The never-ending story of the fight against tuberculosis: from Koch’s bacillus to global control programs

Tuberculosis (TB) is one of the oldest diseases known to affect humanity, and is still a major public health problem. It is caused by the bacillus Mycobacterium tuberculosis (MT), which was first isolated in 1882 by Robert Koch. In 1882, Franz Zhiel and Fredrich Neelson stained MT with the acidalcohol-fast bacillus, a technique still used today. Until the 1950s, X rays were used as a cheap method of diagnostic screening together with the tuberculin skin sensitivity test. In the diagnosis and treatment of TB, an important role was also played by surgery, such as artificial intrapleural pneumothorax, though this approach often led to complications, such as empyema. The late 19th century saw the introduction of the tuberculosis sanatorium, which proved to be one of the first useful measures against TB. Subsequently, Albert Calmette and Camille Guérin used a non-virulent MT strain to produce a live attenuated vaccine. In the 1980s and 1990s, the incidence of tuberculosis surged as a major opportunistic infection in people with HIV infection and AIDS; for this reason, a combined strategy based on improving drug treatment, diagnostic instruments and prevention was needed in order to better control the disease, as recommended by the World Health Organization (WHO). Since the beginning of the 21st century, new prophylactic and therapeutic vaccines have been tested in order to better control the pulmonary form of TB