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JAMA. 2005;293:2693.

TUBERCULOSIS
A JAMA THEME ISSUE

Edited by Catherine D. DeAngelis, MD, MPH, and Annette Flanagin, RN, MA

Preventing TB in HIV-Infected South African Men
Grant and colleagues investigated the effect of isoniazid therapy on new and recurrent cases of TB in a cohort of South African miners infected with HIV but without evidence of active TB. Although TB incidence remained high compared with rates before the intervention, over a median 22.1 months of follow-up, TB incidence declined 38% in the entire cohort and 46% among men with no prior history of TB.

(SEE ARTICLE)

Multidrug-Resistant TB
Multidrug-resistant TB (MDR-TB) has declined in the United States, but it continues to be a problem worldwide and is the subject of 2 articles in this issue. First, Drobniewski and colleagues (SEE ARTICLE) report results of a population-based molecular epidemiological study to determine the prevalence of the Beijing-family strain of MDR-TB in civilian and incarcerated populations in the Samara region, Russia. They found Beijing-family strains in 66.6% of cases, with an even higher prevalence in individuals with a history of incarceration. In a second study, Granich and colleagues (SEE ARTICLE) reviewed California data on MDR-TB from 1994-2003 and found that the proportion of MDR-TB cases remained stable at 1% to 2% over the study period, with 83% of cases among California residents who were born outside the United States. In a commentary, Nettleman (SEE ARTICLE) discusses factors associated with MDR-TB and its containment.

Radiographic Correlates of Primary and Reactivated TB
Traditionally, primary and reactivation TB have been thought to have distinctive radiographic features. In a study using DNA fingerprinting to distinguish recent from distant acquisition, Geng and colleagues examined radiographic features from 456 TB cases and found little correlation between radiographic appearance and time of TB acquisition. Patients with TB and HIV infection commonly had atypical radiographs.

(SEE ARTICLE)

Diagnosing Latent TB Infection
Two articles in this issue compare results from 2 generations of a whole-blood interferon (IFN-) assay with tuberculin skin testing (TST) to identify persons with latent TB infection. Pai and colleagues (SEE ARTICLE) examined health care workers in rural India and found similar prevalence estimates (approximately 40%) using either test and high (81%) agreement between the TST and IFN- methods. In the second article, Kang and colleagues (SEE ARTICLE) report TST and IFN- assay results from Korean individuals who had received bacille Calmette-Guérin vaccination and were estimated to have a minimal to high risk of infection. They found that the IFN- assay provided a better indication of TB risk than TST. In a commentary, Whalen (SEE ARTICLE) discusses screening for latent TB infection.

Evolution of TB Control
Dye and colleagues analyzed World Health Organization data on TB prevalence, treatment outcomes, and death and analyzed national prevalence surveys of infection and disease to evaluate the prospects for reducing global TB incidence, prevalence, and death rates to levels consistent with internationally recognized goals by 2015. They estimate the goals could be reached in many regions of the world, with Africa and Eastern Europe posing the greatest challenges.

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Medical News & Perspectives
Efforts are under way to design a better vaccine to prevent tuberculosis and to develop novel drugs to treat the disease.

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TB and Homelessness
In the United States, patients with TB who are homeless are more likely to have a history of substance use or incarceration and less likely to be born outside the United States or have multidrug-resistant TB compared with those who are not homeless.

(SEE ARTICLE)

CLINICIAN’S CORNER
TB Treatment Update
Recommendations for the treatment of active and latent TB infection.

(SEE ARTICLE)

TB Vulnerability
Without access to appropriate and effective health care, everyone is vulnerable to TB.

(SEE ARTICLE)

JAMA Patient Page
For your patients: Information about tuberculosis.

(SEE ARTICLE)

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