Why is tuberculosis so hard to beat?

So there are successes against tuberculosis, but they have been hardly achieved over long periods of time. This makes the setbacks in the pandemic years all the more tragic The number of deaths rose by about 100,000 in 2020 and 2021, reversing the long-term trend.. The impact of the pandemic can also be seen in the number of new cases. In 2021, about half a million people fell ill compared to 2020.

However, this is only a small part of the damage caused by the epidemic in the fight against tuberculosis. Because not only do people frequently die without a diagnosis and treatment: they also infect many other people while they are sick. The true extent of this effect will not emerge until later, because the larger group of people with latent infection increases the number of cases over a long period of time. A person infected with untreated TB can infect up to 15 other people a year.

Therefore, expert treatment of the underlying infection is increasingly being treated. Attacking the bacteria with antibiotics at this early stage is one way to reduce the incidence of disease in the long term without waiting for an outbreak. In addition, in recent years this has been proven There is a gray area between latent non-communicable infection and infectious TB diseaseAsymptomatic people have bacteria in their lungs and airways and can therefore be infectious. Even if active TB disease is treated promptly, it is often too late to prevent the pathogen from spreading.

Who should get treatment?

Doctors have been debating the actual significance of latent TB for decades. Do all these people really carry the pathogen? So far, tests for tuberculosis have only shown the immune reaction to the bacteria – but say nothing about whether the bacteria are still present and the disease can break out. Therefore, some experts suspect that a significant proportion of those with “latent infections” may have cleared the virus on their own long ago. This means that the group of those who can still get sick is actually much smaller than expected.

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It is therefore important that you only treat those with a latent infection who are likely to develop an active infection. But so far there is no test that can predict who this will happen to. Anyway, one thing is certain: there are countless people with latent TB who will never get sick.

to select that group Who will develop active TB disease is currently a major target for TB research. Because treatment is more complex than for other infections. Those affected must take a course of four antibiotics for two months, followed by two of these for another four months. A new therapeutic approach reduces time to a total of four months, but requires the active ingredient rifapentine, It is not available in most countries of the European Union.

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