The return of tuberculosis

At the end of the 20th century, tuberculosis remains a major public health issue. In developing countries tuberculosis is a lending cause of morbidity and mortality, and the spread of the HIV epidemic contributes significantl y to the worsening of the situation. Coinfection with tuberculosis and HIV results in special diagnostic and therapeutic problems and uses up larger a mounts of medical resources in developing countries. Outbreaks of multidrug resistant tuberculosis (MDX-TB) were first reported from US-American cente rs caring for HIV patients, but have now been observed in many other countr ies. In Western Europe the tuberculosis epidemic is under control, but incr easing incidence rates in migrants raise new problems in these countries. T uberculosis is uncontrolled in large parts of the former Soviet Union due t o the socio-economic break-down in these countries. Only rigorous infection control measures on a world-wide scale will prevent further detoriation of this situation. Therefore, the extension of surveillance systems, and suff icient funding for the prevention, diagnosis, and treatment of tuberculosis by national governments and international organizations are all urgently n eeded. (C) 1999 Elsevier Science Inc.