Tuberculosis in the AIDS era

Abstract

A resurgence of tuberculosis has occurred in recent years in the United States and abroad. Deteriorating public health services, increasing numbers of immigrants from countries of endemicity, and coinfection with the human immunodeficiency virus (HIV) have contributed to the rise in the number of cases diagnosed in the United States. Outbreaks of resistant tuberculosis, which responds poorly to therapy, have occurred in hospitals and other settings, affecting patients and health care workers. This review covers the pathogenesis, epidemiology, clinical presentation, laboratory diagnosis, and treatment of Mycobacterium tuberculosis infection and disease. In addition, public health and hospital infection control strategies are detailed. Newer approaches to epidemiologic investigation, including use of restriction fragment length polymorphism analysis, are discussed. Detailed consideration of the interaction between HIV infection and tuberculosis is given. We also review the latest techniques in laboratory evaluation, including the radiometric culture system, DNA probes, and PCR. Current recommendations for therapy of tuberculosis, including multidrug-resistant tuberculosis, are given. Finally, the special problem of prophylaxis of persons exposed to multidrug-resistant tuberculosis is considered.

Recent transmission of tuberculosis involving retired patients

“…3,9,10 Knowledge about TB transmission dynamics has been greatly enhanced by the use of molecular strain typing techniques. In population-based studies, it is assumed that TB patients carrying a strain with a unique genotyping profile are considered to have reactivation TB and those patients with isolates sharing indistinguishable genotypic profiles are considered to belong to clusters, representing disease from a recently acquired infection.…”

Brain abscess due to Mycobacterium tuberculosis in a patient with AIDS: report of a case and review of the literature

“…1 Central nervous system (CNS) tuberculosis is a disseminated or extrapulmonary form of the disease in which Mycobacterium tuberculosis (MTB) migrate to the CNS and meninges by haematogenous spread, manifesting as three clinical and pathological forms: (a) meningoencephalitis (the most frequent); (b) intracranial tuberculomas and (c) cerebral abscesses. 2 Here a case of cerebral abscess due to MTB in a patient with AIDS is described along with a review of the literature.…”

Current issues in global tuberculosis control

“…90 Once infected with MTB, progressive deterioration of cellmediated immunity caused by HIV infection increases the risk of TB disease by a hundred-fold or more. 91,92 In 1999, the WHO estimated that 11.8 million people were living with HIV/MTB co-infection, the majority being in sub-Saharan Africa. Once active TB develops, MTB is a potent and virulent pathogen that spreads readily to others with HIV infection, even causing re-infection in those who have completed TB treatment.…”