Revised Guidelines for the Diagnosis and Control of Tuberculosis
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REVIEW ARTICLE
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Revised Guidelines for the Diagnosis and Control of Tuberculosis Impact on Management in the Elderly Paul Van den Brande Division of Pulmonology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 663 1. Tuberculosis in the Third Millennium: One Disease, Three Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . 664 2. Is Tuberculosis in the Elderly a Different Disease? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 665 3. Diagnosing Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 668 4. Control of Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671 4.1 Treatment of Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 671 4.1.1 Principles of Antituberculous Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 672 4.1.2 Antituberculous Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673 4.1.3 Antituberculous Regimens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 676 4.1.4 Initiation of Antituberculosis Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 678 4.1.5 Follow-Up During Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 679 4.2 Treatment of Latent Tuberculosis Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 680 4.3 Prevention of Transmission of Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 682 5. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683
Abstract
Despite major progress in the development of new strategies for diagnosing and treating tuberculosis, the disease still remains a major challenge for healthcare workers throughout the world. A number of causes are responsible for this threat but, unfortunately, many of these cannot be resolved easily because of cultural and social factors. Furthermore, not all countries throughout the world have enough financial resources to support educational and therapeutic programmes. The major challenges with tuberculosis are 2-fold: (i) to deal with the growing epidemic around the world (and especially in ‘low-income’ [developing] countries), and; (ii
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