Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis

摘要: Lack of access to human tissues with untreated tuberculosis (TB) has forced generations researchers use animal models and adopt a paradigm that granulomas are the characteristic lesion both primary post TB. An extended search studies lung failed find any reports support this paradigm. We found scores publications from gross pathology in 1804 through high resolution CT scans 2015 identify obstructive lobular pneumonia, not granulomas, as developing post-primary This paper reviews literature together other relevant observations formulate new TB three distinct stages: three-act play. First, TB, war attrition, begins infection spreads via lymphatics blood stream before inducing systemic immunity contains controls organisms within granulomas. Second, sneak attack, develops during latent an asymptomatic pneumonia persons effective immunity. It is paucibacillary process no bronchi accumulates mycobacterial antigens host lipids for 1-2 years suddenly undergoing caseous necrosis. Third, fallout, responsible nearly all clinical disease. necrotic either retained become focus fibrocaseous disease or coughed out leave cavity. three-stage suggests testable hypotheses plausible answers long standing questions