Examining the biology of tuberculosis

The task of critically reviewing current advances in a scientifically burgeoning topic such as tuberculosis is daunting. From 2965 published articles on tuberculosis in 1997 cited in MEDLINE, 180 were selected, and approximately one third of those are included in this review. This paper highlights how molecular biology has greatly advanced our understanding of the epidemiology and transmission of tuberculosis worldwide. In addition, recent data on the dynamics of transmission between close contacts are provided that may challenge conventional views. A global view of drug-resistant tuberculosis is presented, and new data on the prevalence of tuberculosis in diabetics, bone marrow transplant recipients, patients with renal disease, and HIV-infected persons are highlighted. Recent studies on the genetic susceptibility of tuberculosis are outlined, and we review immunotherapy and the impact of tuberculosis on the natural course of HIV infection. Chemoprevention, duration of therapy, and bacille Calmette-Guérin vaccination in the setting of HIV are discussed. The value and limitation of nucleic acid amplification tests in rapid diagnosis is addressed, and old diagnostic tests are revisited with new data. Novel mycobacterial culture systems are discussed and screening-for-infection approaches are revisited, including tuberculin skin testing in bacille Calmette-Guérin vaccinees. Therapeutic issues addressing antituberculous drug absorption in HIV-infected patients, the role of pharmacokinetics in predicting clinical outcomes, and important drug-drug interactions are discussed.