Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713


Publication continuous and bimonthly

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Current Issue: 2018 - Volume 44 - Number 2 (March/April)


Tuberculosis: where are we?

Tuberculose: onde estamos?


Fernanda Carvalho de Queiroz Mello1; a; Denise Rossato Silva2; b; Margareth Pretti Dalcolmo3; c


1. Instituto de Doenças do Tórax - IDT - Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.
2. Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.
3. Centro de Referência Hélio Fraga, Fundação Oswaldo Cruz, Rio de Janeiro (RJ) Brasil.




Tuberculosis is the ninth leading cause of death worldwide and the leading cause of death from a single infectious agent, ranking above HIV/AIDS. The BRICS countries (i.e., Brazil, Russia, India, China, and South Africa) account for 53% of all tuberculosis cases in the world. In 2016, there were an estimated 1.3 million tuberculosis deaths among HIV-negative individuals and an additional 374,000 deaths among HIV-positive individuals. An estimated 10.4 million people (adults, 90%; males, 65%; and people living with HIV, 10%) fell ill with tuberculosis (i.e., were incident cases) in 2016. Drug-resistant tuberculosis is a persistent threat, a total of 490,000 cases of multidrug-resistant tuberculosis having occurred in 2016, with an additional 110,000 cases of rifampin-resistant, isoniazid-susceptible tuberculosis.(1)

The World Health Assembly, convened annually by the World Health Organization, passed a resolution approving with full support the new post-2015 Global TB Strategy with its ambitious targets. The strategy is aimed at ending the global tuberculosis epidemic, with targets to reduce tuberculosis deaths by 90% and to cut new cases by 90% between 2015 and 2035.(1)

It has been estimated that two thirds of all incident tuberculosis cases worldwide are notified to national tuberculosis control programs and reported to the World Health Organization; strengthening and expansion of the existing network of diagnostic facilities are required in order to guarantee universal access to early and accurate diagnosis of tuberculosis.(2)

An accurate diagnosis of active tuberculosis is a prerequisite for any successful tuberculosis control program: at the individual level, a patient who has tuberculosis and goes undiagnosed remains infectious to others, being at risk of dying, whereas a patient who does not have tuberculosis and is misdiagnosed as having tuberculosis is unnecessarily exposed to potentially toxic drugs, and scarce public health resources are wasted. (3) In addition, only a fraction of the estimated cases of multidrug-resistant tuberculosis have a laboratory-confirmed diagnosis. Adequate capacity to diagnose all cases of drug-resistant tuberculosis is essential to make further progress in global tuberculosis care and control. (2) Therefore, the tuberculosis control strategy should ensure provision of services for early diagnosis and proper treatment of all forms of tuberculosis affecting people of all ages.(2,4) New, safer, affordable, and more effective drugs allowing treatment regimens that are shorter in duration and easier to administer are key to improving treatment outcomes of drug-resistant tuberculosis.(5)

A search of the recent literature reveals one review focusing on tuberculosis treatment and presenting current evidence on this fundamental aspect of tuberculosis control,(6) as well as a worldwide survey of the current use and acceptability of novel diagnostic tests for active tuberculosis.(7) In addition to contributing to individual case management, such studies contribute to developing updated local guidelines and local health care policies, especially in countries with a significant burden of the disease, such as Brazil.


1. World Health Organization. Global tuberculosis report 2017. Geneva: World Health Organization; 2017.
2. World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: World Health Organization; 2013.
3. Drobniewski F, Nikolayevskyy V, Balabanova Y, Bang D, Papaventsis D. Diagnosis of tuberculosis and drug resistance: what can new tools bring us? Int J Tuberc Lung Dis. 2012;16(7):860-70.
4. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017;64(2):e1-e33.
5. World Health Organization. Treatment of tuberculosis: guidelines for treatment of drug-susceptible tuberculosis and patient care (2017 update). Geneva: World Health Organization; 2017.
6. Rabahi MF, Silva Júnior JLRD, Ferreira ACG, Tannus-Silva DGS, Conde MB. Tuberculosis treatment. J Bras Pneumol. 2017;43(6):472-486.
7. Amicosante M, D'Ambrosio L, Munoz M, Mello FCQ, Tebruegge M, Chegou NN, et al. Current use and acceptability of novel diagnostic tests for active tuberculosis: a worldwide survey. J Bras Pneumol. 2017;43(5):380-392.



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