title: Immunology in tuberculosis: challenges in monitoring of disease activity and identifying correlates of protection.
abstract: Humans have always lived with tubercle bacilli. Host susceptibility  both inherited and acquired  determines whether an individual infected with Mycobacterium tuberculosis will eventually fall ill and develop tuberculosis (TB). After infection with M. tuberculosis, a latent TB infection may ensue reflected by immune recognition of specific antigenic epitopes expressed by M. tuberculosis  the Region of Difference 1 proteins ESAT-6 and CFP-10 leading to interferon gamma release in vitro. Multi-Drug-Resistant TB has emerged as an enormous infectious threat in certain regions in the world, and the Acquired immunodeficiency by co-infection with HIV has accelerated the TB epidemic even further. A paradoxical response  or Immune Response Inflammatory Syndrome in the context of treatment of HIV co-infection - is an increased inflammatory reaction during effective reduction in the bacterial load. This should be differentiated from treatment failure. A huge challenge is to develop novel markers that can differentiate paradoxical responses from treatment failure. We discuss the role of protection of vaccines  especially BCG, iron metabolism and the role of vitamin D.
authors.affiliation: Department of Pulmonary Diseases & Tuberculosis, University Medical Center Groningen, University of Groningen, the Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: van Altena
authors.forename: Sridevi
authors.initials: S
authors.lastname: Duggirala
authors.forename: Matthias I P
authors.initials: MI
authors.lastname: Gröschel
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
mesh_terms: D000818:Animals; D000942:Antigens, Bacterial / Q000276:immunology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D004198:Disease Susceptibility; D000939:Epitopes / Q000276:immunology; D015658:HIV Infections / Q000150:complications; D006801:Humans; D055985:Latent Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification*; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*; D032581:Tuberculosis Vaccines / Q000276:immunology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology
chemical_list: D000942:Antigens, Bacterial; D000995:Antitubercular Agents; D000939:Epitopes; D032581:Tuberculosis Vaccines