The bacterial troops of the intestinal and pulmonary regiments unite in the fight against tuberculosis
Tuberculosis is caused by a bacterium, Mycobacterium tuberculosis, code name Koch's bacillus (after the man who discovered it). The site of infection is the microbiota of the intestines and lungs. There is a range of therapies available to complement current treatments, including so-called good bacteria.
About this article
Tuberculosis is a highly contagious infectious disease that affects (sidenote: Tuberculosis_WHO Oct 2021 ) (WHO, Oct 2021). Although cases are becoming rarer in developed countries thanks to vaccination programs, tuberculosis remains a major public health problem. What is more, the Covid-19 pandemic has reversed years of progress worldwide in the fight against tuberculosis, and for the first time in over a decade, the tuberculosis death rate has risen, (sidenote: Tuberculosis deaths rise for the first time in more than a decade due to the COVID-19 pandemic _WHO Oct 2021 ) . Much collateral damage is being sustained by the microbiota in our gut and lungs, which are heavily involved in this infection.
Disruptions to the gut microbiota
The first microbiota in the line of fire is our intestinal flora, which works closely with our immune cells throughout our lives. Tuberculosis stops this microbiota from operating at full capacity; it loses its diversity and certain bacteria begin to dwindle, while others become more abundant. This imbalance of certain bacterial species (dysbiosis) could even be characteristic of the stages of disease progression.
1.4 million In 2019, 1.4 million people died from tuberculosis (WHO, 2020).
In addition, based on results from animal models, these disruptions to the gut microbiota make tuberculosis drugs less effective. Hence the idea, not yet validated, of restoring balance to the gut microbiota using probiotics and (sidenote: Postbiotics A preparation of inanimate microorganisms and/or their components that confers a health benefit on the host. Salminen S, Collado MC, Endo A, et al. The International Scientific Association of Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of postbiotics. Nat Rev Gastroenterol Hepatol. 2021 Sep;18(9):649-667. ) . The aim is to increase the efficacy of the tuberculosis drugs and strengthen the patient’s immune defenses against the bacteria responsible for TB.
Intestinal and pulmonary troops uniting against infection
Although in different locations, the gut and lung microbiota do not appear to work in isolation. These two microbiota communicate closely and their diversity changes in tandem: the gut microbiota contributes to the pulmonary immune response, and the lung infection in turn affects the composition of the gut microbiota. They are therefore not just two microbiota, but an intestinal/pulmonary unit with a role to play in TB infection and treatment. This could therefore justify a new treatment approach.