Zusammenfassung
Robert Kochs Entdeckung des M. tuberculosis, eine der größten wissenschaftlichen Errungenschaften aller Zeiten, bereitete den notwendigen Boden für anschließende bahnbrechende Untersuchungen, die es Fachleuten ermöglicht haben, über die endgültige Eradikation der Tuberkulose nachzudenken - der gefürchteten Seuche, die jahrhundertelang weltweit die bedeutendste Todesursache war. Weitere für die Tuberkulosebekämpfung bedeutende Meilensteine waren die Entdeckung der Röntgenstrahlen, die Entwicklung der BCG-Impfung, die Einführung der antituberkulösen Chemotherapie und der Chemoprävention sowie die Dechiffrierung des Genoms von Mycobacterium tuberculosis. Zunächst müssen jedoch Wege gefunden werden, dem neuen Aufleben der Krankheit in Sub-Sahara-Afrika zu begegnen, das durch eine andere Geißel, HIV/AIDS, gefördert wird. Hinzu kommt das globale Problem der sich verschlechternden Resistenz gegenüber antituberkulösen Medikamenten. Die Eradikation ist denkbar und auch ein lohnendes Ziel, aber vermutlich werden wir auf einen oder zwei weitere hilfreiche „Meilensteine” auf dem Weg zum lange erwarteten Nirwana warten müssen.
Abstract
Robert Koch's single-handed discovery of M. tuberculosis, one of the most gigantic scientific accomplishments of all times, provided the necessary foundation for subsequent investigative breakthroughs that have made it possible for experts to begin to contemplate the ultimate eradication of TB: the dreaded pestilence that for centuries was the greatest cause of death in the world. Further important milestones in the fight against TB were the discovery of X-rays, the development of BCG vaccination, the introduction of chemotherapy and chemoprophylaxis, and deciphering the genome of Mycobacterium tuberculosis. First of all, though, we must find a way to deal with the recent resurgence of the disease in the poor countries of sub-Saharan Africa, which is being fueled by another scourge, HIV/AIDS. And there is also the global problem of worsening anti-TB drug resistance. Eradication is conceivable and a worthy goal, but, I suspect, we will need to wait for another one or two additional “milestones” to help us along before the long-awaited nirvana can finally occur.
Literatur
-
1
Koch R.
Die Aetiologie der Tuberculose.
Berlin Klin Wschr.
1882;
19
221-230
-
2 Global tuberculosis control: surveillance, planning, financing. WHO Report 2007. Geneva: World Health Organization. WHO/HTM/TB/2007.376 2007
-
3
CDC, Deaths: preliminary data for 2004.
Nat Vital Stat Rep.
2006;
54
1-50
-
4 Röntgen W C. Ueber eine neue Art von Strahlen. Würzburg: Physikalisch-Medizinische Gesellschaft 28. Dezember 1895
-
5
Lentle B, Aldrich J.
Radiological sciences, past and present.
Lancet.
1997;
350
280-285
-
6 Guérin C. The history of BCG. Chapter 3. In: Rosenthal SR (Hrsg). BCG Vaccine: Tuberculosis-Cancer. Littleton, MA, PSG Publishing Co 1980: 35-43
-
7
Calmette A, Guérin C, Weill-Hallé B. et al .
Essais de prémunition par le BCG contre l'infection tuberculeuse de l'homme et des animaux.
Bull Acad Med.
1924;
91
787
-
8 Dubos R, Dubos J. The white plague: tuberculosis, man and society. Boston, MA: Little Brown and Co 1952: 123
-
9
Berlin Correspondent .
The Lübeck trial.
Lancet.
1932;
I
365
-
10 Fine P EM. BCG vaccines and vaccination. Chapter 19. In: Reichman LB, Hershfield ES (Hrsg). Tuberculosis. A Comprehensive International Approach. 2nd Ed. New York, NY: Marcel Dekker 2000: 503-522
-
11
Han R E, Pan J G.
Can intravesical bacillus Calmette-Guérin reduce recurrence in patients with superficial bladder cancer? A meta-analysis of randomized trials.
Urology.
2006;
67
1216-1223
-
12
Murray J F.
A century of tuberculosis.
Am J Respir Crit Care Med.
2004;
169
1181-1186
-
13 Ryan F. The forgotten plague: how the battle against tuberculosis was won and lost. Boston, MA: Little Brown 1992: 251-261
-
14
Medical Research Council .
Treatment of pulmonary tuberculosis with para-aminosalicylic acid and streptomycin: a preliminary report.
BMJ.
1949;
2
1521
-
15 Ryan F. The forgotten plague: how the battle against tuberculosis was won and lost. Boston, MA: Little Brown 1992: 359
-
16
Fox W, Ellard G A, Mitchison D A.
Studies on the treatment of tuberculosis undertaken by the British Medical Research Council Tuberculosis Units 1946 - 1986, with relevant subsequent publications.
Int J Tuberc Lung Dis.
1999;
3 (Suppl 2)
231-279
-
17 WHO .The five elements of DOTS. http://www.who.int/tb/dots/whatisdots/en/index.html am 6 April 2007
-
18 World Health Organization .Guidelines for the programmatic management of drug-resistant tuberculosis. WHO/HTM/TB2006.361. Geneva: World Health Organization 2006
-
19
Migliori G B, Loddenkemper R, Blasi F. et al .
125 years after Robert Koch's discovery of the tubercle bacillus: the new XDR-TB threat. Is “science” enough to tackle the epidemic?.
Eur Respir J.
2007;
29
423-427
-
20
Ferebee S H.
Controlled chemoprophylaxis trials in tuberculosis: a general review.
Bibl Tuberc.
1970;
26
28-106
-
21
Ferebee S H, Mount F W, Comstock G W.
Controlled trials of isoniazid prophylaxis in the USA.
T.
1962;
3
8-22
-
22
Ewer K, Deeks J, Alvarez L. et al .
Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak.
Lancet.
2003;
361
1168-1173
-
23
Jasmer R M, Nahid P, Hopewell P C.
Latent tuberculosis infection.
N Engl J Med.
2002;
347
1860-1866
-
24
Cole S T, Brosch R, Parkhill J. et al .
Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence.
Nature.
1998;
393
537-544
-
25
Huard R C, Babre M, de Haas P. et al .
Novel genetic polymorphisms that further delineate the phylogeny of the Mycobacterium tuberculosis complex.
J Bacteriol.
2006;
188
4271-4287
-
26
Murray J F.
Mycobacterium tuberculosis and the cause of consumption: from discovery to fact.
Am J Respir Crit Care Med.
2004;
169
1086-1088
-
27
De Jonge M I, Brosch R, Brodin P. et al .
Tuberculosis: from genome to vaccine.
Expert Rev Vaccines.
2005;
4
541-551
-
28
Arcus V L, Lott J S, Johnston J M. et al .
The potential impact of structural genomics on tuberculosis drug discovery.
Drug Discov Today.
2006;
11
28-34
1 Nach dem Einführungsreferat auf dem Internationalen Symposium in Berlin aus Anlass des Welttuberkulosetags 2007
John F. Murray M.D., F.R.C.P. Professor Emeritas of Medicine (University of California San Fransisco)
International Union against Tuberculosis and Lung Disease
68, boulevard Saint Michel
75006 Paris, Frankreich
Email: johnfmurr@aol.com
