THE CHANGING FACE OF TUBERCULOSIS

Tuberculosis (TB) remains an important public health problem worldwide , resulting in an estimated 8 to 10 million new cases and 2 to 3 milli on deaths each year. Between 1953 and 1985, the number of TB cases in the US declined by an average of 6% per year. However, since 1985, TB has been increasing in the US. Approximately 64,000 additional cases o f the disease have been reported beyond the number expected had the ra te of decline observed from 1980 to 1984 continued from 1985 through 1 993. Increases in the number of TB cases have been significant in raci al and ethnic minorities, in persons born outside the US, and in child ren less than 15 years of age. Infection with the human immunodeficien cy virus (HIV) has also been recognized as a major risk factor for the development of active TB in persons with latent Mycobacterium tubercu losis infection. The unusual radiographic findings and the increased l ikelihood of extrapulmonary TB in HIV-infected persons make diagnosis of the disease problematic. Lastly, concomitant with the resurgence of TB has been the emergence of drug resistance. All of these factors ma ke successful control of TB in the US difficult.