Pulmonology Pulmonology
Pulmonol 2018;24:67-8 - Vol. 24 Num.2 DOI: 10.1016/j.pulmoe.2018.01.002
Editorial
Strengthening tuberculosis control to advance towards elimination: The 2018 Rev. Port. Pneumol. (RPP) TB Series
R. Duartea,, , G.B. Migliorib, A. Zumlac, C.R. Cordeirod
a National Reference Centre for MDR-TB, Hospital Centre Vila Nova de Gaia, EpiUNIT Instituto de Saúde Pública da Universidade do Porto, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
b World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, IRCCS (Istituto di Ricovero e Cura a Carattere Sceintifico), Italy
c Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
d Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal

Despite the global efforts, that have succeeded in reducing tuberculosis (TB) mortality rate by 37% since 2000, TB was one of the top 10 causes of death worldwide in 2016, the main cause of deaths related to antimicrobial resistance and the leading cause of death among people with HIV.1

According to WHO report, in 2016, there were an estimated 10.4 million new TB cases worldwide, 10% of which were people living with HIV. An estimated 1.7 million people died from TB, including nearly 400,000 people who were co-infected with HIV. This represents a decrease of 4% from 2015.1

Multidrug-resistant TB (MDR-TB) remains a public health threat. WHO estimates that there were 490,000 MDR-TB cases.1

Elimination of TB is not an easy goal. A realistic approach to tuberculosis elimination2–5 has to rely on the development of innovative diagnostic, treatment and preventive tools. But it will not be possible without a strong political commitment and addressing the socio-economic determinants of the disease.6–12

The aim of this tuberculosis series is to present an update on tuberculosis and provide a framework for future discussions among clinicians for the development of strategies towards tuberculosis elimination.

Despite the evolution in tuberculosis diagnostic tools, we still have several unmet needs – we need diagnostic tests which are more accurate, more rapid, affordable, simple and with the ability to give a same-day result at point of care. We will discuss the diagnostic methods available and the potential impact of potential point of care diagnostics for tuberculosis.13 We will then update on the role of the newly developed drugs as well as repurposed drugs.14

There is a growing consensus on the need to act on the social determinants and co-morbidities of tuberculosis. It will not be enough to act only in diagnostics and treatment. There is a need to identify interventions ensuring social protection and tackling the challenges of urbanization in order to reduce the risk of exposure, infection and development of disease.15

To provide proper treatment for MDR-TB cases may be a challenge due to the limited availability of second-line drugs, occurrence of serious adverse events, risk of further resistance.3,16–20 We will discuss the available tools to help physicians to manage these difficult cases.21

Tuberculosis in children remains a partially neglected topic, and this is why a specific article will present the state-of-the-art management of tuberculosis and latent tuberculosis infection in children.22

Given the migration crisis a specific article ‘making the point’ on the migrant and refugee emergency, and on the necessary response of national programmes in terms of prevention, diagnosis and treatment has been included.23

Finally, given the difficulties of managing NTM we have included a special article on this difficult topic.24

Overall, the path forward for the lowest TB burden countries seems clear: continue to improve surveillance within coordinated national programmes; decrease diagnosis and treatment delay; approach and manage vulnerable populations; promote effective treatment for active TB in order to prevent drug resistance; and increase the impact of preventive actions – screening for latent tuberculosis infection and treatment of those infected. This will not happen without high-level political commitment and continuous medical education of health staff.

References
1
WHO
Global Tuberculosis Report 2017
(2017)
doi:WHO/HTM/TB/2017.23
2
A. Rendon,Z. Fuentes,C.A. Torres-Duque,M. del Granado,J. Victoria,R. Duarte
Roadmap for tuberculosis elimination in Latin American and Caribbean countries: a strategic alliance
3
A. Dudnyk,D. Butov,V. Crudu,C. Lange,D. Chesov
MDR-TB in Eastern Europe in the era of the TB elimination action framework
Int J Tuberc Lung Dis, 21 (2017), pp. 2-3 http://dx.doi.org/10.5588/ijtld.16.0732
4
C. Lienhardt,A.M. Kraigsley,C.F. Sizemore
Driving the way to tuberculosis elimination: the essential role of fundamental research
Clin Infect Dis, 63 (2016), pp. 370-375 http://dx.doi.org/10.1093/cid/ciw250
5
K. Lönnroth,G.B. Migliori,I. Abubakar,L. D’Ambrosio,G. de Vries,R. Diel
Towards tuberculosis elimination: an action framework for low-incidence countries
6
J. Francisco,O. Oliveira,Ó. Felgueiras,A.R. Gaio,R. Duarte
How much is too much alcohol in tuberculosis?
Eur Respir J, 49 (2017), pp. 1601468 http://dx.doi.org/10.1183/13993003.01468-2016
7
I. Franco,P. Sousa,M. Gomes,A. Oliveira,A.R. Gaio,R. Duarte
Social profile of the highest tuberculosis incidence areas in Portugal
Rev Port Pneumol, 22 (2016), pp. 50-56 http://dx.doi.org/10.1016/j.rppnen.2015.08.006
8
K. Lönnroth,G.B. Migliori,I. Abubakar,L. D’Ambrosio,G. de Vries,R. Diel
Towards tuberculosis elimination: an action framework for low-incidence countries
Eur Respir J, 45 (2015), pp. 928-952 http://dx.doi.org/10.1183/09031936.00214014
9
M. Dias,R. Gaio,P. Sousa,M. Abranches,M. Gomes,O. Oliveira
Tuberculosis among the homeless: should we change the strategy?
Int J Tuberc Lung Dis, 21 (2017), pp. 327-332 http://dx.doi.org/10.5588/ijtld.16.0597
10
S. Imtiaz,K.D. Shield,M. Roerecke,A.V. Samokhvalov,K. Lönnroth,J. Rehm
Alcohol consumption as a risk factor for tuberculosis: meta-analyses and burden of disease
11
A.F. Santos-Silva,G.B. Migliori,R. Duarte
Tuberculosis, alcohol and tobacco: dangerous liaisons
12
P. Sousa,A. Oliveira,M. Gomes,A.R. Gaio,R. Duarte
Longitudinal clustering of tuberculosis incidence and predictors for the time profiles: the impact of HIV
Int J Tuberc Lung Dis, 20 (2016), pp. 1027-1032 http://dx.doi.org/10.5588/ijtld.15.0522
13
A.L. Garcia-Basteiro,A. Dinardo,B. Saavedra,D.R. Silva,D. Palmero,M. Gegia
Point of care diagnostics for tuberculosis
[in press]
14
S. Tiberi,M. Muñoz-Torricoc,R. Duarted,M. Dalcolmo,L. D’Ambrosio,A. Zumlag
New drugs and perspectives for new anti-Tuberculosis regimens
[in press]
15
R. Duarte,F.L.M.A.C. Munoz
Tuberculosis, social determinants and co-morbidities (including HIV)
[in press]
16
G. Günther,F. Van Leth,N. Altet,M. Dedicoat,R. Duarte,G. Gualano
Beyond multidrug-resistant tuberculosis in Europe: a TBNET study
Int J Tuberc Lung Dis, 19 (2015), pp. 1524-1527 http://dx.doi.org/10.5588/ijtld.15.0274
17
F.A. Khan,M.A.H. Salim,P. du Cros,E.C. Casas,A. Khamraev,W. Sikhondze
Effectiveness and safety of standardised shorter regimens for multidrug-resistant tuberculosis: individual patient data and aggregate data meta-analyses
Eur Respir J, 50 (2017), pp. 1700061 http://dx.doi.org/10.1183/13993003.00061-2017
18
L. D’Ambrosio,R. Centis,G. Sotgiu,E. Pontali,A. Spanevello,G.B. Migliori
New anti-tuberculosis drugs and regimens: 2015 update
ERJ Open Res, 1 (2015), pp. 00010-02015 http://dx.doi.org/10.1183/23120541.00010-2015
19
S.E. Borisov,K. Dheda,M. Enwerem,R. Romero Leyet,L. D’Ambrosio,R. Centis
Effectiveness and safety of bedaquiline containing regimens in the treatment of MDR- and XDR-TB: a multicentre study
20
G. Günther,F. Van Leth,S. Alexandru,N. Altet,K. Avsar,D. Bang
Multidrug-resistant tuberculosis in Europe, 2010–2011
21
L. D’Ambrosio,G. Bothamley,J.A. Caminero Luna,R. Duarte,L. Guglielmetti,M. Muñoz
Team approach to manage difficult-to-treat TB cases: experiences in Europe and beyond
[in press]
22
I. Carvalho,D. Goletti,S. Manga,D. Rossato,D. Manissero,G. Migliori
Managing LTBI and TB in children
[in press]
23
A. Rendon,R. Centis,I. Solovic,C.A. Torres-Duque,C. Robalo Cordeiro,F.C. de Queiroz Mello
Migration, TB control and elimination: whom to screen and treat
[in press]
24
J. Chalmers,T. Aksamit,A.C. Carvalho,A. Rendon,I. Franco
Non-tuberculous mycobacterial pulmonary infections
[in press]
Corresponding author. (R. Duarte rdmelo@med.up.pt)
Copyright © 2018. Sociedade Portuguesa de Pneumologia
Pulmonol 2018;24:67-8 - Vol. 24 Num.2 DOI: 10.1016/j.pulmoe.2018.01.002
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