Tuberculosis and the Nutritionally Disadvantaged: Conclusions

Mycobacterium tuberculosis is a highly infectious human pathogen which is spread person-to-person by means of droplet infection from a patient with open cavitary disease. Most adults are innately resistant to tuberculosis, developing a latent form of the disease in which small numbers of virulent tubercle bacilli can persist within the tissues for long periods of time. This quiescent infection may later reactivate during old age or in individuals suffering from severe malnutrition, chronic alcoholism, drug abuse or human immunodeficiency virus (HIV) infection which ablate the normally effective cellular defenses. Prolonged malnutrition also adversely affects macrophage activity, a phenomenon seen in low birth-weight babies and HIV-infected patients with the “wasting’ syndrome, contributing to the immunodeficiency discussed in a laboratory setting and from a clinical viewpoint. The chapter discusses the double role played by malnutrition and HIV infection in many parts of Eastern Europe, Africa, India, and China, areas where tuberculosis is already well entrenched.