ST Cole, R Brosch, J Parkhill, et al (Wellcome Trust Genome Campus, Hinxton, UK; Institut Pasteur, Paris; NIH, Hamilton, Mont; et al)
Deciphering the Biology of Mycobacterium tuberculosis from the complete Genome Sequence.
Nature 393:537-544, 1998
The pattern of dormancy and reactivation observed in the tubercle bacillus plays a key role in the chronic nature of tuberculosis. This pattern is believed to be genetically programmed. The most widely studied strain of M.tuberculosis is the H37Rv strain.
Even after years of study, the molecular basis of virulence of the tubercle bacillus remains unclear.
A Pabloz-Mendez, for the WHO-International Union Against tuberculosis and Lung Disease Working Group on Anti-Tuberculosis Drug Resistance WHO, Geneva; Columbia Univ, New York; International Union against Tuberculosis and Lung Disease, Paris; et al).
Global Surveillance for Antituberculosis-Drug Resistance, 1994-1997.
N Engl J Med 338:1641-1649, 1998.
The report includes 1994-1997 data on multidrug resistance, defined as resistance to at least isoniazid and rifampin.
About one third of all tuberculosis cases worldwide were found in India.
BL Davidson, (Allegheny Univ, Philadelphia)
A Controlled Comparison of Directly Observed Therapy vs Self administered Therapy for Active Tuberculosis in the Urban United States.
Chest 114: 1239-1243, 1998.
The single best way to control and prevent tuberculosis is successfully completed treatment of active disease. This required that patients take medication for at least 6 months. Directly observed therapy (DOT) is a successful, yet controversial approach; patients only take medication while being supervised and observed.
The study quoted herewith had involved 319 patients with confirmed active TB who began an outpatient drug therapy over period of a year.
The study represents a contemporary trial in the United States evaluating the completion rates of DOT versus SAT. The completion rates at 6 months and 8 months were 52% for DOT and 35% for SAT. Evaluating the completion rates calculated at 12 months in the trial, the completion of therapy was 70% for DOT and 53% for SAT. In order to successful treat TB and to prevent the development of multidrug resistant TB, we need to be treating the majority of patients with DOT programs which has been recommended by the Centers for Disease Control and Prevention as well as the WHO.
In this day of modern era where prevention has to be focused on we need take every measure to aggressively treat a case of active TB rather than conducting trials of self administered therapy which have failed over the past decades as evidence with the growing threat of multi-drug resistant TB.