This review explores the potential of bacteriophage therapy as an emerging strategy against mycobacterial infections, including Mycobacterium tuberculosis and non-tuberculous mycobacteria. Conventional treatments for these pathogens are prolonged, poorly tolerated, and increasingly ineffective due to multidrug- and extensively drug-resistant strains, highlighting the urgent need for innovative alternatives. Bacteriophages, viruses that specifically infect and lyse bacteria, offer a targeted and adaptable alternative or adjunct to antibiotics. The review summarizes the biology of mycobacteriophages, methods for their isolation and formulation, and mechanisms of bacterial lysis. It also compiles preclinical and clinical evidence supporting their efficacy in reducing bacterial burden, enhancing antibiotic susceptibility and improving outcomes, particularly in refractory Mycobacterium abscessus infections. Despite promising advances, challenges such as phage resistance, host immune responses, and regulatory inconsistencies remain. Well-designed clinical trials and standardized production protocols are essential to translate this therapy into clinical practice.
Tuberculosis (TB) remains a global public health challenge. In countries with low annual incidence (≤ 10 cases/100,000 population), it mainly affects vulnerable populations with difficult access to care. In this context, passive case-finding systems may not be effective in detecting and treating all cases. Active case finding (ACF) strategies in these at-risk groups are essential to detect active or latent TB cases, improve treatment outcomes, and prevent transmission. This review addresses current ACF strategies in vulnerable populations, drawing on recent international guidelines. In addition, a focus on the situation in Barcelona is provided as an example of local implementation.
Drug-resistant tuberculosis (DR-TB) is associated with lengthy, poorly tolerated, and less effective treatment compared with drug-susceptible TB, as well as high rates of mental health disorders and socioeconomic vulnerability. The aim of this article is to describe the potential of a holistic treatment approach as a complementary strategy to the chemotherapy of DR-TB. At the specialized TB hospital Serveis Clínics in Barcelona, Spain, a multidisciplinary team has implemented a holistic, person-centered approach using comprehensive clinical and psychosocial assessments that address patients’ main needs, rather than focusing solely on airborne isolation and observed therapy, thereby improving adherence and outcomes. However, our experience may be difficult to extrapolate to other settings, where limited access to novel drugs, insufficient funding of national TB programs, and poor multisectoral coordination remain significant barriers. In conclusion, future clinical studies should evaluate the integration of malnutrition treatment, pulmonary rehabilitation, and psychological interventions within DR-TB care models.
A considerable proportion of tuberculosis (TB) cases are diagnosed without microbiological confirmation, particularly in early or paucibacillary disease. This review explores the diagnostic and therapeutic approach to non-microbiologically confirmed TB, integrating evidence from recent studies and international guidelines. Patients without microbiological confirmation often have milder symptoms and less extensive radiological findings, reflecting an early stage of disease with lower bacterial load and transmission risk. Radiological tools, mainly chest X-ray and computed tomography, remain essential but lack specificity, emphasizing the need for careful clinical correlation. Empiric anti-TB therapy should be initiated in cases with strong clinical and radiological evidence, followed by close monitoring to confirm response and exclude alternative diagnoses. Emerging technologies, including computer-aided radiological detection and blood-based biomarker assays, may improve diagnostic accuracy in smear-negative or immunocompromised patients. Early recognition and prompt treatment are crucial to reduce morbidity, mortality, and transmission, supporting global TB elimination goals.
Antimicrobial stewardship (AMS) aims to optimize antimicrobial use, improve outcomes, and limit resistance. Tuberculosis (TB), causing 10.8 million cases and 1.25 million deaths in 2023, contributes substantially to the global resistance burden but has rarely been integrated into AMS initiatives. This review evaluates how AMS principles apply to TB care. Key differences include long standardized combination regimens, predominance of outpatient management, and the central role of adherence, which limit conventional AMS approaches such as empiric therapy or treatment shortening. Diagnostic stewardship, rapid drug susceptibility testing, therapeutic drug monitoring, and outcome documentation are critical to prevent treatment failure and emerging resistance. We conclude that explicit integration of TB into national AMS strategies is essential to preserve the efficacy of existing and novel TB drugs and improve patient outcomes.
Idiopathic pulmonary fibrosis (IPF) is a rare disease characterized by chronic, fibrosing, progressive, and irreversible lung involvement of unknown etiology and poor prognosis. It is considered a complex disease resulting from the interaction between genetic susceptibility, cellular and molecular aging, and repeated environmental exposures. This review is part of a position paper on the diagnosis and treatment of IPF, developed by the clinical-radiological-pathological study group on diffuse interstitial lung diseases of the Catalan Society of Pulmonology. Based on published clinical evidence, it highlights key aspects of the diagnostic process: a systematic approach that includes invasive procedures (such as lung biopsy) in selected cases, the central role of multidisciplinary discussion, and the importance of genetic testing. Moreover, holistic therapeutic management of IPF is essential, combining antifibrotic therapy with supportive and non-pharmacological interventions such as supplementary oxygen, pulmonary rehabilitation, symptom control strategies, patient education, and palliative care.
Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease resulting from repeated inhalation of environmental antigens in genetically susceptible individuals. Its incidence and prevalence vary globally, influenced by geographic, occupational, and environmental factors. HP can present in non-fibrotic or fibrotic forms, the latter associated with a worse prognosis. Diagnosis involves a multidisciplinary approach, including clinical, radiological, serological, histopathological, and environmental data. Identification and elimination of the offending antigen are critical for management. Serological testing for specific immunoglobulin G, bronchoalveolar lavage lymphocytosis, and high-resolution computed tomography patterns are useful but have limitations. Specific inhalation challenge and lymphocyte proliferation tests are reserved for specialized centers. This article reviews current diagnostic strategies and discusses radiologic, bronchoscopy, and biopsy findings, emphasizing the role of antigen identification and classification into fibrotic or non-fibrotic forms to guide treatment and prognosis.
Pulmonary hypertension (PH) is one of the major comorbidities of interstitial lung diseases (ILD) and negatively impacts on patients’ symptoms and prognosis. PH-ILD diagnosis is made following a three-step strategy. In a first step, suspicion of PH-ILD should be raised if a combination of symptoms, signs, functional impairments, radiological features, and biomarkers is present. In a second step, patients in whom PH-ILD is suspected should undergo transthoracic echocardiography (TTE) for PH screening. In a third step, depending on TTE findings and clinical suspicion, right heart catheterization should be performed to diagnose or rule out PH. Once PH-ILD is diagnosed, a holistic approach is needed, considering optimization of the underlying ILD, assessment of comorbidities, pulmonary rehabilitation, oxygen supplementation, symptom control, evaluation for lung transplantation, and PH therapy. The decision about PH-targeted therapies should be made using a multimodal approach in a multidisciplinary PH-ILD committee.
Interstitial lung diseases (ILD) are a group of complex diseases characterized by inflammation and/or fibrosis of the lung interstitium. Idiopathic pulmonary fibrosis (IPF), the most common and aggressive form of ILD, has been at the central stage in genetic studies. To disentangle its genetic architecture and advance in developing precision medicine approaches for better care of patients, the studies have mostly relied on genome-wide association studies. Next-generation sequencing studies have also accelerated our understanding of IPF genetics, with approaches involving family studies and population-scale analyses. The emerging picture supports that IPF is governed by more than 30 genetic loci linked to telomere dysfunction, host defense, transforming growth factor-beta signaling, cell-cell adhesion, and mitotic spindle assembly, involving rare and common genetic variation, exerting non-additive effects in patient trajectories. In contrast, genetic research into non-IPF did not keep up the pace. However, a significant genetic overlap in terms of susceptibility and progression has been observed between IPF and other ILD subtypes. In this review, we summarize the main findings published in the literature and discuss their potential utility for diagnosis, risk stratification, and prognosis.
Community-acquired pneumonia (CAP) is a significant global health problem with a considerable clinical burden. It especially affects children under 5 years old, the elderly, people with multiple comorbidities, and the immunocompromised. Despite advances in the diagnosis and treatment of CAP, mortality rates remain high, particularly among patients who develop severe pneumonia with life-threatening complications. Notably, the long-term consequences of CAP include the worsening of pre-existing comorbidities, the development of new medical conditions, and a reduction in life expectancy, especially in older adults. Key factors that influence mortality include the initial severity of disease, the presence of prior comorbidities, and the status of the immune system. This review discusses current scientific evidence and emerging data on various aspects of CAP, including changes in its epidemiology, the role of viral causes, updated treatment approaches, the use of corticosteroids, and available preventive measures.
