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This Week in JAMA
June 8, 2005

This Week in JAMA

JAMA. 2005;293(22):2693. doi:10.1001/jama.293.22.2693
TUBERCULOSIS

A JAMA THEME ISSUE

Edited by Catherine D. DeAngelis, MD, MPH, and Annette Flanagin, RN, MA

Preventing TB in HIV-Infected South African Men

Grant and colleagues investigated the effect of isoniazid therapy on new and recurrent cases of TB in a cohort of South African miners infected with HIV but without evidence of active TB. Although TB incidence remained high compared with rates before the intervention, over a median 22.1 months of follow-up, TB incidence declined 38% in the entire cohort and 46% among men with no prior history of TB.

Article
Multidrug-Resistant TB

Multidrug-resistant TB (MDR-TB) has declined in the United States, but it continues to be a problem worldwide and is the subject of 2 articles in this issue. First, Drobniewski and colleaguesArticle report results of a population-based molecular epidemiological study to determine the prevalence of the Beijing-family strain of MDR-TB in civilian and incarcerated populations in the Samara region, Russia. They found Beijing-family strains in 66.6% of cases, with an even higher prevalence in individuals with a history of incarceration. In a second study, Granich and colleaguesArticle reviewed California data on MDR-TB from 1994-2003 and found that the proportion of MDR-TB cases remained stable at 1% to 2% over the study period, with 83% of cases among California residents who were born outside the United States. In a commentary, NettlemanArticle discusses factors associated with MDR-TB and its containment.

Radiographic Correlates of Primary and Reactivated TB

Traditionally, primary and reactivation TB have been thought to have distinctive radiographic features. In a study using DNA fingerprinting to distinguish recent from distant acquisition, Geng and colleagues examined radiographic features from 456 TB cases and found little correlation between radiographic appearance and time of TB acquisition. Patients with TB and HIV infection commonly had atypical radiographs.

Article
Diagnosing Latent TB Infection

Two articles in this issue compare results from 2 generations of a whole-blood interferon γ (IFN-γ) assay with tuberculin skin testing (TST) to identify persons with latent TB infection. Pai and colleaguesArticle examined health care workers in rural India and found similar prevalence estimates (approximately 40%) using either test and high (81%) agreement between the TST and IFN-γ methods. In the second article, Kang and colleaguesArticle report TST and IFN-γ assay results from Korean individuals who had received bacille Calmette-Guérin vaccination and were estimated to have a minimal to high risk of infection. They found that the IFN-γ assay provided a better indication of TB risk than TST. In a commentary, WhalenArticle discusses screening for latent TB infection.

Evolution of TB Control

Dye and colleagues analyzed World Health Organization data on TB prevalence, treatment outcomes, and death and analyzed national prevalence surveys of infection and disease to evaluate the prospects for reducing global TB incidence, prevalence, and death rates to levels consistent with internationally recognized goals by 2015. They estimate the goals could be reached in many regions of the world, with Africa and Eastern Europe posing the greatest challenges.

Article
Medical News & Perspectives

Efforts are under way to design a better vaccine to prevent tuberculosis and to develop novel drugs to treat the disease.

See Article

TB and Homelessness

In the United States, patients with TB who are homeless are more likely to have a history of substance use or incarceration and less likely to be born outside the United States or have multidrug-resistant TB compared with those who are not homeless.

See Article

CLINICIAN’S CORNER

Recommendations for the treatment of active and latent TB infection.

See Article

TB Vulnerability

Without access to appropriate and effective health care, everyone is vulnerable to TB.

See Article

JAMA Patient Page

For your patients: Information about tuberculosis.

See Article

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