Recent advances in the diagnosis and management of tuberculosis.
OBJECTIVE
Tuberculosis (TB) remains one of the leading infectious killers of adults in the world today. This paper will review recent advances and understanding in the epidemiology, diagnosis, and management of TB.


RESULTS
Tuberculosis remains a significant global threat, particularly in regions of the world heavily affected by HIV. Diagnosis of TB infection and disease rely on outdated and problematic methods, but newer immunologic and nucleic acid-based techniques are emerging. Treatment of latent TB infection still relies mainly on the use of isoniazid but several treatment-shortening strategies are being studied. Treatment of active disease has advanced little since the introduction of short-course chemotherapy with rifampin, but several new drugs are being developed and studied. Timely initiation of HIV treatment in co-infected patients is increasingly seen as important and strategies for initiating therapy for both diseases are being refined. The existence of immune reconstitution inflammatory reactions is also becoming more widely appreciated. Other populations at risk for TB such as those receiving TNF-alpha antagonists are being recognized and improved screening and control measures implemented.


CONCLUSIONS
The global epidemiology of TB has been shaped in recent decades by HIV, urbanization and poverty. Diagnosis and treatment remain challenging, however, improved screening of at-risk populations and new diagnostic modalities and treatment strategies offer hope to the millions who suffer from tuberculosis.
Furin
Jennifer J
JJ
Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA. Jfurin@partners.org
Johnson
John L
JL
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology
D000995:Antitubercular Agents