Purpose of reviewTuberculosis (TB) has been a most turbulent problem prevailing for the last several decades. The emergence of multidrug-resistant strains and the dearth of anti-TB drugs are threatening the future containment of TB. Nanotechnology presents an exciting opportunity for proper identification of mycobacterial strains and to improve the potential of drugs for the treatment of TB. Recent findingsNanoscience has provided humankind with several unique and comparatively more effective drug delivery carriers, encompassing liposomal-mediated drug delivery, solid lipid nanoparticles, polymeric nanoparticles, dendrimers, nanoemulsions, nanosuspensions and other nanosystems exploiting the extraordinary properties of matter at the nanoscale. Nanoparticle-based assays have shown significant improvements in diagnosis, treatment and prevention of TB. Nanoparticles as drug carriers enable higher stability and carrier capacity along with immense improvement of drug bioavailability which further leads to reduction in dosage frequency. SummaryThis review covers the prospect of using nanotechnology for the detection of mycobacterial strains and nanotechnology-based drug delivery systems for effective eradication of mycobacterial infections.

Purpose of reviewUsing the evidence published over the last 2 years, this review discusses the epidemiology, diagnosis, treatment and prevention of HIV-related pulmonary infections other than mycobacterial disease. Recent findingsLongstanding, vertically acquired and apparently stable HIV infection is associated with significant and symptomatic small airways disease in African adolescents. The use of population-based pneumococcal vaccination in children is changing the severity and serotypes associated with HIV-related pneumococcal disease. Data on the use of blood 1,3,β-d-glucan show it has promise as a rule-out test for Pneumocystis pneumonia (PCP). SummaryWith widespread antiretroviral medication usage, the pattern of HIV-associated pulmonary disease is changing. Whereas opportunistic infections such as PCP still occur in people not using antiretroviral therapy (ART), HIV-related infections are similar to those present in the general population. Chronic lung disease is more prevalent, leading to its own infectious complications. The use of specific immunizations against infections is important, though their precise benefit with concomitant widespread ART and population-based vaccination programmes in the non-HIV community is undetermined.

Purpose of reviewDespite reduction in incidence in several regions, tuberculosis (TB) remains a pandemic of world-wide significance. There is an urgent need to develop better regimens, to shorten treatment and to effectively manage both drug-sensitive and drug-resistant disease. Recent findingsThere has been a substantial increase in numbers of drugs in the development pipeline and two of the candidates are expected to receive widespread accelerated approval for the treatment of multidrug-resistant TB (MDR-TB). An important determining factor in the choice of regimens for phase III is the speed with which patients become culture negative during treatment, measured as either time to culture conversion or culture negativity at a given time point. It is impossible to consider the treatment of TB in sub-Saharan Africa without considering the patients who are coinfected with HIV, and the decision of when to commence treatment with antiretrovirals is critical. What, if any, is the role of adjunctive treatments such as vitamin D? SummaryIn this review, we describe the encouraging data on a number of drugs which are about to enter phase II or phase III trials, results from trials of standard regimens in close to programme conditions and a series of trials highlighting the importance of an early commencement of antiretroviral treatment.

Purpose of reviewAccording to the WHO, lower respiratory tract infections are one of the most prevalent causes of death in Africa. Estimates based on verbal autopsies are inaccurate compared with the gold standard for determining cause of death, the anatomical postmortem. Here, we review all respiratory postmortem data available from Africa and assess disease prevalence by HIV status in both adults and children. Recent findingsPulmonary and extrapulmonary tuberculosis was detected in over 50% of HIV-infected adults, four to five-fold more prevalent than in HIV-uninfected cases. Overall tuberculosis was less prevalent in children, but was more prevalent in HIV-uninfected compared with HIV-infected children. Bacterial pneumonia was more prevalent in children than adults and was relatively unaffected by HIV status. Pneumocystis jirovecci and human cytomegalovirus pneumonia were detected almost exclusively in HIV-infected mortalities, twice as prevalent in children as in adults. Coinfections were common and correlation with premortem clinical diagnoses was low. SummaryRespiratory tract infections are important causes of mortality in Africa. Of the 21 reviewed studies, only four studies (all adults) were undertaken in the last decade. There is hence an urgent need for new postmortem studies to monitor cause of death in new and emerging patient groups, such as those on antiretroviral therapy and HIV exposed uninfected children.