TB or Not TB

g ■ Imost one-third of the world's population is infected with / 1 Mycobacterium tuberculosis, with about 8 million devel-JL -JL oping active disease and 2 million dying of the disease each year. Contributing to the problem is a raging AIDS pandemic that causes activation of latent tuberculosis. Moreover, the worldwide incidence of M. tuberculosis strains resistant to medications is rising steadily. Countries of Asia, Africa, and Latin America have tuberculosis rates 5 to 30 times as high as the United States; cur rently, more than 40% of tuberculosis cases in the United States occur in foreign-born individuals, and this percentage is rising. There is little prospect of new cheap, effective antitubercular medications, and BCG, the most widely used of all vaccines, has not controlled the disease. The short-term challenge is to apply tuberculosis control methods shown to be successful in some Western countries to the rest of the world. Beyond this, studies of the molecular biology of M. tuberculosis are revealing mechanisms of pathogenicity much more complex than simple possession of a protective lipid coat. The long-term challenge is to apply this new information to the development of better vaccines and antitubercular medications.

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