Experts believe that tuberculosis, or TB, has been a scourge for humans for some 15,000 years, with the first medical documentation of the disease coming out of India around 1000 B.C.E. Today, the World Health Organization reports that TB is still the leading cause of death worldwide from a single infectious agent, responsible for some 1.5 million fatalities annually. Primary treatment for TB for the past 50 years has remained unchanged and still requires patients to take multiple drugs daily for at least six months. Successful treatment with these anti-TB drugs — taken orally or injected into the bloodstream — depends on the medications “finding their way” into pockets of TB bacteria buried deep within the lungs.
Now, researchers at Johns Hopkins Medicine and four collaborating medical institutions have developed what they say is a novel means of improving how TB can be treated. Their system adapts two widely used imaging technologies to more precisely track, over time, if an anti-TB drug actually reaches the areas where the bacteria are nested.
The new imaging tool incorporates positron emission tomography and computed tomography — commonly known as PET and CT scans — to noninvasively measure the effectiveness of rifampin, a key anti-TB medicine. The researchers describe a trial using the tool in TB patients in a paper published Feb. 17, 2020, in the journal Nature Medicine.
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“While most TB patients are successfully treated with drug regimens which include rifampin, it still takes at least a six-month course to cure the disease,” says Sanjay Jain, M.D., senior author of the paper; professor of pediatrics, and radiology and radiological science at the Johns Hopkins University School of Medicine; and professor of international health at the Johns Hopkins Bloomberg School of Public Health. “We now have evidence that imaging the lungs with PET and CT scans may help researchers and physicians better determine how much rifampin is reaching the bacteria over time, and then use the data to steer decisions for speedier and more effective TB-fighting measures such as higher doses of the drug.”
A serious treatment issue for patients is that the TB infectious agents, called Mycobacterium tuberculosis, protect themselves by acting like a microbial mole, burrowing safe-haven cavities in the lungs. The cavities are carved by the same cell-killing activity that the TB bacteria use to produce pneumonia and its characteristic pulmonary lesions (commonly referred to as “spots on the lungs” when seen on CT scans). Because the process also destroys blood vessels and builds up scar tissue in the area surrounding a cavity, it can be difficult for anti-TB drugs travelling through the bloodstream to reach the microbes nested inside.