TUBERCULOSIS IN THE 1990S

Purpose: To summarize major recent developments in tuberculosis and current approaches to its treatment and prevention. Data Identification: Articles published since 1987 that addressed important issues in tuberculosis were identified by searching the MEDLINE database and bibliographies of relevant articles. Study Selection: One hundred one references were selected that were judged by the authors to contain information most relevant to practicing internists. Results: Recent increases in tuberculosis morbidity in the United States are concentrated in racial and ethnic minorities, the foreign-born, and persons with human immunodeficiency virus infection. Amplification of Mycobacterium tuberculosis DNA by polymerase chain reaction allows rapid diagnosis of tuberculosis, and ''DNA fingerprinting'' of individual M. tuberculosis strains allows delineation of patterns of tuberculosis transmission. These techniques are available in research laboratories and are promising clinical tools for the future. Treatment regimens for drug-susceptible tuberculosis yield cure rates of more than 95%. Failure to ensure compliance with antituberculosis medications has resulted in an increasing prevalence of multiple-drug-resistant tuberculosis that responds poorly to therapy. Guidelines for isoniazid chemoprophylaxis have been modified in the past 5 years and are summarized. Conclusion: Control of tuberculosis in the United States will require improved implementation of established techniques to diagnose, treat, and prevent tuberculosis, with renewed emphasis on ensuring compliance with therapy.