TUBERCULOSIS IN THE 1990S

The steady decline in tuberculosis case rate reversed in the mid-1980s , and tuberculosis cases have increased dramatically since that time. Important factors contributing to this increase are the human immunode ficiency virus (HIV) epidemic and tuberculosis occurring in foreign-bo rn persons. Tuberculosis outbreaks have occurred in HIV clinics and wa rds, prisons, homeless shelters, nursing homes, and health care facili ties. Some of the outbreaks have involved strains of tuberculosis resi stant to multiple antituberculosis drugs. Recent recommendations for i nitial therapy of tuberculosis include the use of four drugs and direc tly observed therapy in an effort to prevent the emergence of further drug resistance.