Tuberculosis: an unpredictable long-standing human companion still in need of rapid diagnostic tests


Palaeomicrobiology investigations worldwide have now confirmed that tuberculosis is an ancient enemy of humans, and therefore is also an ancient human companion, yet their intricate relationship remains poorly understood [1]. Here, Donoghue [2] reviews how palaeomicrobiology data have indeed reshaped our vision of this long-standing tuberculosis—humankind relationship. In fact, combining palaeomicrobiology and genomic data allows the creation of a co-evolutionary scenario, where the deletion-based decaying genome combined with minor lateral gene transfer [3] lead to unpredictable evolution of the Mycobacterium tuberculosis complex–human relationships [4]. These complex relationships are better understood in the current post-genomic area, with more than ten M. tuberculosis genome sequences available. Here, Gagneux [5] explains the co-evolution of M. tuberculosis families and human populations leading to tuberculosis phylogeography. Such works ultimately served as a basis for the current whole genome-based genotyping of M. tuberculosis [6]. One particular aspect of the ongoing, unpredictable evolution of M. tuberculosis is the surge in the worldwide spread of antimycobacterial-resistant strains, illustrating our collective incapacity to stop pandemics in the 21st century, and putting tuberculosis treatment more than half a century back; here, Sougakoff [7] reviews these aspects of tuberculosis evolution. Determining the host status relies on direct demonstration of the M. tuberculosis organisms, and Pai et al. [8] herein show that recently used quantification of interferon-γ release tests unfortunately do not allow for the diagnosis of current tuberculosis. These data indicate that the only suitable approach is surveillance and diagnosis, and that surveillance and diagnosis of tuberculosis still rely on direct detection of the causative organisms, including all eight M. tuberculosis complex species, in specimens with improved culture-based [9] and DNA-based [10] methods. Research on improved, time-effective, reliable methods of direct diagnosis must therefore be encouraged.

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The author has no conflict of interests to declare.