.6.3 Vitamin D Deficiency and Susceptibility to Tuberculosis . 15 3 Clinical Manifestations ................................. 17 3.1 Primary Tuberculosis . 17 3.2 Pulmonary Tuberculosis . 18 3.2.1 Parenchymal Disease . 18 3.2.2 Endobronchial Tuberculosis . 19 3.2.3 Intra-Thoracic Lymphnode Disease. 20 3.3 Extra-Pulmonary Tuberculosis . 20 3.3.1 Pleural Tuberculosis . 21 3.3.2 Miliary Tuberculosis. 21 3.3.3 Extra-Thoracic Lymphnode Disease . 22 3.3.4 Central Nervous System Tuberculosis . 23 vii viii Contents 3.3.5 Tuberculous Pericarditis . 25 3.3.6 Spinal Tuberculosis . 25 3.3.7 Other Forms of Extra-Pulmonary Tuberculosis . 26 4 Diagnosis ........................................... 27 4.1 Smear Microscopy . 27 4.2 Mycobacterial Culture . 31 4.3 Nucleic Acid Amplification Tests . 32 4.4 Diagnosing Drug-Resistant Tuberculosis . 34 4.5 Other Diagnostic Methods . 35 4.6 Diagnosing Latent Tuberculosis Infection . 36 5 Treatment .......................................... 39 5.1 First-Line Antituberculous Treatment . 39 5.2 HIV Associated Tuberculosis . 43 5.3 Treatment of Drug-Resistant Tuberculosis . 44 5.4 The Role of Fluoroquinolones . 47 5.5 Bedaquiline . 48 5.6 Delamanid . 49 6 Prevention .......................................... 51 6.1 Prophylactic Treatment . 51 6.2 Prophylactic Treatment in Multi-drug Resistant Tuberculosis . 52 6.3 Vaccines . 53 6.4 Concluding Remarks. 54 References............................................. 57 Index ................................................ 65 Chapter 1 Epidemiology Abstract This chapter will describe the pathogen which causes tuberculosis: Mycobacterium tuberculosis. It will give an overview of the historical context, the molecular and clinical epidemiology of tuberculosis in adults and children globally and describes how other epidemics, such as HIV and diabetes, influence disease control. It also summarizes the current efforts of the WHO to curtail the pandemic. Keywords Tuberculosis Á Mycobacterium tuberculosis Á Lineage Á Virulence Á Drug-resistance Á Epidemiology Á HIV Á Prognosis 1.1 Tuberculosis in History Tuberculosis (TB) has caused more deaths through the last 200 years than any other infectious disease, and has been with us since ancient times (Paulson 2013). Evidence of tuberculosis has been found in 9,000 year old mummies. There are conflicting theories of the timing of the emergence of Mycobacterium tuberculosis (M.tuberculosis) as a human pathogen with two recent theories proposing 70,000 years ago (Comas et al. 2013) or 6,000 years ago. The later study proposed that seals first transmitted the disease to humans (Bos et al. 2014). Tuberculosis (TB) is a chronic granulomatous disease caused by the bacterium M. tuberculosis, and more rarely, other species of the Mycobacterium tuberculosis complex including Mycobacterium bovis and Mycobacterium africanum. The term “tubercle” in the context of consumptive (“wasting”) disease was first coined by Fransiscus de la Boë (also known as Sylvius of Leyden), a Dutch anatomist in the 17th century. He found tubercles (from: tuberculum, “small lump” in Latin) in the lungs of most consumptives. Before the discovery of the pathogen in 1882 by Robert Koch, the spectrum of diseases caused by the mycobacteria were known by many names including: consumption, phtisis (from Greek “phtinein” to waste away), scrofula (swelling of lymphnodes, especially in the neck), Pott’s disease (tuberculous spondylitis, named after a British orthopedic surgeon Percivall Pott, in © The Author(s) 2015 1 D. Heemskerk et al., Tuberculosis in Adults and Children, SpringerBriefs in Public Health, DOI 10.1007/978-3-319-19132-4_1 2 1 Epidemiology THE CAPTAIN OF ALL THESE MEN OF DEATH: Deaths from Infectious Diseases in last 200 years Fig. 1.1 The burden of tuberculosis. From Paulson T. Nature, 2013. Reprinted with permission the 18th century, but found in Egyptian mummies and art as early as 1000 BC), yaksma (from Sanskrit: gradual destruction) and shaky oncay (Incan), balasa (Hindu: swelling). The European epidemic in the 17th century was known as “the white plague” (Fig.