The article is about tuberculosis. Tuberculosis is a bacterial disease caused by Mycobacterium tuberculosis. The article is relating tuberculosis to HIV and it is explaining how people who have HIV are more susceptible to tuberculosis. The epidemiology is discussed as well in the article explaining how tuberculosis is multi-drug resistant. The article also discusses the interaction between the host and the pathogen. It states that one type of interaction is the pathogen living inside the macrophage. Mycobacterium tuberculosis has six lineages that are for specific populations. One tuberculosis lineage is the East Asian lineage which is also known as the West Beijing strains. These strains have a greater virulence than any other strains.
The mycobacterial cell wall is also discussed. The different toll-like receptors are explained. An example of a toll-like receptor used is toll-like receptor 9 (TLR9), which combines with TLR2 to help in creating host resistance. TLR4 in mice plays different roles. In some mice TLR4 has a big effect on tuberculosis but in other mice it does not have much of an effect.
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The diagnosis of tuberculosis is discussed as well. The article states that the diagnosis of tuberculosis depends on the whether or not acid fast bacilli is detected. Some ways of diagnosing tuberculosis that are described in this article are by centrifugation of cerebrospinal fluid, using fluorescent microscope, and nucleic acid amplification tests.
The article also talks about the treatment of tuberculosis. The treatment that is used most often is combining isoniazid, rifampicin, pyrazinamide, and ethambutol for a couple of months and then taking isoniazid and rifampicin for four months. Another international way of controlling and treating tuberculosis is using the DOTS strategy. The DOTS strategy is cost efficient so it is useful in developing countries. DOTS plus is used to treat drug resistant tuberculosis. A problem with the tuberculosis treatment is that many patients stop the treatment process when they think they are better instead of continuing with the whole course. Tuberculosis becoming more and more drug resistant is also a problem. An example of this is that rifapentine is a rifamycin that is good for treating patients but HIV infected patients have acquired resistance to rifamycin. Preventive therapy is used to reduce tuberculosis in HIV positive and negative people. Vaccination is also discussed in this article as a preventive measure. BCG vaccinations protect against tuberculosis in children but it does not help against the transmission of tuberculosis. Controlling tuberculosis that is associated with HIV is also discussed in this article.
One important study in this article is tuberculosis in HIV patients. HIV infected patients are susceptible to latent tuberculosis being reactivated. HIV infection increase the transmission of tuberculosis in children. Antiretroviral treatment is used to control tuberculosis in HIV positive individuals. Secondary preventive therapy is also used to control tuberculosis incidences in HIV infected people. Combining antiretroviral and antitubercular therapy is not easy because patients who are given these increase their chances at adverse drug effects or
reactions. Protease inhibitors increase drug resistance and they cause the disease to get worse. Rifampicin was used to reduce protease inhibitors. One risk in patients with tuberculosis who are going through antiretroviral therapy is that they can develop immune reconstitution inflammatory syndrome. This syndrome can make tuberculosis in those patients worse. The risk is higher in patients with HIV.
Another important study in this article is the fact that tuberculosis is multi-drug resistant. Multi-drug resistant means that it has to at least be resistant to the drugs rifampicin and isoniazid. This makes tuberculosis a hard disease to treat.
The study of different toll-like receptors is also explained in this article. The study of some toll-like receptors was done on mice. The main intracellular pathway in mice is the activation of inducible nitric oxide synthase and p47 GTPase by the cytokine interferon but it is still unknown whether or not nitric oxide helps against the mycobacteria in humans. Studies show that vitamin D may help prevent tuberculosis. The two gene homologues that exist in humans out of the 23 genes in mice are IRGC and IRGM. IRGM deals with the bacteria being taken up by the endoplasmic reticulum and then dying.
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Another study described is how tuberculosis can survive in a immune area. One of the studies described is that almost every non-essential gene of Mycobacterium tuberculosis was mutated. This study showed that 194 genes are needed to have growth in mice. In the second study, it is examined how random mutation in BCG effects intracellular growth and the ability to resist phagosomal acidification. These studies showed that membrane-associated proteins and small molecule transporters are important. The membrane-associated proteins are
important in virulence and the small molecule transporters are important in bacterial replication.
Different diagnosis techniques are analyzed in this article. One type of diagnosis test is the tuberculin skin test (TST). Another type of test is the nucleic acid amplification test. This test is highly specific. There is also a way to detect whether there is resistance to rifampicin. There are many techniques used to detect this. One technique is the line probe assay. Being able to detect drug resistance early helps start therapy early and helps with infection control measures.
In the treatment of tuberculosis the DOTS and the DOT strategy are analyzed. The DOTS strategy is used to treat drug resistant tuberculosis. It helped reduce the tuberculosis cases worldwide. Direct observed therapy (DOT) helps to improve treatment completion. Although a recent analysis showed that DOT did not help improve treatment completion.
The importance of studying drug resistance bacterial strains is to find out better ways to treat tuberculosis even when it has drug resistance. Also knowing how HIV and tuberculosis are related can help in preventing tuberculosis in HIV patients. The study with the mice can help treat tuberculosis in disease because it will help come up with more drugs. It is also very important to come up with better ways to diagnose a disease so that early treatment can be induced.
I think that this is a good article to learn about tuberculosis because it will help with different ways to prevent and treat this disease. Also learning about the Mycobacterium tuberculosis will help come up with different ways to help fight it. This analysis should now come up with better treatment and preventive measures. This was a very insightful article on the different properties of tuberculosis. Different ways of diagnosing, preventing, and treatment can help reduce the number of tuberculosis cases worldwide.