Tuberculosis

Over the past several years, the incidence of tuberculosis has dramatically increased. Complicating the rise in number of cases is the emergence of multi-drug-resistant strains of tuberculosis. In certain segments of the population, this problem has reached epidemic proportions and has taxed the resources of the health care delivery system, particularly in inner-city areas. The problem of tuberculosis has reemerged after years of relative quiescence not only because of the AIDS epidemic but also because of increased immigration from countries with uncontrolled tuberculosis. Control of the current tuberculosis problem depends not only on public health policy but also relies heavily on the ability of primary care physicians to recognize and facilitate appropriate treatment of patients with this disease to decrease morbidity, mortality, and communicability. This review will focus on practical aspects of the diagnosis and treatment of tuberculosis with particular emphasis on central nervous effects of TB infection and its treatment. The safety and efficacy of drugs recently added to the therapeutic armamentarium, as well as those that have been available for many years, will be reviewed. Last, medicolegal and ethical issues regarding tuberculosis control will be discussed.