Tuberculosis. A chemotherapeutic triumph but a persistent socioeconomic problem.

There is evidence that man has suffered from tuberculosis for more than 5,000 years, and through crowded living conditions, debilitation, and malnutrition, tuberculosis became epidemic in Western civilization and was a major cause of mortality. Identification of the tubercle bacillus as the causative agent in 1882 firmly established the infectious nature of the disease and the development of sanatoriums soon followed. Before the advent of effective chemotherapeutic agents, treatment involved rest, diet, and various surgical procedures, which were of little or no benefit to the patient. The discovery of dihydrostreptomycin, aminosalicylic acid, and isoniazid in the late 1940s and early 1950s meant that tuberculosis was now entirely curable in virtually all patients. Despite these effective chemotherapeutic and preventive agents, tuberculosis has receded to socioeconomically disadvantaged urban and rural areas, where the incidence parallels that of developing countries. Conquest of the disease will require improved health care delivery to the indigent and dispossessed.

Drug-resistant and atypical mycobacterial disease. Bacteriology and treatment.

The treatment of drug-resistant mycobacterial disease requires excellent laboratory technology combined with an effective means of monitoring patients for drug toxicity and assuring patient compliance in treatment. Most tuberculosis is readily treated with easily administered, well-tolerated antituberculous combination medications such as isoniazid-ethambutol hydrochloride or isoniazid-rifampin. Primary drug-resistant tuberculosis is prevalent in many developing countries; drug resistance in the United States is generally acquired through inadequate or irregular drug ingestion. Drug-resistant tuberculosis and many "atypical" mycobacterioses required carefully designed drug regimens based on accurate drug susceptibility studies. Occasionally, patients with certain types of infection will have isolated pulmonary involvement for which surgical extirpation is beneficial. Despite the continued decline in the incidence of tuberculosis, atypical mycobacterial disease has remained constant and may eventually become the most prevalent mycobacteriosis in the United States.