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For the chapter in the Wells Handbook, please go to Chapter 49. Tuberculosis.



  • image Tuberculosis (TB) is the most prevalent communicable infectious disease on earth; and 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 In the United States, TB disproportionately affects the foreign born and other ethnic minorities, reflecting immigration patterns and greater ongoing transmission in these communities. Additional TB surveillance and preventive treatments are required within these communities.

  • image TB is the leading cause of death in human immunodeficiency virus (HIV) infection worldwide. Coinfection with HIV and TB accelerates the progression of both diseases, thus requiring rapid diagnosis and treatment of both diseases.

  • image 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 TB can produce atypical signs and symptoms in infants, the elderly, and immunocompromised hosts, and it can progress rapidly in these patients.

  • image Latent TB infection (LTBI) can lead to reactivation disease years after the primary infection occurred.

  • image 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 Isoniazid and rifampin are the two most important drugs in the treatment of TB. Organisms resistant to both these drugs (multidrug-resistant TB [MDR-TB]) are much more difficult to treat.

  • image Directly observed treatment (DOT) should be used whenever possible to reduce treatment failures and the selection of drug-resistant isolates.

  • image To avoid the development of resistance, never add a single drug to a failing TB treatment regimen.

image 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 and—one third of the world’s population currently is infected.1 Given increasing drug resistance, it is critical that a major effort be made to control TB before the most potent drugs are no longer effective.

TB rates generally have risen with increasing urbanization and overcrowding because it is easier for an airborne disease to spread when people are living in closer proximity to each other. Hence, TB became a significant pathogen in Europe during the Middle Ages and peaked during the Industrial Revolution, when it caused significant mortality in Europe and in the United States.1 This dire threat led to the rise of public health departments and to procedures such as the isolation ...

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