PERSISTERS AND CHEMOTHERAPY IN TUBERCULOUS INFECTION

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  • KANAI Koomi
    From the First Department of Bacteriology and Department of Tuberculosis, National Institute of Health

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  • 結核感染におけるpersisters (持続生残菌) と化学療法
  • ケッカク カンセン ニ オケル persisters ジゾク セイザンキン ト

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Abstract

In the chronic stage of tuberculous infection, the bacilli reside in host tissue keeping analmost constant level of viable counts for a long period of time. This interpreted to be due tothe static equlibrium between host and parasite, which means that resting (or dormant) tuberclebacilli survive in the lesions without appreciable multiplication.<BR>This physiological state of the bacilli make them insensitive to most of antituberculousdrugs, thus producing so-called “microbial persistence”. The literatures so far available suggestthat such persisters have the altered metabolic pattern and sometimes even a morphologicalchange. They will take the glycolytic pathway rather than the oxidative ones to obtain energyin the tissue environment of low oxygen tension. The conversion to L-forms in the lesions isalso suggested as a particular morphology of persisters, by which they can escape from theattack of chemotherapy.<BR>It is a general rule that the bactericidal activity of chemotherapeutic agents works onlyagainst the bacilli in multiplication. In vitro and in vivo experiments show that this is alsothe case with SM, KM, and INH, but RFP is rather exceptional. RFP is active in killing theresting bacilli, though the degree of activity is a little lower than that against the multiplyingbacilli. In view of this fact, regimens containing RFP are recommended as an improved chemotherapy to eliminate persistent bacilli, or to sterilize them.

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