The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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The incidence of tuberculosis in the United States declined steadily until 1985 when increases were seen, in part due to the AIDS epidemic. Although the decline resumed in 1992, tuberculosis remains a public health problem in Louisiana and nationally. In Louisiana in 1997, HIV infection was present in 14% of persons with tuberculosis whose HIV status was known. ⋯ TB infection in immunocompetent persons under age 35 is treated with 6 months of isoniazid. TB disease is generally treated with 4 drugs until antimicrobial sensitivities are known. Directly observed therapy is an inexpensive way to ensure compliance and is routinely used for patients in Louisiana.
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In the decade since the gene responsible for cystic fibrosis (CF) was identified, our understanding of the pathophysiology of CF pulmonary disease has significantly improved. The current model for CF lung disease suggests several levels at which clinical interventions may be made in an attempt to alter the natural course of disease progression. ⋯ New developments in well-established modes of therapy such as mucolytic therapy, airway clearance therapy, and antibiotic therapy are discussed next. The review concludes with a look at the use of two forms of therapy that have been adapted to CF care, anti-inflammatory therapy and lung transplantation.
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The diagnosis of infection and disease due to Mycobacterium tuberculosis in infants and children presents many clinical challenges. The distinction of infection from disease (tuberculosis) in children is often unclear. There is difficulty in obtaining positive microbiological confirmation of infection in sputum, gastric, tracheal, or bronchial aspirates and in other body fluids in infants and children. ⋯ Children become infected from exposure to an adult or adolescent with contagious pulmonary tuberculosis. The results of drug susceptibility tests in the source case in contact with an exposed child can guide the antituberculous chemotherapy. Chemotherapy regimens for treatment of pediatric tuberculosis have become shorter and more intensive with a marked increase in directly observed therapy (DOT).