TUBERCULOSIS SYMPOSIUM - EMERGING PROBLEMS AND PROMISE

Between 1985 and 1991, 39,000 cases of tuberculosis occurred in excess of those expected based on previous trends. Immigration from high-pre valence countries, coinfection with human immunodeficiency virus (HIV) , and outbreaks in congregative facilities are most responsible for th e increase. Coincident with the increase in tuberculosis, outbreaks of multidrug resistant (MDR) tuberculosis have occurred. Clinical and ep idemiologic data support nosocomial transmission. MDR tuberculosis occ urred late in the course of HIV infection and was refractory to treatm ent. Compounding the problems of rising incidence and increasing resis tance was the sudden recognition of shortages of antituberculous drugs . The problems currently posed by tuberculosis require new approaches to diagnosis and rapid sensitivity testing as well as assuring an adeq uate supply of licensed drugs and development of new drugs. A number o f steps have been taken by governmental agencies to assure that the ch allenge is met.