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TB is an ancient disease, however, it is still a major health problem in the world (Centers for Disease Control and Prevention, 2006). The number of new cases of TB worldwide roughly correlates with economic conditions: the highest incidences are seen in those countries with the lowest gross national products (countries mainly in Africa, Asia, and Latin America). WHO numbers indicate that 8 million people are newly infected and nearly 2 million people die of TB every year; translating to one person infected every 4 seconds and one person dying every 18 seconds (WHO, 2007). WHO estimates that by year 2020 up to 36 million people will die of TB every year (WHO, 2010). The current TB burden in the world is strictly associated to Mycobacterium tuberculosis (M.tb) co-infection with HIV, and the recent emergence of practically untreatable extensive-, extremely-, and totally-drug resistant M.tb strains (XDR-, XXDR-, and TDR-) in endemic areas. In this context, a person infected with a XDR/XXDR M.tb strain currently has a survival rate between 36-50%, however, for people co-infected with HIV, their survival rate drops to ~15% with a life span of 16 days upon XDR/XXDR M.tb infection (Gandhi et al., 2006). XXDR-M.tb strains are resistant to all first and second line of drugs currently available, and TDR-M.tb strains are even resistant to the new developed drugs currently in clinical trials (Andrews et al., 2010;Basu et al., 2009; Gandhi et al., 2006, 2010). Very little is known about the cell wall composition of XDR/XXDR/TDR M.tb strains. The presence of phenolic glycolipids and triglycerides in the M.tb cell wall has been directly related to the hypervirulence observed in some strains (Reed et al., 2004, 2007). However, in the case of XDR/XXDR/TDR M.tb strains, it still is unknown which bacterial and host factors are involved in the induction of the overwhelming host immune response generated by these strains.

Broadening Our View About the Role of Mycobacterium tuberculosis Cell Envelope Components During Infection: A Battle for Survival