Sepkowitz K A, Raffalli J, Riley L, Kiehn T E, Armstrong D
Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Clin Microbiol Rev. 1995 Apr;8(2):180-99. doi: 10.1128/CMR.8.2.180.
A resurgence of tuberculosis has occurred in recent years in the United States and abroad. Deteriorating public health services, increasing numbers of immigrants from countries of endemicity, and coinfection with the human immunodeficiency virus (HIV) have contributed to the rise in the number of cases diagnosed in the United States. Outbreaks of resistant tuberculosis, which responds poorly to therapy, have occurred in hospitals and other settings, affecting patients and health care workers. This review covers the pathogenesis, epidemiology, clinical presentation, laboratory diagnosis, and treatment of Mycobacterium tuberculosis infection and disease. In addition, public health and hospital infection control strategies are detailed. Newer approaches to epidemiologic investigation, including use of restriction fragment length polymorphism analysis, are discussed. Detailed consideration of the interaction between HIV infection and tuberculosis is given. We also review the latest techniques in laboratory evaluation, including the radiometric culture system, DNA probes, and PCR. Current recommendations for therapy of tuberculosis, including multidrug-resistant tuberculosis, are given. Finally, the special problem of prophylaxis of persons exposed to multidrug-resistant tuberculosis is considered.
近年来，美国及其他国家和地区结核病再度流行。公共卫生服务的恶化、来自结核病高发国家的移民数量增加以及与人类免疫缺陷病毒（HIV）的合并感染，导致美国确诊病例数量上升。对治疗反应不佳的耐药结核病已在医院及其他场所爆发，影响了患者和医护人员。本综述涵盖了结核分枝杆菌感染与疾病的发病机制、流行病学、临床表现、实验室诊断及治疗。此外，还详细介绍了公共卫生及医院感染控制策略。讨论了包括使用限制性片段长度多态性分析在内的新型流行病学调查方法。对HIV感染与结核病之间的相互作用进行了详细探讨。我们还综述了实验室评估的最新技术，包括放射性培养系统、DNA探针及聚合酶链反应（PCR）。给出了当前结核病治疗的建议，包括耐多药结核病的治疗。最后，考虑了接触耐多药结核病患者的预防这一特殊问题。
