Tuberculosis in the 21st century

Tuberculosis remains a significant global problem, principally affecting the developing countries, which are also heavily afflicted by HIV. In the industrialized countries, tuberculosis concerns mostly the immigrant, the immunocompromised, and the elderly. More recently, TNF-alpha antagonists are being recognized as an important risk factor for tuberculosis, and guidelines for improved screening and control have been issued. Diagnosis of tuberculosis remains cumbersome, and the newer nucleic acid-based techniques are insufficiently sensitive. New immunologic methods to improve the diagnosis of latent tuberculosis are being studied. Isoniazid and rifampicin remain the mainstay of the treatment of active disease, but several new drugs are being evaluated. The existence of immune reconstitution inflammatory reactions in HIV patients is also becoming more widely appreciated. Treatment of latent tuberculosis still relies mainly on the use of isoniazid, and efforts continue to improve patient compliance.