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Cold Spring Harb Perspect Med. 2015 Feb 6;5(11). pii: a017889. doi: 10.1101/cshperspect.a017889.

Tuberculosis Comorbidity with Communicable and Noncommunicable Diseases.

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University of Zambia-University College London Medical School (UNZA-UCLMS) Research and Training Project, University Teaching Hospital, Lusaka RW1X, Zambia Center for Clinical Microbiology, Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom.
Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI) and The Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia.
National Institute of Health Research, Biomedical Research Centre, Royal Free Campus Rowland Hill St, University College London Hospitals, London NW3 2PF, United Kingdom.


The 18th WHO Global Tuberculosis Annual Report indicates that there were an estimated 8.6 million incident cases of tuberculosis (TB) in 2012, which included 2.9 million women and 530,000 children. TB caused 1.3 million deaths including 320,000 human immunodeficiency virus (HIV)-infected people; three-quarters of deaths occurred in Africa and Southeast Asia. With one-third of the world's population latently infected with Mycobacterium tuberculosis (Mtb), active TB disease is primarily associated with a break down in immune surveillance. This explains the strong link between active TB disease and other communicable diseases (CDs) or noncommunicable diseases (NCDs) that exert a toll on the immune system. Comorbid NCD risk factors include diabetes, smoking, malnutrition, and chronic lung disease, all of which have increased relentlessly over the past decade in developing countries. The huge overlap between killer infections such as TB, HIV, malaria, and severe viral infections with NCDs, results in a "double burden of disease" in developing countries. The current focus on vertical disease programs fails to recognize comorbidities or to encourage joint management approaches. This review highlights major disease overlaps and discusses the rationale for better integration of tuberculosis care with services for NCDs and other infectious diseases to enhance the overall efficiency of the public health responses.

[Indexed for MEDLINE]
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