Lung Remodeling in Pulmonary Tuberculosis

• Published in: The Journal of infectious diseases Vol. 192; no. 7; pp. 1201 - 1210
• Main Authors: Dheda, Keertan, Booth, Helen, Huggett, Jim F., Johnson, Margaret A., Zumla, Alimuddin, Rook, Graham A. W.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.10.2005; University of Chicago Press; Oxford University Press
• Subjects: Apoptosis; Bacteria; Biological and medical sciences; Cytokines; Fibrosis; Fundamental and applied biological sciences. Psychology; Granuloma; Humans; Infectious diseases; Lung - immunology; Lung - microbiology; Lung - pathology; Lungs; Macrophages; Medical sciences; Microbiology; Mycobacterium tuberculosis; Mycobacterium tuberculosis - pathogenicity; Necrosis; Necrosis - immunology; Necrosis - microbiology; Necrosis - pathology; Pulmonary Fibrosis - immunology; Pulmonary Fibrosis - microbiology; Pulmonary Fibrosis - pathology; Pulmonary tuberculosis; T lymphocytes; Tuberculosis, Pulmonary - immunology; Tuberculosis, Pulmonary - microbiology; Tuberculosis, Pulmonary - pathology; Infection; Lung disease; Microbiology; Respiratory disease; Pulmonary tuberculosis; Bacteriosis; Mycobacterial infection
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/444545

Tuberculosis is a global public health catastrophe responsible for >8 million cases of illness and 2 million deaths annually. Pulmonary cavitation with cough-generated aerosol is the principle means of spread, and lung remodeling (healed cavitation, fibrosis, and bronchiectasis) is a major cause of lung disability, surpassing all other diffuse parenchymal lung diseases combined. Efficient granuloma turnover is mycobactericidal, and extracellular matrix is disbanded without scarring. In many with progressive disease, however, there is dysregulated granuloma turnover, liquefactive necrosis, and pathological scarring. The pathological mechanisms and the related immunological pathways underpinning these phenomena are reviewed in the present article. Further studies are needed to identify and develop specific immunotherapeutic interventions that target immunopathology, since they have the potential to substantially reduce spread