Occurrence Of TB Research Articles

Diagnosis of latent tuberculosis and prevention of reactivation in rheumatic patients receiving biologic therapy: international recommendations.

To review the official international recommendations on the management of latent tuberculosis infection (LTBI) in patients with rheumatic diseases undergoing biologic therapy. A systematic search of all clinical practice recommendations on the diagnosis and treatment of LTBI in rheumatic patients eligible for starting biologic drugs published between January 2002 and March 2013. For the diagnosis of LTBI, based on positivity of tuberculin skin test (TST), interferon-γ release assay (IGRA) is also available. Most recommendations advise using both TST and IGRA, especially in case of Bacillus Calmette-Guérin vaccination, to screen patients before commencing biologic drugs. There is a general consensus that evaluation of the global risk of TB infection is a crucial point and that patients with LTBI must receive chemoprophylaxis prior to biologic therapy. However, recommendations on the need for rescreening for activation of LTBI or new TB infection while patients are being treated are inadequate. Nevertheless, the main concern is poor compliance with TB recommendations of rheumatologists in clinical practice, which seems to be the main cause of the occurrence of active TB in rheumatic patients receiving biologic therapy. Notwithstanding some differences, mainly related to regional TB incidence, international recommendations strongly suggest careful screening for LTBI before starting biologic therapy. However, the critical point is implementing dissemination and awareness of the recommendations among rheumatologists to improve adherence in real life.

Active tuberculosis case finding and detection of drug resistance among HIV-infected patients: A cross-sectional study in a TB endemic area, Gondar, Northwest Ethiopia

BackgroundTuberculosis (TB) patients co-infected with human immunodeficiency virus (HIV) often lack the classic symptoms of pulmonary tuberculosis, making the diagnosis difficult. Current practices in resource-limited settings often indicate that these co-infected patients are diagnosed when they clinically manifest disease symptoms, resulting in a delayed diagnosis and despite continued transmission. The aim of this study is to determine the prevalence of undiagnosed pulmonary tuberculosis cases through active case finding and including multidrug-resistant TB (MDR-TB) among HIV-infected patients. Materials and methodsA total of 250 HIV-infected patients, aged 18years and above were evaluated in a cross-sectional design between February 2012 and November 2012. Socio-demographic and clinical data were collected using a structured questionnaire. Sputum samples were collected from all participants for acid fast bacilli (AFB) direct smear microscopy and Mycobacteria culture. A PCR-based RD9 deletion and genus typing, as well as first-line anti-TB drug susceptibility testing, was performed for all culture-positive isolates. ResultsFollowing active TB case finding, a total of 15/250 (6%) cases were diagnosed as TB cases, of whom 9/250 (3.6%) were detected by both smear microscopy and culture and the remaining 6/250 (2.4%) only by culture. All the 15 isolates were typed through RD9 typing of which 10 were Mycobacterium tuberculosis species; 1 belonged to Mycobacterium genus and 4 isolates were non-tuberculous mycobacteria. The prevalence of undiagnosed pulmonary TB disease among the study participants was 4.4%, which implies the possibility of identifying even more undiagnosed cases through active case finding. A multivariate logistic regression showed a statistically significant association between the presence of pneumonia infection and the occurrence of TB (OR=4.81, 95% CI (1.08–21.43), p=0.04). In addition, all the isolates were sensitive to all first-line anti-TB drugs, except for streptomycin, seen in only one newly diagnosed TB patient, and MDR-TB was not detected. ConclusionThe prevalence of undiagnosed pulmonary TB infection among HIV-infected patients in Gondar was 4.4%. Additionally, the possibility of these undiagnosed TB cases in the community could also pose a risk for the transmission of the disease, particularly among family members. Active screening of known HIV-infected individuals, with at least one TB symptom is recommended, even in persons with opportunistic infections.

Tuberculosis in Trinidad a Small Developing Country: Will we Reach the Millennium Development Goal 8 (MDG8) as we Countdown to 2015?

Aims: The aim of this study was to describe the epidemiological pattern of tuberculosis in Trinidad between 1993-2012, and use this data to answer three questions: (1) where as a developing country we stand in respect to MDG 8? What factors affect the rate of progress? Is it still possible to achieve these goals in the time remaining to 2015? Methods: We used a cohort study design in which all cases attending public facilities for diagnosis and treatment of tuberculosis were entered into a database and followed over time. Data on age and gender were recorded. Results: Over the period 1993-1999 the number of new cases of TB ranged from 128 in 1993 to 259 in 1997, with an average of approximately 178 (SD ± 43) new cases occurring each year. However between 2000-2012 the number of new cases ranged from 161 in 2004 to 268 in 2008. The average number of new cases occurring each year for this period was 216 (SD ± 35), which translated into an average annual cumulative incidence rate of 15.2 per 100 000 population. This represented a significant increase in the occurrence of TB between 2000-2012 compared with the period 1993-1999. Conclusion: We have not met MDG 8 and we are unlikely to meet this MDG by 2015, adequate resources to detect and treat TB are crucial to the future control and prevention of TB.

Inhaled Corticosteroid Is Associated With an Increased Risk of TB in Patients With COPD

It is well known that oral corticosteroid and anti-tumor necrosis factor-α agents increase the risk of TB. However, little is known about whether inhaled corticosteroid (ICS) increases the risk of TB. We performed this study to assess the risk of pulmonary TB among ICS users, based on the presence of the radiologic sequelae of pulmonary TB. A retrospective cohort study was performed. Between January 1, 2000, and December 31, 2005, a total of 778 patients who had COPD were recruited. Among them, 162 patients were excluded according to the exclusion criteria. In total, 616 patients were followed until December 31, 2010. They were divided into four groups according to whether they used ICS and whether they had radiologic sequelae of prior pulmonary TB. A total of 20 patients developed pulmonary TB. Kaplan-Meier estimates showed an increased risk of pulmonary TB among the ICS users who had radiologic sequelae of prior pulmonary TB ( P , .001). Multivariate Cox regression showed that ICS use was an independent risk factor for the occurrence of pulmonary TB in patients who had a normal chest radiograph (hazard ratio, 9.079; 95% CI, 1.012-81.431; P 5 .049) and in patients who had radiologic sequelae of prior pulmonary TB (hazard ratio, 24.946; 95% CI, 3.090-201.365; P 5 .003). ICS use increases the risk of pulmonary TB in patients with COPD and the risk is greater in patients who have radiologic sequelae of prior pulmonary TB.

Tuberculosis among HIV-1-infected subjects in a tertiary out-patient service in São Paulo city, Brazil

TB is currently considered to be the most important infectious disease among HIV-1-infected subjects in developing countries, such as Brazil. A retrospective analysis of TB cases was performed, occurring from January 1995 to December 2010 in our cohort of 599 HIV positive patients. The primary outcome was the occurrence of active TB. Forty-one TB cases were diagnosed over this period of 16 years, among 599 HIV positive patients in an open cohort setting in the city of Sao Paulo, Brazil. All-time lowest mean CD4 T cell count at the time of TB diagnosis was 146 and 186 cells/mm³, respectively. The mean HIV viral load was 5.19 log10 copies/mL, and 59% of the patients were on HAART. TB incidence was 1.47 per 100 person-years, for a total follow-up time of 2775 person-years. The probability of surviving up to 10 years after diagnosis was 75% for TB patients as opposed to 96% for patients with other, non-TB opportunistic diseases (p = 0.03). TB can be considered a public health problem among people living with HIV in Brazil despite of the widespread use of antiretrovirals for the treatment of HIV infection/AIDS.

Tuberculosis of Oral Mucosa Mimicking Malignancy: A Case Report

Abstract Tuberculosis (TB) is an epidemic infectious disease that seldom takes an oral form. Because of the still increased incidence of TB in our country, in the differential diagnosis of chronic oral ulcerations, tuberculosis should always be considered. Oral TB is frequently overlooked as a possible cause of oral ulceration. Therefore dentists should be aware of the possible occurrence of TB of the oral cavity. How to cite this article: Pramod R C, Suresh K V, Sunil L A, Mohan Kumar K P. Tuberculosis of Oral Mucosa Mimicking Malignancy: A Case Report. CODS J Dent 2015;7: 87-89

Preliminary study on the epidemiology of bovine tuberculosis in Jimma town and its surroundings, Southwestern Ethiopia

A cross-sectional study was conducted from October 2007 to April 2008 on 384 dairy cattle in Jimma Town and 1,102 adult cattle slaughtered at Jimma abattoir. The objective of the study was to generate preliminary epidemiological data on bovine TB both in dairy and beef cattle in Jimma and its area. Simple random sampling, single intradermal tuberculin (SIDT) and comparative intradermal tuberculin (CIDT) tests of dairy cattle and postmortem inspection of slaughter cattle were used. On the basis of CIDT test, herd and animal prevalence were found to be 48.6% (95% CI, 34.8-68.0) and 21.4% (95% CI, 17.3-25.5), respectively. In dairy herd, prevalence of bovine TB was significantly affected by herd size (c2 = 7.1; P< 0.05) and age (c2 =14.7; P<0.05). A prevalence of 5.4% (95% CI, 4.1-6.7) was recorded in cattle slaughtered at Jimma abattoir based on detailed postmortem examination. The occurrence of tuberculous lesions was variable in different tissues: 63.3% in the lungs and associated lymph nodes, 23.5% in the mesenteric lymph nodes and the remaining 13.2% in the lymph nodes of the head region. In conclusion, the result of the present study indicated the prevailing occurrence of bovine TB in the area and warrants for launching of control methods. Key words: Bovine tuberculosis, prevalence, risk factors, tuberculin tests, meat inspection, Jimma, Ethiopia.

High rate of Quantiferon positive and tuberculin negative tests in infants born at a large Italian University Hospital in 2011: a cautionary hypothesis

In the summer of 2011, an outbreak of Mycobacterium tuberculosis infection was suspected, and widely publicized, to have occurred in a maternity ward of an Italian University Hospital based on a case of tuberculosis in a nurse and another case in a newborn. More than 1300 newborns in the Hospital were surveyed for the occurrence of latent TB by the use of interferon-gamma released assays, which was positive in 118 newborns, all negative at the tuberculin skin test. We present here several theoretical arguments and literature data suggesting caution in interpreting the interferon-gamma released assays positivity alone as indication of latent TB infection in newborns.

HLA-B∗57 and Gender Influence the Occurrence of Tuberculosis in HIV Infected People of South India

Background. Substantial evidence exists for HLA and other host genetic factors being determinants of susceptibility or resistance to infectious diseases. However, very little information is available on the role of host genetic factors in HIV-TB coinfection. Hence, a longitudinal study was undertaken to investigate HLA associations in a cohort of HIV seropositive individuals with and without TB in Bangalore, South India. Methods. A cohort of 238 HIV seropositive subjects were typed for HLA-A, B, and DR by PCR-SSP and followed up for 5 years or till manifestation of Tuberculosis. HLA data of 682 HIV Negative healthy renal donors was used as control. Results. The ratio of males and females in HIV cohort was comparable (50.4% and 49.6%). But the incidence of TB was markedly lower in females (12.6%,) than males (25.6%). Further, HLA-B*57 frequency in HIV cohort was significantly higher among females without TB (21.6%, 19/88) than males (1.7%, 1/59); P = 0.0046; OR = 38. CD4 counts also were higher among females in this cohort. Conclusion. This study suggests that HIV positive women with HLA-B*57 have less occurrence of TB as compared to males.

A review of infection of wildlife hosts with Mycobacterium bovis and the diagnostic difficulties of the ‘no visible lesion’ presentation

The pathology, frequency and diagnostic implications of ‘no visible lesion’ (NVL) tuberculosis (Tb), i.e. infection with Mycobacterium bovis in the absence of macroscopic lesions, are described in a wide taxonomic range of wildlife hosts. Information collected and evaluated on the definition and occurrence of NVL Tb, histopathological characteristics, post-mortem techniques to detect minimal lesions, and diagnostic difficulties revealed most Tb-infected individuals with NVL had minute tuberculous lesions, which were difficult to see by eye. Acidfast organisms (AFO) were sometimes detected in the lesions. Ideally, mycobacterial culture of pools of lymph nodes and/or oropharyngeal tonsils is necessary for the accurate diagnosis of Tb in the absence of macroscopic lesions. At a very minimum, the diagnostic methods applied for studying the prevalence of Tb in the population should be clearly described, to allow comparison between studies.

Extensively drug-resistant tuberculosis

To describe the origin, epidemiology, diagnosis, treatment, prevention, and control of extensively drug-resistant tuberculosis (XDR TB). XDR TB is defined as the occurrence of TB in persons whose Mycobacterium tuberculosis isolates are resistant to isoniazid and rifampin and to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). As of June 2008, XDR TB has been found in 49 countries including the United States. It generally takes several weeks to detect XDR TB using conventional culture-based methods, although some progress is being made in developing rapid molecular tests. Treatment for XDR TB is difficult, usually requiring at least 18-24 months of four to six second-line anti-TB drugs. Treatment success rates are generally 30-50%, with very poor outcomes in HIV-infected patients. Management of contacts to infectious XDR TB patients is complicated by the lack of a proven effective treatment for XDR latent tuberculosis infection. XDR TB is an emerging global health threat. The disease is difficult and expensive to diagnose and treat, and outcomes are frequently poor. New rapid diagnostic tests and new classes of anti-TB drugs are needed to successfully combat this global problem.

New Frontiers in the Therapy of Tuberculosis: Fighting with the Global Menace

Tuberculosis has remained an enemy of humankind since its inception. It has affected all facets of human life and remained leading cause of mortality and morbidity despite of availability of effective chemotherapy and BCG vaccine in 21st century. This has exposed the frailties of the current drug armamentarium. No new drug is available acting through novel mechanism of action for last 40 years. This has culminated into resistant strain of TB, MDR-TB and XDR-TB. Concomitant occurrence of TB and HIV presents a lethal combination. The availability of the M. tuberculosis genome sequence and mycobacterial genetic tools, such as transposon mutagenesis, gene knockout and gene transfer, greatly facilitate target identification. This review provides a comprehensive literature compilation on the present research paradigm of anti-TB drug discovery including advances in the new structural classes analogs reported in last decade.

Incidence and profile of spinal tuberculosis in patients at the only public hospital admitting such patients in KwaZulu-Natal

A retrospective chart review at the major provincial public hospital serving patients with spinal injuries/pathology. To determine the incidence of spinal tuberculosis (Tb) and establish the profile of these patients treated at King George V Hospital (KGV) in KwaZulu-Natal, South Africa. A total of 525 medical records for the period March 2005 to April 2006 were reviewed. Data from 104 files of Tb spine cases were categorized according to demographic details, medical conditions and length of stay in hospital. The South African mid-year 2006 census was used to calculate associations and risk rates for race, gender, adulthood, urbanization and employment and analyzed using the STATA version 9.0 statistical package. About 90% of the patients were African and 10% from other races. Females comprised 58% of the patients. The incidence of Tb spine is 1.02 per 100,000 and 3.13 per 100,000 for Africans and other races, respectively. The incidence rate is 1.17 per 100,000 females and 0.916 per 100,000 males. All the participants had a history of pulmonary Tb and 28% were human immunodeficiency virus positive. Thoracic spine was affected in 42% of the cases. About 32% presented with incomplete paraplegia. The average length of stay at this hospital for these patients was 41 days. About 20% of all patients seen for spinal conditions at KGV over the past year presented with Tb spine. A higher association between living in an urban area, adulthood (age 18+), being non-Black patients and the occurrence of spinal Tb was observed.

Diagnosis of pulmonary tuberculosis in children--what's new?

However, evidence suggests that in developing countries, where most disease occurs, childhood TB constitutes a large proportion of the TB caseload, contributing approximately 15 - 20% of all cases. The burden in children and impact on child health has been under-recognised, partly because of difficulties in confirming the diagnosis. Diagnostic confirmation may be difficult because of many factors including nonspecific clinical signs, coexisting malnutrition, variable interpretation of chest radiographs, paucibacillary disease, difficulty in obtaining specimens for culture and relatively low rates of bacteriological confirmation. As a result diagnosis in children has relied mainly on clinical case definitions, tuberculin skin testing and chest radiography. 2 Diagnostic uncertainty has been compounded by the HIV epidemic in which chronic lung disease, anergy, coexisiting malnutrition and nonspecific clinical and radiological signs make definitive diagnosis even more challenging. The consequences of undiagnosed or untreated paediatric TB are especially serious as children are more likely to develop miliary or severe disease. Furthermore cases of childhood TB frequently reflect an undiagnosed adult infectious source case; therefore the occurrence of TB in children frequently indicates failure of a TB control programme. Moreover, definitive diagnosis and microbiological confirmation have become increasingly important in the era of multidrug-resistant TB (MDR) and extremely extensively drug-resistant TB (XDR). This review considers currently available and new diagnostic methods for pulmonary TB (PTB). Current methods have relied predominantly on clinical case definitions, tuberculin skin testing and chest radiography. Newer methods include improved specimens and microbiological methods, immune testing, especially gamma-interferon assays, phage-based tests, polymerase chain reaction and antigen detection.

XDR-TB in South Africa: Revised Definition

The authors should be commended for a thoughtful and stimulating article [1]. However, we wish to clarify the historical record about the use of the term XDR-TB. The concept of XDR-TB as a distinct nosological entity was first developed at the Centers for Disease Control and Prevention (CDC) in March 2005 and introduced into public use in October 2005 at the 36th World Conference on Lung Health in Paris [2,3]. At that meeting, data on second-line drug resistance from a global survey of supranational TB reference laboratories conducted by CDC and the World Health Organization, as well as treatment outcomes of XDR-TB patients in Latvia, were first presented. Shortly thereafter, the cluster of TB deaths with resistance to second-line drugs in HIV-infected persons in KwaZulu-Natal was presented at the 13th Conference on Retroviruses and Opportunistic Infections in Denver in February 2006 [4]. The original definition for XDR-TB published in the Morbidity and Mortality Weekly Report in March 2006 [5] that they have used, however, was revised in October 2006 at an emergency meeting of the Global XDR-TB Task Force. The revised definition was published on November 3, 2006 in an MMWR notice to readers [6]. Currently, XDR-TB is defined as the occurrence of TB in persons whose Mycobacterium tuberculosis isolates are resistant to isoniazid and rifampin plus any fluoroquinolone and at least one of the three injectable second-line drugs (amikacin, kanamycin, capreomycin). The definition was revised because drug susceptibility testing to these drugs produces reliable and reproducible results, and is more accessible in resource-limited settings. In addition, patients meeting the revised definition have significantly poorer treatment outcomes. The new definition is important for those intending to conduct surveillance for XDR-TB in their setting.

Future Prospects for the MODS Assay in Multidrug-Resistant Tuberculosis Diagnosis

Extensively drug-resistant tuberculosis In 2004/2005, workers in Kwazulu-Natal, South Africa, became aware that some patients receiving effective antiretroviral therapy in their pioneering integrated HIV/tuberculosis (TB) program were dying despite undetectable HIV viral loads. Their subsequent detailed epidemiological study with enhanced surveillance for TB drug resistance finally blew the lid off an issue that has been smouldering unspoken for too long – that the era in which standardized, ‘best guess’, empirical TB therapy was an adequate blanket approach to TB control is over. Gerry Friedland and colleagues uncovered a previously unnoticed outbreak of extensively drug-resistant (XDR) TB [1], the current definition of which is the occurrence of TB in persons whose Mycobacterium tuberculosis isolates are resistant to isoniazid and rifampicin (thus all XDR is also multidrugresistant [MDR]) and also resistant to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin or capreomycin) [2].

Electron paramagnetic resonance and other allied studies of sol–gel derived nanocrystallinechromium oxides in a silica glass matrix

Monolithic silica gels doped with various concentrations (1, 5, 10 mol%) of chromium oxide areprepared by a sol–gel process and are subjected to calcination at different temperatures up to1200 °C. This has principally led to the formation ofCr2O3 nanocrystalsand also of CrO3 nanocrystals at the higher calcination temperatures. The sizes of theCr2O3 nanocrystals have been determined by x-ray diffraction (XRD) and transmission electronmicroscopy (TEM) studies and have been found to lie in the range 5–30 nm depending upon thedopant concentration as well as the calcination temperature. The formation of nonmagneticCrO3 crystals in 10 mol% chromium oxide doped silica glass calcined at1200 °C as a result ofoxidation of Cr5+ ions to Cr6+ ions has been confirmed from XRD studies. Optical, infrared and X-band electron paramagneticresonance (EPR) spectra of these nanocrystals have also been studied. EPR behaviours such as theg-factor andlinewidth of Cr2O3 nanocrystals investigated at room and liquid nitrogen temperatures havebeen found to be quite distinct from those of antiferromagnetic (AF) bulkCr2O3 crystals and may be manifestations of superparamagnetism/ferromagnetism in thesenanocrystals. A narrow anisotropic EPR line () has been detected for chromium oxide doped silica gel calcined at800 °C and has beenassigned to isolated Cr5+ ions in a tetragonally distorted tetrahedral environment. Studies of the thermaldependence of zero-field-cooled (ZFC) and field-cooled (FC) magnetization(σ) 10 mol% chromium oxide doped silica glasses calcined at800 °C by aSQUID magnetometer in the 5–300 K temperature range have revealed the occurrence of the blockingtemperature TB at about 250 K, which is a characteristic feature of superparamagnetism inCr2O3 nanocrystals. The superparamagnetic effects are almost quenched in the samples calcined at 1000and 1200 °C because of the presence of larger nanocrystals in these samples. Magnetichysteresis effects in these calcined samples at 300 K as well as at 5 K in the ± 6 T magnetic field range have also been investigated. The existence of ferromagnetic order atlow temperature (5 K) as well as at room temperature (300 K) (for samples calcined athigher temperatures) has been confirmed.

Tuberculosis in the developing world.

Pediatric PulmonologyVolume 37, Issue S26 p. 53-54 Research Article Tuberculosis in the developing world Heather J. Zar MBBCh, PhD, Corresponding Author Heather J. Zar MBBCh, PhD [email protected] Department of School Adolescent and Child Health, University of Cape Town, South AfricaDepartment of School Adolescent and Child Health, Red Cross Children's Hospital, University of Cape Town, 5th floor, ICH Building, Klipfontein Road, Cape Town, South Africa.Search for more papers by this author Heather J. Zar MBBCh, PhD, Corresponding Author Heather J. Zar MBBCh, PhD [email protected] Department of School Adolescent and Child Health, University of Cape Town, South AfricaDepartment of School Adolescent and Child Health, Red Cross Children's Hospital, University of Cape Town, 5th floor, ICH Building, Klipfontein Road, Cape Town, South Africa.Search for more papers by this author First published: 06 February 2004 https://doi.org/10.1002/ppul.70049Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume37, IssueS26February 2004Pages 53-54 RelatedInformation

Adverse events of standardized regimens of corticosteroids for prophylaxis and treatment of nerve function impairment in leprosy: results from the ‘TRIPOD’ trials

Reactions in leprosy causing nerve function impairment (NFI) are increasingly treated with standardized regimens of corticosteroids, often under field conditions. Safety concerns led to an assessment of adverse events of corticosteroids, based on data of three trials studying prevention of NFI (the TRIPOD study). A multicentre, randomized, double-blind placebo-controlled trial was conducted in leprosy control programmes in Nepal and Bangladesh. Treatment was with prednisolone according to fixed schedules for 16 weeks, starting in one trial with 20 mg/day (prophylactic regimen: total dosage 1.96 g) and in the other two trials with 40 mg/day (therapeutic regimen: total dosage 2.52 g). Minor adverse events were defined as moon face, fungal infections, acne, and gastric pain requiring antacid. Major adverse events were defined as psychosis, peptic ulcer, glaucoma, cataract, diabetes and hypertension. Also, the occurrence of infected plantar, palmar, and corneal ulceration was monitored, together with occurrence of TB. Considering all three trials together, minor adverse events were observed in 130/815 patients (16%). Of these, 51/414 (12%) were in the placebo group and 79/401 (20%) in the prednisolone group. The relative risk for minor adverse events in the prednisolone group was 1.6 (P = 0.004). Adverse events with a significantly increased risk were acne, fungal infections and gastric pain. Major adverse events were observed in 15/815 patients (2%); 7/414 (2%) in the placebo group and 8/401 (2%) in the prednisolone group. No major adverse events had a significantly increased risk in the prednisolone arm of the trials. No cases of TB were observed in 300 patients who could be followed-up for 24 months. Standardized regimens of corticosteroids for both prophylaxis and treatment of reactions and NFI in leprosy under field conditions in developing countries are safe when a standard pre-treatment examination is performed, treatment for minor conditions can be carried out by field staff, referral for specialized medical care is possible, and sufficient follow-up is done during and after treatment.

The fall after the rise: Tuberculosis in the United States, 1991 through 1994.

Factors associated with decreases in tuberculosis cases observed in the United States in 1993 and 1994 were analyzed. Changes in case counts reported to the national surveillance system were evaluated by dividing the number of incident cases of TB reported in 1993 and 1994 by the number of cases reported in 1991 and 1992 and stratifying these ratios by demographic factors, AIDS incidence, and changes in program performance. Case counts decreased from 52,956 in 1991 and 1992 to 49,605 in 1993 and 1994 (case count ratio = 0.94, 95% confidence interval [CI] = 0.93, 0.95). The decrease, confined to US-born patients, was generally associated with AIDS incidence and improvements in completion of therapy, conversion of sputum, and increases in the number of contacts identified per case. Recent TB epidemiology patterns suggest that improvements in treatment and control activities have contributed to the reversal in the resurgence of this disease in US-born persons. Continued success in preventing the occurrence of active TB will require sustained efforts to ensure appropriate treatment of cases.