Nuevos desafíos en tuberculosis

Abstract

Tuberculosis (TB) is a main cause of disease and death in many countries of the world. The efforts to control this scourge have not been very successful. Even in Chile where we are near to reach the advanced stage of elimination of TB as a public health problem, five persons each week die of this disease. The main challenges for the control of TB and the most recent advances to counteract them are reviewed. A series of modern methods of diagnosis based on the techniques of molecular biology are reviewed. There is a need to develop procedures that can be applied in the so called "point of diagnosis", like the Xpert MTB/RIF test. There are new techniques for the diagnosis of latent TB infection (IGRA's), in order to identify infected subjects of high risk to develop disease to subject them to chemo-profilaxis. We need to develop shorter treatments for new cases and better drugs for multi-resistant patients. Ten new drugs have progressed into the clinical development pipeline for TB. New vaccines against tuberculosis are being investigated. Some of them are already being tried in the field. In the last years two new challenges have appeared: the association TB-AIDS, and the new epidemics of Multi Drug Resistant Tuberculosis (TB MDR and TB XDR). New techniques of diagnosis are described. Our main challenge is to make all this advances available for everybody. In Chile only the private sector has some of these techniques.