Tuberculosis

 

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This issue is devoted to mycobacterial infections, including tuberculosis and infections caused by nontuberculous mycobacteria. Leading experts from around the world have contributed to this volume, and the material presented is timely and comprehensive.

Tuberculosis remains one of the world's great public health crises, with little sign of abating. This disease, known for centuries, continues to exact a heavy toll on the world's most vulnerable citizens. The issue dedicates considerable attention to this problem, with contributions from leading international experts in the areas of epidemiology, diagnosis, and treatment. Barun Mathema and colleagues provide a fascinating overview of the evolution of Mycobacterium tuberculosis and other important mycobacterial species. Work in this field has provided important insights that could be useful in studying the spread of disease around the world. Knut Lönnroth and Mario Raviglione from the World Health Organization give a comprehensive analysis of current global epidemiology of tuberculosis, bringing attention to the problems of drug resistant tuberculosis and HIV-associated tuberculosis. Drs. Burzynski and Schluger provide a detailed overview of tuberculosis epidemiology in the United States, which has had one of the most successful tuberculosis control programs in the world and is currently at historical lows in terms of numbers of cases. Carole Mitnick and colleagues provide outstanding insight into the problems of treating drug resistant tuberculosis, particularly in resource-limited countries. The enormously important topic of HIV-associated tuberculosis is covered by Dr. Wafaa El-Sadr, one of the world's great experts in this area, and her colleague, Dr. Simon Tsiouris.

The past several years have seen more attention focused on research in tuberculosis pathogenesis, diagnosis, and treatment than in many decades, and the most important work in those areas is presented here in expert reviews by Drs. Sterling, Nuermberger, Ginsberg, and Pai and O'Brien. These authors describe the use of animal models to test new drug combinations; developments in testing for latent infection and active disease, which are now coming into widespread clinical use; new drugs moving through the pipeline into advanced stages of clinical trials and development; and strategies to improve tuberculosis control efforts through more efficient treatment of latent infection.

In recent years in the United States and elsewhere (mainly in industrialized nations), there has also been a sharp increase in disease caused by nontuberculous mycobacteria. The most difficult to treat of these infections are covered here by outstanding physician-scientists. Drs. Shannon Kasperbauer and Charles Daley review the diagnosis and treatment of infections caused by Mycobacterium avium complex organisms, and Drs. Rhonda Colombo and Kenneth Olivier do the same for infections caused by rapidly growing mycobacteria. These expert contributions provide the most up-to-date thinking on these subjects, and the information is extremely valuable for practicing physicians.

We hope that this issue will educate its readers and prove useful to clinicians regarding important global public health issues, that it will stimulate many to think critically about the great challenges which these infections provide, and that it will encourage innovative thinking and research on these topics.

Neil W SchlugerM.D. 

Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center

PH-8E, Rm. 101, 622 W. 168th St., New York, NY 10032

Email: ns311@columbia.edu