Mycobacterium tuberculosis infections

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Abstract
Ninety-five percent of the new cases of tuberculosis are observed in developing countries, where the disease is frequently associated with human immunodeficiency virus (HIV) infection. After a century of decline in the United States, tuberculosis is increasing, predominantly among ethnic minorities, immigrants, homeless persons, and HIV-infected patients. Many outbreaks of nosocomially acquired, multi-drug-resistant tuberculosis have been reported recently. In each outbreak, over 80% of cases have occurred in HIV-infected patients. Horizontal transmission was demonstrated by analysis of the cultured organisms by restriction fragment length polymorphism. In addition, health care workers have been infected in some outbreaks. A strict adhesion to Centers for Disease Control guidelines represents, at the present time, the only means of attempting to reduce nosocomial transmission of the disease. Improved methods for rapid diagnosis of tuberculosis are needed. The polymerase chain reaction offers the possibility of rapid and sensitive detection of mycobacterial infection, but further effort is required to simplify laboratory procedures and to reduce the risk of sample contamination. In developed countries, the prognosis of tuberculosis does not seem to be altered by coinfection with HIV, except in cases due to multidrug-resistant isolates. In the third world, a higher overall failure rate has been reported in HIV-infected patients, suggesting the necessity for a more bactericidal treatment including rifampin in these countries.

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