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Tuberculosis: Yesterday, Today, and Tomorrow
- John A. Sbarbaro, MD, MPH
- University of Colorado Health Sciences Center, Denver, CO 80262 Requests for Reprints: John A. Sbarbaro, MD, 2908 Pierson Way, Lakewood, CO 80215.
Tuberculosis has plagued humans for more than three millennia and still rages through many countries of the world. In the United States, however, rapidly declining rates of the disease had combined with effective chemotherapy to relegate tuberculosis to a diagnostic afterthought. This changed with reports of mini-epidemics of tuberculosis within hospitals, accounts of health workers dying of disease caused by multidrug-resistant organisms, and the recent imposition of strict infection control requirements from the Occupational Safety and Health Administration.
A renewed interest in the disease has resulted. Tuberculosis has become a featured topic in many continuing medical education programs, conferences, and grand rounds. Younger physicians have been reviewing the literature of yesterday for insights into the epidemiology, infectiousness, pathogenesis, control, and treatment of tuberculosis. Indeed, in these archives there is much to be relearned, but in the disease itself, there is much yet to be discovered.
Three articles about this ancient plague in this issue demand the attention of the reader [1-3]. As an introduction, it should be recalled that in 1985, although confirming that drug-resistant mycobacteria were just as contagious as drug-sensitive organisms, Snider and colleagues [4] found that there was enormous variability in the infectivity of individual patients with clinically similar disease status. These investigators noted that infectiousness tended to be an “all or nothing” phenomenon, even after their results were adjusted for sputum smear status (a “positive” acid-fast smear indicates that the patient's sputum carries …
