This is the first report of a continuing survey of tuberculosis primary drug resistance conducted by the Center for Disease Control (CDC) in cooperation with 16 public health laboratories located t...

After an outbreak of hepatitis in Washington, D.C. in 1970 among a group of persons taking isoniazid to prevent tuberculosis, an isoniazid surveillance study was conducted among 13,838 persons in 21 participating health departments. Age appeared to be the predominant factor influencing the risk of developing isoniazid-related hepatitis, i.e., increasing age was associated with an increasing risk. Drinking alcohol, especially on a daily basis, also seemed to enhance the risk of hepatitis among persons concurrently taking isoniazid. In general, case rates among males and females of the same race, and rates among different races, were not markedly different; however, there were striking differences in the case rates among males of different races. The incidence of hepatitis varied greatly among the 21 cities, but was not unique to any geographic region, nor was it related to a specific manufacturer of isoniazid. The onset, in most cases, occurred within the first few months of treatment. Eight fatalities wer...

Three hundred ninety-eight tuberculosis patients with tubercle bacilli resistant to isoniazid and/or streptomycin were matched by age, race, sex, and geographic area to an equal number of patients with tubercle bacilli susceptible to 9 drugs, including isoniazid and streptomycin, in an effort to determine whether the risk of infection and disease among contacts of patients with resistant bacilli is different from the risk among contacts to patients with susceptible bacilli. The risk of infection among contacts of previously untreated patients was not significantly different, regardless of whether the bacilli were drug-resistant or susceptible. However, the risk of infection increased if the index patient with resistant bacilli had been previously treated. We found no evidence of a lower risk of infection among contacts exposed to bacilli resistant to the highest concentration of isoniazid tested or among contacts exposed to bacilli resistant to both isoniazid and streptomycin. There was a strong association between infection risk among contacts and the age of the index case; younger patients were more infectious. Index cases tended to infect most (or all) or few (or none) of their contacts. The investigation of contacts of patients excreting drug-resistant bacilli should be given high priority.

"Delayed Tuberculin Boosting in the Older Population." American Review of Respiratory Disease, 134(5), pp. 857–858

This chapter reviews the current epidemiology of tuberculosis (TB) in the world. Although the authors concentrate on the number of new cases of deaths from this disease, they also aim at presenting the exact numbers of new cases of TB and deaths from TB that occur each year. The ability of the tuberculin skin test to detect the presence of Mycobacterium tuberculosis infection can be used to measure the prevalence of infection. The annual risk of infection is the probability that any individual will be infected with M. tuberculosis in 1 year. It is estimated that about 1,700 million people are infected with M. tuberculosis. Primary resistance is defined as the presence of drug resistance to at least one anti-TB drug in a TB patient who has never received prior treatment. Without recognition of the TB crisis confronting the world and prompt, effective action, the TB epidemic can be expected to worsen for several reasons. First, demographic forces are at work. Children born in past decades in regions with high population growth rates are now reaching the ages at which morbidity and mortality for TB are high. Second, famine, war, and natural disasters that create large populations of displaced, malnourished people in crowded living conditions may cause increases in TB case rates. Third, age-specific TB incidence rates can be expected to rise in those areas of the world where immunity of the population is seriously challenged by HIV infection.

Disclaimer: The interpretations and views expressed in this article are those of the authors and are not the official positions of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

In 2000, of approximately 32 million persons who received health insurance coverage through Medicaid programs, an estimated 11.5 million (36%) smoked. One of the national health objectives for 2010 is to provide coverage by Medicaid in the 50 states and the District of Columbia (DC) for nicotine-dependence treatment. The Guide to Community Preventive Services recommends reducing the cost of tobacco-dependence treatments to increase the number of smokers who successfully quit smoking. The 2000 Public Health Service (PHS) Clinical Practice Guideline also supports expanded insurance coverage for tobacco-dependence treatments. The amount and type of coverage for tobacco-dependence treatment offered by Medicaid has been reported previously for 1998, 2000, and 2001. In 2002, all states and DC were surveyed again about the amount and type of coverage they provided. This report summarizes the results of the survey, which indicate that as of December 31, 2002, 1) 36 Medicaid programs covered some tobacco-dependence counseling or medication for all Medicaid recipients, 2) four states offered coverage only for pregnant women, 3) two states offered coverage for all pharmacotherapy and counseling treatments recommended by the 2000 PHS guideline, and 4) seven states covered all recommended medications and at least one form of counseling. To improve the health of populations with disproportionately high rates of smoking, the 50 states and DC should provide coverage under Medicaid for all recommended tobacco-dependence treatments.

This statement provides new recommendations for targeted tuberculin testing and treatment regimens for persons with latent tuberculosis infection (LTBI) and updates previously published guidelines (1, 2). This statement is issued in recognition of the importance of these activities as an essential component of the TB Elimination Strategy promoted by the U.S. Public Health Service Advisory Council on the Elimination of Tuberculosis, and reports the deliberations of expert consultants convened by the American-Thoracic Society (ATS) and Centers for Disease Control and Prevention (CDC).Isoniazid for 6-12 mo has been the mainstay of treatment for LTBI in the United States for more than 30 yr. However, the application of isoniazid for LTBI has been limited because of poor adherence, due to the relatively long duration of treatment required, and because of concerns about toxicity. Therefore, there has been interest in the development of shorter, rifampin-based regimens as alternatives to isoniazid for the treatment of LTBI, During the past decade, a series of studies of "short-course" treatment of LTBI in persons with human immunodeficiency virus (HIV) infection has been undertaken. The results of these trials have recently become available, and the in-depth analyses of these and prior studies of isoniazid form the scientific basis of the treatment guidelines presented in this report. In addition, many changes to previous recommendations regarding testing for and treatment of LTBI are presented (Table 1).

In this issue of the Journal, Pablos-Méndez et al., on behalf of the World Health Organization–International Union against Tuberculosis and Lung Diseases Working Group on Anti-Tuberculosis Drug Resistance Surveillance, report data on drug resistance in 35 countries or regions.1 Among patients with no history of prior treatment, a median of 9.9 percent (range, 2 to 41 percent) of Mycobacterium tuberculosis strains were resistant to at least one drug. Among patients with histories of prior treatment for more than one month, the prevalence of resistance to any drug ranged from 5.3 to 100 percent, and the prevalence of multidrug resistance (defined . . .

To examine intensive care unit (ICU) admission rates and diagnoses of patients with HIV infection, and to determine the outcomes of different critical illnesses, we analyzed data derived from the 63 patients who were admitted to an ICU from among the 1,130 adults with HIV infection who did not have AIDS at the time of enrollment in a multicenter prospective study. Patients were admitted and treated according to the judgment of their physicians. During 4,298 patient-years of follow-up for the entire cohort, there were 1,320 hospital admissions, of which 68 (5%) included admission to an ICU. Twenty-five (40%) of the patients admitted to the ICU died during that admission. Twenty-four patients (38%) were admitted with a principal diagnosis of lung disease; 11 had Pneumocystis carinii pneumonia (PCP), one of whom was coinfected with Aspergillus fumigatus and Legionella pneumophilia, and six of them (55%) died. Four had bacterial pneumonia, two had pulmonary edema caused by renal failure, and one each had pulmonary tuberculosis, pulmonary Kaposi's sarcoma, pneumothorax, adult respiratory distress syndrome, severe pulmonary fibrosis, cytomegalovirus pneumonitis, and metastatic adenocarcinoma to the lungs. Eleven of these 14 patients (79%) died. Thirty-nine patients had 44 admissions for nonpulmonary diagnoses, including gastrointestinal disorders (14 admissions), cardiovascular disorders (nine), sepsis syndrome (six), neurologic disorders (four), monitoring and ICU nursing care during or after a procedure (four), metabolic disorders (three), trauma (two), drug overdose (one), and unknown reasons (one). Nine (23%) of these patients died. Twenty-eight patients underwent mechanical ventilation, and 16 (57%) died. Seven (25%) had PCP (five died), seven had other primary pulmonary diseases (six died), and 14 were placed on mechanical ventilation for nonpulmonary disorders (five died). Survival did not correlate with CD4 count determined within 6 mo of admission to the ICU. In conclusion, the range of indications for critical care in patients with HIV infection is diverse. PCP accounted for only 16% of the ICU admissions, and mechanical ventilation for PCP and other pulmonary disorders was associated with a high mortality rate. In contrast, mechanical ventilation for nonpulmonary disorders, and admission to the ICU for nonpulmonary diagnoses was associated with a more favorable outcome.

Statistics in MedicineVolume 15, Issue 17 p. 1835-1836 Miscellaneous INTRODUCTION AND WELCOME DIXIE. E. SNIDER, Corresponding Author DIXIE. E. SNIDER Address not knownAddress not knownSearch for more papers by this author DIXIE. E. SNIDER, Corresponding Author DIXIE. E. SNIDER Address not knownAddress not knownSearch for more papers by this author First published: 15 September 1996 https://doi.org/10.1002/(SICI)1097-0258(19960915)15:17<1835::AID-SIM394>3.0.CO;2-NAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume15, Issue1715 September 1996Pages 1835-1836 RelatedInformation

In Reply.—We agree with Mr Kocs on the need to broaden our approach to tuberculosis. Kocs condemns the imbalance between disease burden and research that has been best described by the Commission on Health Research for Development: 95% of health research is done in industrialized countries, whereas 93% of the disease burden is in the developing world.1This must be addressed by the world health and research community. Kocs rightly points out the need to attune tuberculosis control to local societies and cultures. Of course, far more operational research would help greatly in this regard. However, each year nearly 3 million people die of tuberculosis in the developing world. Since cost-effective techniques for treating tuberculosis in low-income countries are well established and the strategy for their implementation is known, the priority must therefore be intervention, and rapidly. The control strategy adopted by the World Health Organization has been

This article describes the global epidemiology of tuberculosis and reviews recent estimates of tuberculosis incidence and mortality in the world. The highest prevalence of tuberculosis infection and estimated annual risk of tuberculosis infection are in sub-Saharan Africa and Southeast Asia. Overall, almost 3.8 million cases of tuberculosis were reported in the world in 1990, of which 49% were in Southeast Asia. From the period 1984 through 1986 to the period 1989 through 1991, notification rates increased in all World Health Organization regions, except the American and the European regions. In 1990, there were an estimated 7.5 million cases of tuberculosis and 2.5 million deaths worldwide. The human immunodeficiency virus epidemic is causing increases in the number of tuberculosis cases, particularly in Africa, although increases are also expected in Southeast Asia. In many industrialized countries, tuberculosis has recently failed to decline, and in eastern Europe and the former Soviet Union, cases and deaths are increasing. Drug resistance is a serious problem, especially in the United States. If worldwide control of tuberculosis does not improve, 90 million new cases and 30 million deaths are expected in the decade 1990 through 1999.

Journal Article Editorial: The Good News and the Bad News About Multidrug-Resistant Tuberculosis Get access Kenneth G. Castro, Kenneth G. Castro Division of Tuberculosis Elimination, National Center for Prevention Services, Centers for Disease Control and Prevention, and Office of the Director, Centers for Disease Control and Prevention Atlanta, Georgia Reprints or correspondence: Dr. Kenneth G. Castro, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road (E-10), Atlanta, Georgia 30333 Search for other works by this author on: Oxford Academic PubMed Google Scholar Dixie E. Snider, Jr. Dixie E. Snider, Jr. Division of Tuberculosis Elimination, National Center for Prevention Services, Centers for Disease Control and Prevention, and Office of the Director, Centers for Disease Control and Prevention Atlanta, Georgia Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 21, Issue 5, November 1995, Pages 1265–1266, https://doi.org/10.1093/clinids/21.5.1265 Published: 01 November 1995 Article history Received: 20 July 1995 Published: 01 November 1995