Ré-émergence de la tuberculose et multirésistance du bacille de Koch.

Abstract

La tuberculose aurait dû être en net recul. Malheureusement, il n’en est rien. La progression du nombre des malades est aggravée par la co-infection avec le virus du SIDA, par la désorganisation des systèmes de santé et par l’émergence des bactéries résistantes aux antimycobactériens majeurs. Les progrès récents concernent, d’une part, le génome complet de M. tuberculosis et, d’autre part, les mécanismes physiopathologiques de la maladie, ils ouvrent de nouveaux espoirs vers la maîtrise de cette pandémie mondiale.

Tuberculosis, an ancestral human disease, remains the most widespread infectious disease in the world. Tuberculosis remains in constant expansion and the number of new cases is projected to continue to rise, especially in low-income countries in spite of all efforts made for its eradication and the existing efficacious treatment, known for more than 30 years. About one third of the world population (2 billions) is already infected with Mycobacterium tuberculosis. The annual number of new cases of tuberculosis is estimated to about 8 millions of patients, with 2 millions of deaths. At the end of the XXth century, tuberculosis remains a disease closely related to poverty and is dramatically more marked in countries or regions where the tuberculosis-control programs are absent or poorly functionning. More than 95% of all tuberculosis cases are present in the low-income countries. Within this pandemic context, the emergence of multidrug resistant strains, on the one hand, arising mostly after inadequate treatment and follow-up, and on the other hand, the HIV coinfection that increases considerably the number of tuberculosis infected individuals moving rapidly to contagious tuberculosis disease, create new conditions where all the constituants are assembled for the occurence of outbreaks of severe tuberculosis unmanageable by current antimycobacterial antibiotics. Joint efforts should address the issue of the global implantation of the World Health Organisation recommandations to control tuberculosis and of research needs for developing new effective vaccine and new drugs based upon new knowledge on molecular and cellular physiopathological mechanisms of tubercle bacillus in the host.