[Tuberculosis: epidemiological, bacteriological and therapeutic changes].

The regular decline in the incidence of tuberculosis up to 1985 left us with the hope that the disease might one day be totally irradicated. But from 1985 on the number of cases has remained unchanged at about 8000 new cases per year in France. Resistant strains have also been identified, requiring new treatment strategies. Polyresistant strains may develop because of non-compliance to standard treatment or, particularly in immunosuppressed patients with AIDS, infection with atypical mycobacteria such as Mycobacterium avium. In developed countries, prophylactic measures for tuberculosis should be based on early diagnosis, rapid initiation of a proven treatment protocol not only to obtain cure but also to reduce contagion, and avoiding contract between high-risk patients. Chemoprophylaxy should be prescribed in case of doubt about contact as the tuberculin test is no longer discriminate due to widespread vaccination. For AIDS patients, the treatment protocol is the same as for normal subjects but should be prolonged. In case of M. avium infection, the most effective treatment combines pyrazinamide, clarithromycin and a third anti-tuberculosis drug.