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  • Image not available.Tuberculosis (TB) is the most prevalent communicable infectious disease on earth; it remains out of control in many developing nations. These nations require medical and financial assistance from developed nations in order to control the spread of TB globally.
  • Image not available. In the United States, TB disproportionately affects ethnic minorities as compared with whites, reflecting greater ongoing transmission in ethnic minority communities. Additional TB surveillance and preventive treatment are required within these communities.
  • Image not available. Coinfection with human immunodeficiency virus (HIV) and TB accelerates the progression of both diseases, thus requiring rapid diagnosis and treatment of both diseases.
  • Image not available. Mycobacteria are slow-growing organisms; in the laboratory, they require special stains, special growth media, and long periods of incubation to isolate and identify.
  • Image not available. TB can produce atypical signs and symptoms in infants, the elderly, and immunocompromised hosts, and it can progress rapidly in these patients.
  • Image not available. Latent TB infection (LTBI) can lead to reactivation disease years after the primary infection occurred.
  • Image not available. The patient suspected of having active TB disease must be isolated until the diagnosis is confirmed and the patient is no longer contagious. Often, isolation takes place in specialized “negative-pressure” hospital rooms to prevent the spread of TB.
  • Image not available.Isoniazid and rifampin are the two most important TB drugs; organisms resistant to both these drugs [multidrug-resistant TB (MDR-TB)] are much more difficult to treat.
  • Image not available. Never add a single drug to a failing TB treatment regimen!
  • Image not available. Directly observed treatment should be used whenever possible to reduce treatment failures and the selection of drug-resistant isolates.

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On completion of the chapter, the reader will be able to:

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  • 1. Compare the risk for active tuberculosis (TB) disease among patients based on their age, immune status, place of birth, and time since exposure to an active case.
  • 2. Design an appropriate therapeutic plan for an immunocompetent, immunocompromised, pregnant, and pediatric patient.
  • 3. Assess the effectiveness of therapy in TB patients.
  • 4. Cite the names of the drugs most likely to cause hepatotoxicity.
  • 5. Argue for and against bacillus Calmette-Guérin (BCG) in the prevention or eradication of tuberculosis.
  • 6. Select patients for whom therapeutic drug monitoring can be valuable.
  • 7. Design, evaluate, and assess appropriate regimens for the treatment of latent TB (formerly preventive therapy) in all patient populations.
  • 8. Debate the need for extended durations of treatment for patients with TB meningitis or TB osteomyelitis.
  • 9. Design a treatment plan for a TB patient who is receiving hemodialysis.

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Image not available.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 Left untreated or improperly treated, TB causes progressive tissue destruction and, eventually, death. Because of renewed public health efforts, TB rates in the United States continue to decline. In contrast, TB remains out of control in many developing countries—to the point that one-third of the world's population currently is infected.1...

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