Clinical Microbiology: Open Access

Abstract

Can the Triumphant March of TB be Stopped? A Critical Appraisal of the Currently Applied Policy of Eradication

Roland Maes

The fight against TB is organized by International (WHO, International Union of Tuberculosis and Lung Diseases (UTLD) and National organizations (Ministries of Health). Their strategy is based on a "herd medicine" approach. The vaccine and the massive administration of four drugs (isoniazid, rifampicin, ethambutol and pyrazinamide-with streptomycin eventually added for the resistant cases) worldwide during decennia were expected to solve the TB problem. They did not because the means applied to fight the disease were not appropriate. The BCG vaccine is the only vaccine in use, yet it sometimes promotes TB multiplication instead of eradication; only four drugs were imposed by Standard Operating Procedures during decennia, of which some are immunodepressive and may, under some conditions, add to the immunodepressive activity of the pathogen and favour relapse; the diagnosis limited to the detection of the pathogen ignores the immune condition of the patients under treatment. The prognosis, diagnosis and treatment of tuberculosis can be improved. The BCG vaccine is iatrogenic and needs replacement; diagnostic tests based on the detection of the pathogen have their use but need to be completed with the detection of asymptomatic cases and the monitoring of the immune status of the treated patients with a sero-diagnostic test that detects unapparent infections and immune-depressed cases; the drugs used to fight TB must be re-evaluated and complemented by the application of immune-stimulating products to those refractory patients who show a need therefore. The continuing use of an iatrogenic vaccine and of immunodepressive drugs defeats the purpose.