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Tuberculosis in the 1990s

Peter F. Barnes, MD; and Susan A. Barrows, MD
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From the University of Southern California School of Medicine, Los Angeles, California. Requests for Reprints: Peter F. Barnes, MD, HMR 904, University of Southern California School of Medicine, 2025 Zonal Avenue, Los Angeles, CA 90033. Acknowledgments: The authors thank Drs. Robert Allison, Joseph Indenbaum, Emily Kahlstrom, Richard Lubman, and Jeffrey Starke for their critical review of the manuscript. They also thank Dr. Alan Bloch, Dr. Samuel Dooley, and Gloria Kelly for providing unpublished epidemiologic data. Grant Support: In part by grants AI27285 and AI31066 from the National Institutes of Health.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(5):400-410. doi:10.7326/0003-4819-119-5-199309010-00009
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Purpose: To summarize major recent developments in tuberculosis and current approaches to its treatment and prevention.

Data Identification: Articles published since 1987 that addressed important issues in tuberculosis were identified by searching the MEDLINE database and bibliographies of relevant articles.

Study Selection: One hundred one references were selected that were judged by the authors to contain information most relevant to practicing internists.

Results: Recent increases in tuberculosis morbidity in the United States are concentrated in racial and ethnic minorities, the foreign-born, and persons with human immunodeficiency virus infection. Amplification of Mycobacterium tuberculosis DNA by polymerase chain reaction allows rapid diagnosis of tuberculosis, and DNA fingerprinting of individual M. tuberculosis strains allows delineation of patterns of tuberculosis transmission. These techniques are available in research laboratories and are promising clinical tools for the future. Treatment regimens for drug-susceptible tuberculosis yield cure rates of more than 95%. Failure to ensure compliance with antituberculosis medications has resulted in an increasing prevalence of multidrug-resistant tuberculosis that responds poorly to therapy. Guidelines for isoniazid chemoprophylaxis have been modified in the past 5 years and are summarized.

Conclusion: Control of tuberculosis in the United States will require improved implementation of established techniques to diagnose, treat, and prevent tuberculosis, with renewed emphasis on ensuring compliance with therapy.




Grahic Jump Location
Figure 1.
Production of DNA fragments by cleavage of Mycobacterium tuberculosis DNA using BamHI.M. tuberculosis

IS6110 and adjoining DNA sequences of two hypothetical strains of are shown. The BamHI site of flanking DNA in strain A is closer to the end of IS6110 than is the corresponding site in strain B. Digestion of chromosomal DNA with BamHI, followed by hybridization with a radiolabeled DNA probe yields a 550-base pair fragment for strain A and an 850-base-pair fragment for strain B.

Grahic Jump Location




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