Delayed-type hypersensitivity and cell-mediated immunity in the pathogenesis of tuberculosis.

It is widely believed that cell-mediated immunity and the associated ability of macrophages to destroy or inhibit the bacillus are all that is required to control pulmonary tuberculosis. However, although cell-mediated immunity is a major host defense against the tubercle bacillus, it is fully effective only in one of the four stages of the disease. Here, Arthur Dannenberg describes the entire pathogenesis of tuberculosis, with illustrations from the rabbit model of M.B. Lurie. In addition, he documents that the delayed-type hypersensitivity reaction (producing tissue necrosis) greatly benefits the host by arresting the logarithmic growth of bacilli within immature macrophages.