Tuberculosis at the end of the twentieth century.

Tuberculosis has once again emerged as a significant public health problem in Western countries. Much of the rise has been fueled by the growing numbers of persons infected with HIV. Co-infection with Mycobacterium tuberculosis and HIV has been shown to result in high rates of active tuberculosis, and possibly in acceleration of progression to AIDS. Primary tuberculosis occurs at high rates among dually infected persons, further emphasizing the need for effective isolation of infectious cases. Recent preliminary studies have demonstrated that the survival of persons with multidrug-resistant tuberculosis can be six months and longer, far in excess of the 4 to 12 weeks reported previously. At least seven health care workers have died of occupationally-acquired multidrug-resistant tuberculosis, making control of the spread of tuberculosis in health care settings an urgent public health priority.