Researchers have been digging hard to unearth the hoary past of tuberculosis. Unbelievable as it may seem, growing evidence exists that the first ancestors of Mycobacterium tuberculosis inhabited earth more than 2.6 million years ago. Eons before the hominoids set their feet on this godly planet, and Adam and Eve and their children came into being! Some ancient skeletal and mummified fossils belonging to diverse species, including dinosaurs, Pleistocene bison, and other bovines like goats and cows, have been found stamped with classic tubercular lesions and bearing the irrefutable molecular genetics inscription of mycobacteria. Of the human tuberculosis, the most ancient evidence has been found in the remains of half a million year old hominid. Old medical texts emanating from different parts of the world – in ancient lands of India, China, Egypt, Babylonia, and Greece – portray the disease through its umpteen names and nuances. Known by such grisly appellations as “the Robber of Youth”, “the Graveyard Cough”, “the White Plague”, tuberculosis burnt a deadly trail claiming millions of lives down the ages. The first major breakthrough against it came in 1882, when the German physician Robert Koch isolated the culprit organism. By mid 20th century, a chain of therapeutic molecules had been found to thwart the malevolent bacteria. Still, “the Captain of the Men of Death” carried on its death-game, finding staunch allies in hunger, malnutrition and poverty. Came the 1980s, it found new vigor by teaming with a new half-brother, the human immunodeficiency virus. Epidemics returned to lands where the disease had stood previously diminished; pushing for the discovery of newer treatments and novel therapies. The wicked dance of tuberculosis, however, continues to rage. Current estimates indicate that nearly a third of the world's population is infected with the bacillus, 10.4 million people carry active disease, and more than 2 million perish of the disease each year. The global community has declared a war on the disease and given the clarion call of “End TB strategy”. Yet, only time shall tell who will score the last hurrah: the bacillus or man!

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There has been an ever-expanding list of isolation of organisms in the genus Mycobacterium. Leprosy and tuberculosis are specific diseases caused by mycobacteria; there are now several other mycobacteria that cause human diseases and can be widely found in the environment. These other mycobacteria are called as nontuberculous mycobacteria (NTM) or mycobacteria other than tubercle bacilli (MOTT) or atypical mycobacteria. They cause various human infections in the lungs, lymph glands, skin, wounds, or bone. They may also produce disseminated disease, especially in the immunocompromised. Various molecular, biochemical, and chemical techniques have been developed for rapid identification of these species. While it might be difficult to treat these infections, with duration of treatment longer than that for tuberculosis or leprosy, many drugs such as rifampicin, rifabutin, ethambutol, clofazimine, amikacin, new generation quinolones, and macrolides effective against mycobacterial infections are available that can be used in appropriate combinations and dosage to treat the NTM.

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In many developed countries, tuberculosis (TB) is considered a disease of the past. However, the impact of this disease can be devastating even today, especially in resource poor countries suffering from high burdens of both TB and human immunodeficiency virus (HIV). One of the greatest threats to global TB control is the growing prevalence of drug-resistant bacilli. Correctly diagnosing drug-resistant TB patients is more problematic in resource-limited settings as there is no or limited infrastructure for drug susceptibility testing (DST) of TB bacilli. The conventional phenotypic DST method for TB takes weeks before declaring the results and initiating proper anti-TB treatment. The evolution of molecular diagnostic methods has revolutionized the TB diagnostics. These methods are accurate, rapid, easy to perform, and can solve controversial issues related to TB diagnosis as well as drug susceptibility. It is important to link these rapid molecular techniques with the conventional methods to determine the impact of the disease.

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Tuberculosis (TB) is a notifiable infectious disease. Globally, 20% patients of TB are contributed by India. The World Health Organization (WHO) and the Revised National Tuberculosis Control Program (RNTCP) formulates guidelines for management of TB. There have been advances in various aspects of TB. This review enumerates the progress aiming the therapeutic aspects for TB. The WHO revised definitions in TB in 2013. With the availability of rapid diagnostics and WHO goal of universal access to the same; the diagnostic approach was modified. The RNTCP shifted therapy administration for drug sensitive TB (DS-TB) from thrice weekly to daily regimen in 2017. The WHO updated the drug resistant TB (DR-TB) guidelines in 2016. Bedaquiline and delamanid got enlisted as add-on drugs in the revised classification. In the end, we discuss various pipelines in development of TB.

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Over half million cases of multidrug-resistant (MDR) tuberculosis (TB) occur every year globally, and a significant number of them are affected by extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis. There is limited access to reliable diagnostic facilities to drug-resistant (DR) TB in most developing countries. The treatment of MDR/XDR-TB is unfortunately very expensive, long, and toxic and the success rate is largely unsatisfactory (<50% among MDR-TB and <20% among cases with resistance patterns beyond XDR).The aim of this review is to summarize the available evidence-based updated international recommendations to diagnostic methods and treatment of MDR/XDR-TB, and briefly discuss the shorter MDR-TB regimen and the role of newly developed drugs as well as repurposed drugs. This review will help the reader to formulate treatment regimen for DR-TB patients based on currently available newer rapid diagnostic tests.

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Tuberculosis (TB), true to its description as the “Captain of the men of death,” is now an uncontrolled epidemic of global proportions. Inherent to controlling this looming threat, is a high-end diagnostic and therapeutic approach, with conventional tools, and out of the box approaches. The diagnostic approach to TB has seen accelerated development in an attempt to tackle the epidemic of resistance. On the therapeutic front, progress is slow, and beyond chemotherapy and occasional surgery, hardly any therapeutic approaches to TB have been described. With the advent of newer bronchoscopic techniques such as endobronchial ultrasound (EBUS) and therapeutic bronchoscopy, a host of new options are available to the physician, both in the diagnostic and therapeutic arena. This review focuses on bronchoscopic diagnostic and therapeutic methods in TB and its sequelae. We highlight both the established and cutting edge role of bronchoscopy in the management of specific aspects of TB. In addition, this discussion incorporates the introduction of innovative therapeutic modalities in the disease, and is an overview into the growing role of pulmonary procedures in all aspects of TB.

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Tuberculosis (TB) remains a major cause of mortality worldwide. Effective control of TB is being hampered by the prolonged duration of therapy which leads to poor patient compliance. This can lead to increased relapse rates and emergence of drug-resistant organisms, thus further compounding the problem. An exciting new avenue to reduce the duration of therapy is the use of high-dose rifampicin. High-dose rifampicin is being extensively studied and the data is exciting. It has shown to result in better sterilization and earlier culture conversion with no increase in adverse reactions. These effects of high-dose rifampicin can possibly help reduce the duration of TB treatment. Whether this “high-dose-reduced-duration-rifampicin-regimen” will lead to increased relapse rates is yet to be studied. If not, then this gives physicians a well proven and inexpensive option to cure TB and hence may be the future of TB treatment.

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