To the Editor.—
The recent communications by Furey and Stefancic (235: 168, 1976) and by McConville and Rapoport (235:172, 1976) provide excellent information regarding the present management of tuberculosis. However, the perspective is somewhat limited, perhaps because of the metropolitan purview of the authors of both the former (Chicago) and the latter (Baltimore) articles. Their stress that currently tuberculosis is primarily an urban disease has merit, but it ignores the fact that many tribes of American Indians, who reside on isolated rural reservations, continue to have high rates of tuberculosis1,2 (despite a marked reduction in recent years).In addition, in their discussion of the toxicity of isoniazid, McConville and Rapoport aptly described the small risk of isoniazid hepatotoxicity but, with that circumscribed viewpoint, omitted at least one other important toxic effect—the great potential of massive intentional or accidental isoniazid overdosage to produce disturbed consciousness, intractable convulsions, and death.2,3
Sievers ML, Herrier RN. Tuberculosis Management. JAMA. 1976;235(21):2283–2284. doi:10.1001/jama.1976.03260470011004
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