Host and Microbial risk factors for drug-sensitive and resistant tuberculosis

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PROVIDED. M. tuberculosis is a highly successful pathogen that infects over eight million people per year and leads to over 2 million deaths. One third of the world's population is believed to be infected with this organism, but only a small minority of those infected will go on to develop active disease. Although some risk factors for disease progression have been described, host and microbial mechanisms that lead to increased susceptibility are poorly understood. The identification of factors associated with the transmission and progression of drug sensitive and resistant tuberculosis may provide targets for focused clinical and public health interventions. Such interventions will be of particular importance for the control of drug resistant tuberculosis, since current control measures focus on the effective treatment of infectious cases. The long term goals are to elucidate factors involved in the emergence and transmission of multidrug (MDR) and extensively drug resistant (XDR) tuberculosis and to develop and implement interventions that target these factors in order to reduce tuberculosis progression and transmission. The specific aims of this project are to identify host, microbial and environmental risk factors for the development of drug sensitive (DS) and MDR tuberculosis and to archive strains characterized on the basis of their epidemiologic and clinical behavior so that they can be used in basic research on strain diversity and its contribution to MDR. We will also establish a comprehensive database which will allow real-time surveillance and be used for epidemic modeling and individual prediction models that will assist decision making regarding the treatment of drug resistant tuberculosis.