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Yang Kun
TUBERCULOSIS: THE
"N0.
1"
KILLER AMONGST
INFECTIOUS
DISEASES
Tuberculosis (TB)
that
was
neglected
in
the
last
20 years, has now
become the "No.
1"
killer amongst
all
infectious diseases. ln
China, about
1/3
of the
population
has ever
been
infected
by
this bacteria Mycobacterium
tuberculosis and cases are increasing.
Mantoux
first
perfected the technique
to
use tuberculin
(acquired
as
a
reaction to the bacteria) for skin testing
as
a
convenient diagnostic
aid.
However, positive reactions
only
signify
previous
exposure
rather
than current
active infection.
Moreover, up
to
2O-307"
ol
ill
patients
with
TB may have
a negative
skin
test - especially
those
with
AIDS or others with immunosup-
pressive
treatments. Anti-tuberculosis
agents
for
prevention
has
been
advocated for latent inlection
but
obvert
infection
demands DOT (directly
observed therapy) short
courses.
The
most dramatic contributor to
the
resur-
gence of
TB
is
AIDS
that
changes
the
classical presentation ol TB, e.9., chest
radiographs
are
clear
in
35% ol patients
with
active
TB
and
AIDS. Some
of
the
most potent agents available to control
AIDS
would either interfere with
the
activity of one anti-tuberculosis drug
or
interfere with
the
metabolism
of
another, causing
very
dangerous
overdoses. BCG, though useful, is
a
"live"
vaccine that
may
result
in actual
infection
in
immuno-compromised
patients. We are a
long
way from eradF
cation
of
TB!
31
