Tuberculosis remains a worldwide problem despite well documented, well publicised methods of prevention and cure. Poverty and HIV infection are major reasons for its persistence. 1 2 We review the diagnosis, treatment, and prevention of tuberculosis.
How is pulmonary tuberculosis diagnosed?
Symptoms and signs
Literature, opera, and art have popularised the traditional symptoms and signs of pulmonary tuberculosis (box): cough, sputum, haemoptysis, breathlessness, weight loss, anorexia, fever, malaise, wasting, and terminal cachexia figure in various combinations, not only in the descriptions of the heroes, heroines, and villains but also among the artists, poets, and musicians themselves. 3 However, none of these symptoms is peculiar to tuberculosis. Nowadays, patients with pulmonary tuberculosis who present the full spectrum of symptoms and signs are unusual in developed countries, but doctors and health workers often see such patients in developing countries. Lung cancer has become a more common cause of some or all of these symptoms in developed countries, and, as cigarette smoking increases, this may well become the case in developing countries.
Epidemiological clues to diagnosis
Among immigrants to the West from the Indian subcontinent, sub-Saharan Africa, South East Asia, the Baltic states and Russia (especially if they were previously imprisoned 4 ), the prevalence of tuberculosis is much higher than among the native white population. 2 5 In the native population, tuberculosis is most commonly found among people living in poor conditions and in deprived areas, especially in elderly people and those with unstable social or psychiatric backgrounds, such as hostel dwellers, street dwellers, alcoholics, and drug misusers, as well as in immunocompromised patients. [6][7][8] In developing countries, tuberculosis is most common among very poor people, especially those who are severely malnourished or HIV positive. 1 8 9 Awareness, in both primary and secondary care, of these epidemiological facts increases the chances of prompt diagnosis of tuberculosis. Whereas postviral cough, asthma, reflux oesophagitis, postnasal drip, or lung cancer are more likely explanations in developed countries, cough that persists for more than three weeks despite treatment with a broad spectrum antibiotic should, in developing countries of Africa, Asia, and Europe, lead to examination of at least two