Toward tuberculosis eradication: diagnostic, resistance and monitoring insights

One hundred and thirty four years after Koch’s discovery of Mycobacterium tuberculosis (Mtb) as the cause of tuberculosis (TB), the disease persists with no eradication plan in sight. Almost 2 million people worldwide die from TB each year, but despite this huge disease burden the bacteria remain hard to detect with low case detection rates. Over the years effective drug treatments have been developed to treat TB. However the sheer number of drugs patients have to take coupled with the longer duration of therapy has led to patient non-compliance and the resultant multidrug and extensively drug resistant strains. One major challenge in TB is the absence of a rapid, accurate and convenient method for its diagnosis and detection of drug resistance. Another is the unavailability of a validated means by which clinicians can monitor their patients’ response to drug therapy. In this review, the disease TB is discussed from the focal points of disease progression, development of drug resistance and advancements in diagnostic methods. Finally, insights from current studies aimed at coming out with biomarkers and surrogate end points for monitoring efficacy and safety of therapy are examined as these may represent the best chance mankind has for disease eradication.