| Abstract: |
Recent work utilizing molecular fingerprinting techniques has revolutionized our understanding of the epidemiology of tuberculosis, and helped to explain the exponential increase in cases of MDR-TB seen in New York City from 1987 to 1991. Unexpectedly high rates of acute disease have been identified in urban adults, most pronounced among those with immunosuppressive diseases such as HIV-infection, but also among those with seemingly normal immune function. This finding promises to influence our approach to future tuberculosis control efforts: it demonstrates that control of transmission in congregate settings such as hospitals is as essential as identifying and treating patients with latent or active disease. Strategies utilizing this approach have already been responsible for significant decrease in annual cases in the US in 1993 and again in 1994. Fortunately, it appears that the outcome of persons with primary MDR-TB is favorable. With early introduction of effective therapy, patients with MDR-TB can be expected to be stabilized and most can be cured. |
