TUBERCULOSIS IN THE AIDS ERA

A resurgence of tuberculosis has occurred in recent years in the Unite d States and abroad. Deteriorating public health services increasing n umbers of immigrants from countries of endemicity, and coinfection wit h the human immunodeficiency virus (HIV) have contributed to the rise in the number of cases diagnosed in the United States. Outbreaks of re sistant tuberculosis, which responds poorly to therapy, have occurred in hospitals and other settings, affecting patients and health care wo rkers. This review covers the pathogenesis epidemiology, clinical pres entation, laboratory diagnosis and treatment of Mycobacterium tubercul osis infection and disease. In addition, public health and hospital in fection control strategies are detailed Newer approaches to epidemiolo gic investigation including use of restriction fragment length polymor phism analysis, are discussed. Detailed consideration of the interacti on between HIV infection and tuberculosis is given. We also review the latest techniques in laboratory evaluation, including the radiometric culture system, DNA probes, and PCR. Current recommendations for ther apy of tuberculosis including multidrug-resistant tuberculosis, are gi ven. Finally, the special problem of prophylaxis of persons exposed to multidrug-resistant tuberculosis is considered.