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This chapter reflects current recommendations from the American Thoracic Society/Centers for Disease Control (CDC)/Infectious Disease Society of America on the treatment of tuberculosis; diagnostic standards and classification of tuberculosis in adults and children; targeted tuberculin skin testing; treatment of latent tuberculosis infection (LTBI); and prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus (HIV). It also includes the most recently published data addressing the diagnosis and treatment of tuberculosis, plus the authors’ three decades of experience.

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Tuberculosis (TB) remains a leading infectious killer globally. TB is caused by Mycobacterium tuberculosis, which can produce either a silent, latent infection, or a progressive active disease.1 If left untreated, or improperly treated, TB causes progressive tissue destruction and eventually death. TB remains out of control in many developing countries. One-third of the world’s population currently is infected, and drug resistance is increasing in many areas.1

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Approximately, 2 billion people are infected by M. tuberculosisworldwide, and roughly 2 million to 3 million people die from active TB each year, despite the fact that it is curable.1–3 In the United States, about 13 million people are latently infected with M. tuberculosis, meaning that they are not currently sick, but they could fall ill with TB any time. The United States had over 14 000 new cases of active TB in 2005, and about 1500 deaths4 (for detailed data analysis visit the CDC website at http://www.cdc.gov/tb/).

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Risk Factors for Infection

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Location and Place of Birth

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California, Florida, Illinois, New York, and Texas accounted for over 50% of all TB cases in 2005.4 Within these states, TB is most prevalent in large urban areas.3 The percentage of foreign-born TB patients in the United States has increased annually since 1986, reaching 54% in 2005.4 Two-thirds of these patients came from Mexico, the Philippines, Vietnam, India, China, Haiti, and South Korea.4 Close contacts of pulmonary TB patients are most likely to become infected.2–3 These include family members, coworkers, or coresidents in places such as prisons, shelters, or nursing homes.

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Race, Ethnicity, Age, and Gender

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In the United States, in 2005, non-Hispanic blacks accounted for 27.9% of all TB cases, and Hispan-ics accounted for 28.4%.5 Asians and Pacific Islanders accounted for about 22%, while non-Hispanic whites accounted for only 21% of the new TB cases.5 TB is most common among people aged 25 to 44 years, followed by those aged 45 to 64 years (28%) and more than 65 years (21%).

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Coinfection with HIV

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HIV is the most important risk factor for active TB, especially among people aged 25 to 44 years.2,3,5,6 Roughly 10% of US TB patients are coinfected with HIV, while approximately 20% of TB patients aged 25 ...

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