Potential limitations of community-wide strategy to treat Mycobacterium tuberculosis infection

A quarter of the world's population has immunologic evidence of past or present Mycobacterium tuberculosis (Mtb) infection (MTBI) detected as TST or IGRA positivity. Community-based preventive treatment of individuals with MTBI has resulted in transient decreases in TB cases, but its long-term effectiveness has been controversial. Due to the likelihood that many of those with immune responses to Mtb antigens may no longer harbor Mtb, widespread treatment of all such individuals may result in unnecessary exposure to antibiotics. We raise an additional concern that preventive treatment of individuals with MTBI, who are not at the risk of disease progression, may result in loss of protective im