UNTITLED

Tuberculosis has been a disease of human beings for thousands of years . In recent times it has waxed to become the feared White Plague of th e eighteenth and nineteenth centuries and waned under the impact of ef fective chemotherapy until its elimination seemed possible by the earl y twenty-first century. The resurgence of tuberculosis in the past 10 to 15 years, caused by unanticipated events such as the appearance of the human immunodeficiency virus and deteriorating social conditions, also brought with it the problem of multiple drug resistance. Control measures such as tuberculin skin testing, perhaps somewhat forgotten w hen tuberculosis seemed to be a disease of the past, again became firs t-line defenses against spread of the disease. Environmental controls must be well understood and used effectively. Diagnosis of tuberculosi s requires knowledge of the strengths and shortcomings of the various diagnostic methods and experience in their use. Practitioners are caut ioned to remember that no diagnostic method, by itself, can be relied on to confirm or rule out tuberculosis. Well-tested diagnostic methods of chest radiograph, tuberculin skin testing, smear, and culture have been recently supplemented by rapid diagnostic tests based on amplifi cation of bacterial RNA and DNA. More invasive diagnostic methods are sometimes required to diagnose extrapulmonary disease. Two-drug up to seven-drug therapy may be indicated for a case of tuberculosis, depend ing on evidence of the presence of multiple drug resistance. Duration of treatment can range from 6 to 12 months, also depending on identifi cation of drug-sensitive or drug-resistant organisms. Failure of compl iance can be a significant problem in patients who are homeless, or dr ug abusers, or who for various reasons cannot or will not complete a c ourse of therapy. Directly observed therapy is strongly recommended fo r these patients, and for assistance in its administration the physici an must cooperate with the local or state health department. The healt h department also must be notified whenever a case of tuberculosis is identified.