Tuberculosis. Part I.

摘要: Summary During the nineteenth century, overcrowding and poor sanitation were thought to create miasmas, capable of spreading disease through air. Infection control at that time focused on poverty reduction, miasma. Although TB was then widely believed be a hereditary disorder, improvement in living conditions took place century probably causally related coincident decline eincidence TB. Without effective therapy, remained entirely preventive, even after Koch's isolation tubercle bacillus 1882 realization is indeed infectious. measures employed (sanitoria) primitive, this conception as occurring much between persons within them essentially correct. we now confront person with active an armamentarium powerful diagnostic therapeutic tools, recent outbreaks have made it painfully clear these are no substitute for elementary methods, which been impeded by technological hubris. Partially because altered presentation accelerated course those HIV infection, physicians relearned “atypical” radiographic patterns actually common, immunocompetent hosts, conventional culture sensitivity techniques disturbingly slow, up 50% pulmonary may negative sputum smears. rate MDRTB most areas has low, recognize fact many patients require incentives (sometimes legislative) 80 complete curative therapy. The current focus shifted back miasma, not only form concern over droplet nuclei particulate respirators 81 but also old pseudoepidemiologic sense. rates again falling, years unchecked transmission left certain populations very high infection disease. ACET recommends screening other highrisk groups 82 (Table 3). Despite all institutional failures outlined section, despite epidemic itself, major reduction morbidity would likely occur if followed guidelines tuberculin skin testing chemoprophylaxis. In study cases reported Oregon Health Division during 1991 1992, 43% had received indicated 8% chemoprophylaxis 83 . another conducted three sites around United States, few 84 A significant population studies seen physician before their development Althoug decreasing again, elimination will both close adherence standards health professionals improved access care under-served populations.