Tuberculosis--the threat re-emerges

Tuberculosis remains a significant problem in Australia with five to six new cases per 100,000 of the population per year. The majority of cases occur in individuals born outside Australia. Approximately 70% is pulmonary disease and 30% nonpulmonary. Diagnosis can be made by history, clinical examination, Mantoux testing, chest X-ray plus a thoracic CT scan and sputum analysis. Occasionally bronchoscopy and/or fine needle aspiration biopsy may be indicated. Six months of appropriate supervised chemotherapy achieves a 98% cure. Healthcare workers are at special risk of infection and should have Mantoux testing; if this is negative then either BCG or regular Mantoux surveillance is recommended. Whilst multi-drug resistant tuberculosis is relatively uncommon in Australia, it is a significant problem in the United States and parts of South East Asia and such patients often come to surgical resection of their tuberculous lesions; during such resection healthcare workers are exposed to a potentially lethal infection.