Tuberculosis treatment -new approach to an old problem

Chronic mycobacterium infections are major causes of disease burden of 20% in a tropical country like India. The inflammatory cascade following these bacterial infections often leads to tissue damage and perpetuates necrosis, fibrosis and the disease process. Pulmonary tuberculosis, multi-drug resistant tuberculosis not only affects individuals but society at large. Current remedial measures using various technology platforms singularly did not produce effective and appreciable reduction in global disease burden. On the contrary, the conventional chemotherapeutic chemical moieties have demonstrated variable pharmacogenomic expression, increased drug resistance, non compliance of strict prolonged drug regimens with debilitating side effects and contraindications. Furthermore, secreted inflammatory cytokines results in chronic infection, immune deviation, and immunopathology in the lungs. Hence, identification of immune escape mechanisms leading to chronic mycobacterial infections is crucial for development of new treatments. The review would dwell into the basic pathogenic mechanism and the newer approaches that may need to be considered for developing novel therapeutic strategies.