ON THE DEVELOPMENT OF MYCOBACTERIAL INFECTIONS .1. A REVIEW CONCERNING THE COMMON SITUATION

In this review concerning the common situation of mycobacterial infect ions the following problems are discussed: (1) The worldwide epidemiol ogical situation of tuberculosis reveals an increase in the developing countries but even in some industrialized countries like the United S tates. The reasons for this development are mainly socioeconomic facto rs. (2) The association between tuberculosis and HIV infection has cau sed in general a marked increase in the incidence of tuberculosis in s ome countries. Because of its ability to destroy the immune system, HI V is a significant risk factor for the progression of tuberculosis inf ection as a clinical disease. Taking into account that 5 million perso ns worldwide are infected with tuberculosis as well as with HIV (most of them living in the Sub-Saharan Africa), enormous future problems ca n be anticipated. (3) The new fear of tuberculosis has resulted mainly from reports about outbreaks with multidrug resistant strains of Myco bacterium tuberculosis in the United States. These strains are at leas t resistant to the most important antituberculotic drugs isoniacid and rifampicin. The frequency of multidrug-resistant tuberculosis in the USA is reported to be overall 3-7%, however for New York 19% is estima ted. The main reason for this development is inadequate chemotherapy m ostly due to poor compliance. Therefore in the United States the direc tly observed therapy has been established. Complete and reliable repor ts of the resistance situation in other countries are not available be cause most of these have no resistance surveillance programs. (4) As i mmunocompromised patients become more numerous, the importance of nont uberculous mycobacteria has significantly increased. Mainly organisms of the Mycobacterium avium-intracellular complex play a special role a s opportunistic pathogens for AIDS