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Case Report: Tuberculosis Autoregression after Minimal Treatment and Review of the Literature

Chelsea WalterSection of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts;

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Carlos Acuña-VillaordunaSection of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts;
Lemuel Shattuck Hospital, Department of Public Health, Boston, Massachusetts;

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Natasha S. HochbergSection of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts;
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts

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Pranay SinhaSection of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts;

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ABSTRACT.

Mycobacterium tuberculosis (Mtb) is a complex pathogen causing multiple possible disease states in its host including latency, active disease, and elimination. While there is reasonable indirect evidence of elimination of tuberculosis (TB) in the absence of treatment, direct reports of autoregression are rare. We report a case of smear-negative, polymerase chain reaction (PCR)-positive TB disease regression in the absence of therapy due to severe adverse effects from antimycobacterial drugs. Indirect reports of TB autoregression, or self-cure, in the literature are reviewed, and an updated framework for conceptualizing Mtb infection is discussed.

Author Notes

Address correspondence to Chelsea Walter, Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118. E-mail: waltercr7@gmail.com

Financial support: This work was supported by the National Institutes of Health (Grant no. 5T32AI052074-13 to PS); the Burroughs Wellcome/ASTMH Postdoctoral fellowship to PS; US Civilian Research and Development Foundation (Grant no. USB-31150-XX-13 to NSH); the National Science Foundation (cooperative agreement OISE-9531011 to NSH), with federal funds from the Government of India’s Department of Biotechnology, the Indian Council of Medical Research, the National Institutes of Health, the National Institute of Allergy and Infectious Diseases, and the Office of AIDS Research and distributed in part by CRDF Global; grant from the Warren Alpert Foundation and Boston University School of Medicine (to NSH); the Clinical and Translational Sciences Institute (Grant no. 1UL1TR001430 to NSH); and funding from Boston University Foundation India (to NSH). The funders had no role in study design, analysis, or reporting.

Authors’ addresses: Chelsea Walter and Pranay Sinha, Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, E-mails: waltercr7@gmail.com and pranay.sinha@bmc.org. Carlos Acuña-Villaorduna, Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, and Lemuel Shattuck Hospital, Department of Public Health, Boston, MA, E-mail: carlos.acuna-villaorduna@bmc.org. Natasha S. Hochberg, Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, and Department of Epidemiology, Boston University School of Public Health, Boston, MA, E-mail: nhoch@bu.edu.

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