TUBERCULOSIS IN THE 1990S

Purpose: To summarize major recent developments in tuberculosis and cu rrent approaches to its treatment and prevention. Data Identification: Articles published since 1987 that addressed important issues in tube rculosis were identified by searching the MEDLINE database and bibliog raphies of relevant articles. Study Selection: One hundred one referen ces were selected that were judged by the authors to contain informati on most relevant to practicing internists. Results: Recent increases i n tuberculosis morbidity in the United States are concentrated in raci al and ethnic minorities, the foreign-born, and persons with human imm unodeficiency virus infection. Amplification of Mycobacterium tubercul osis DNA by polymerase chain reaction allows rapid diagnosis of tuberc ulosis, and ''DNA fingerprinting'' of individual M. tuberculosis strai ns allows delineation of patterns of tuberculosis transmission. These techniques are available in research laboratories and are promising cl inical tools for the future. Treatment regimens for drug-susceptible t uberculosis yield cure rates of more than 95%. Failure to ensure compl iance with antituberculosis medications has resulted in an increasing prevalence of multiple-drug-resistant tuberculosis that responds poorl y to therapy. Guidelines for isoniazid chemoprophylaxis have been modi fied in the past 5 years and are summarized. Conclusion: Control of tu berculosis in the United States will require improved implementation o f established techniques to diagnose, treat, and prevent tuberculosis, with renewed emphasis on ensuring compliance with therapy.