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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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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 ...