PT  - JOURNAL ARTICLE
AU  - Giovanni Delogu
AU  - Delia Goletti
TI  - The Spectrum of Tuberculosis Infection: New Perspectives in the Era of Biologics
AID  - 10.3899/jrheum.140097
DP  - 2014 May 01
TA  - The Journal of Rheumatology
PG  - 11--16
VI  - 91
4099  - http://www.jrheum.org/content/91/11.short
4100  - http://www.jrheum.org/content/91/11.full
SO  - J Rheumatol2014 May 01; 91
AB  - The risk of developing active tuberculosis (TB) is higher in patients taking immunosuppressive drugs, either as a result of reactivation of a latent TB infection (LTBI) or following a new infection with Mycobacterium tuberculosis (Mtb). We discuss the pathogenesis and spectrum of Mtb infection in light of its implication for the management of patients following biologic regimens. Among recent findings, during LTBI, Mtb can persist in the host for decades, localizing in many tissues and assuming different metabolic states that protect the bacilli from the harsh host immune defenses. Despite the strong host T cell response against Mtb, the bacilli may also replicate and multiply in vivo, and any event impairing immune function may lead to active and uncontrolled bacteria replication and active disease. The classic dichotomy between active and latent disease is being reconsidered in favor of a continuous and dynamic spectrum extending from infection to disease that can coexist in the same individual. This TB spectrum results from the dynamic interaction between the host immune system and the bacilli and can be maintained in equilibrium for decades, although treatments affecting the host immune cells may result in disease reactivation.