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Infections that last

August 2009

Professional

What’s new in TB?

Volume 38, No.8, August 2009 Pages 578-585

Anna Ralph BMedSci, MBBS, MPH, DTM&H, FRACP, is a PhD Candidate, National Centre for Epidemiology and Population Health, Australian National University and Menzies School of Health Research, and a locum infectious diseases physician, Alice Springs, Northern Territory

Vicki Krause MD, DTM&H, FAFPHM, is Director, Centre for Disease Control and Head, Tuberculosis/ Leprosy Services, Department Community and Families, Darwin, Northern Territory.

Paul Kelly MBBS, DTM&H, PhD, FAFPHM, is Director, Masters of Applied Epidemiology Program, National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory

Background

Australia has among the world’s lowest rates of tuberculosis (TB). However, it remains a leading global cause of morbidity and mortality. In Australia, TB remains more common in Indigenous than non-Indigenous Australians, and rates are rising among migrants, reflecting changing immigration patterns and rising rates in their homelands.

Objective

This article reviews recent developments in TB of relevance to Australian general practice and provides an update of advances in the diagnosis and management of TB, and the role of the general practitioners in co-managing people with TB.

Discussion

First hand experience with imported multidrug resistant TB (MDR-TB) is increasing and is anticipated to rise in Australia. The reach of extensively drug resistant TB is also expanding. Although standard guidelines for management of drug susceptible TB remain unchanged, recent progress in the understanding, diagnosis and management of TB has occurred, driven by the need to respond to the challenges of MDR-TB and HIV-TB co-infection.

Appreciation of what's new in tuberculosis (TB) requires a perspective of what's old: Mycobacterium tuberculosis (MTB) and other members of the MTB complex (Table 1) have been infecting humans since antiquity.1,2 Being therefore consummately adapted to life within the human host,3 MTB infects up to one-third of the global population, is characterised by a dormant phase which confounds diagnosis and control, and in 2006 accounted for an estimated 9.2 million new cases and 1.7 million deaths worldwide.4

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Correspondence afp@racgp.org.au

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Topics

Infectious diseases Respiratory diseases

Type

Professional