ReviewTuberculosis (Edinburgh, Scotland)2016
Tuberculosis as a three-act play: A new paradigm for the pathogenesis of pulmonary tuberculosis.
Review in Tuberculosis (Edinburgh, Scotland), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 98 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
98 citing papers in PubMed, 1 synthesis or guideline pooled it, 195 citations in OpenAlex.
- Computer vision applications for the detection or analysis of tuberculosis using digitised human lung tissue images - a systematic review.BMC medical imaging · 2024Pooled it
- Radiological and functional evidence of the bronchial spread of tuberculosis: an observational analysis.The Lancet. Microbe · 2021Trial
- Identification of a spatially organized TREM2-associated permissive macrophage niche in human pulmonary tuberculosis alveolar pneumonia.Nature communications · 2026Article
- Biofilm Associated Persistence and Drug Tolerance in Mycobacteria Within Host Microenvironments.APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2026Review
- Biodetection of Mycobacterium tuberculosis: nano-biosensors in detection; from principles to recent progresses.Journal of biological engineering · 2026Review
- A co-evolutionary perspective on humans andeLife · 2026Review
- Protein-Mediated Virulence in Mycobacterium tuberculosis.Advances in experimental medicine and biology · 2026Review
- Article
- T cell-macrophage interactions in tuberculosis: What we've got here is failure to communicate.Journal of internal medicine · 2026Review
- Contribution of Proteins to Membrane and Cell Wall Structures in Mycobacterium tuberculosis.Advances in experimental medicine and biology · 2026Review
- Finding and filling the knowledge gaps in mechanisms of T cell-mediated TB immunity to inform vaccine design.Nature reviews. Immunology · 2025Review
- Early and opposing neutrophil and CD4 T cell responses shape pulmonary tuberculosis pathology.The Journal of experimental medicine · 2025Article
- The Intricate Process of Calcification in Granuloma Formation and the Complications FollowingBiomolecules · 2025Review
- A Case Report and Literature Review of Prostatic Tuberculosis Masquerading as Prostate Cancer: A Diagnostic Challenge in a Tuberculosis-Endemic Region.Tropical medicine and infectious disease · 2025Review
- Diagnostic accuracy study of STANDARD TB-Feron FIA and STANDARD TB-Feron ELISA tests for tuberculosis infection diagnosis in Eastern European setting.Journal of clinical tuberculosis and other mycobacterial diseases · 2025Article
- Tissue-wide profiling of human lungs reveals spatial sequestration of macrophages in tuberculosis.bioRxiv : the preprint server for biology · 2025Article
- Chronic Cavitary Pulmonary Histoplasmosis-Novel Concepts Regarding Pathogenesis.Journal of fungi (Basel, Switzerland) · 2025Article
- Characterization of Early Lesions of Human Post-Primary Tuberculosis and Its Progression to Necrosis Using Archival Material of the Pre-Antibiotic Era.Pathogens (Basel, Switzerland) · 2025Article
- Pathogenesis of Post-Tuberculosis Lung Disease: Defining Knowledge Gaps and Research Priorities at the Second International Post-Tuberculosis Symposium.American journal of respiratory and critical care medicine · 2024Review
- The effect of Mycobacterium tuberculosis treatment on thrombelastography-assessed haemostasis: a prospective cohort study.Thrombosis journal · 2024Article
38 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
Abstract
Lack of access to human tissues with untreated tuberculosis (TB) has forced generations of researchers to use animal models and to adopt a paradigm that granulomas are the characteristic lesion of both primary and post primary TB. An extended search of studies of human lung tissues failed to find any reports that support this paradigm. We found scores of publications from gross pathology in 1804 through high resolution CT scans in 2015 that identify obstructive lobular pneumonia, not granulomas, as the characteristic lesion of developing post-primary TB. This paper reviews this literature together with other relevant observations to formulate a new paradigm of TB with three distinct stages: a three-act play. First, primary TB, a war of attrition, begins with infection that spreads via lymphatics and blood stream before inducing systemic immunity that contains and controls the organisms within granulomas. Second, post-primary TB, a sneak attack, develops during latent TB as an asymptomatic obstructive lobular pneumonia in persons with effective systemic immunity. It is a paucibacillary process with no granulomas that spreads via bronchi and accumulates mycobacterial antigens and host lipids for 1-2 years before suddenly undergoing caseous necrosis. Third, the fallout, is responsible for nearly all clinical post primary disease. It begins with caseous necrotic pneumonia that is either retained to become the focus of fibrocaseous disease or is coughed out to leave a cavity. This three-stage paradigm suggests testable hypotheses and plausible answers to long standing questions of immunity to TB.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.