Interventions for Tuberculosis Control and Elimination 2002
Interventions for Tuberculosis Control and Elimination 2002
Interventions for Tuberculosis Control and Elimination 2002
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cipal consideration is the prevailing uncertainty about the quality of bacteriologic<br />
examinations (sputum smear microscopy) in many national tuberculosis<br />
programs.<br />
Clinical trials in extrapulmonary tuberculosis<br />
Two <strong>for</strong>ms of extrapulmonary tuberculosis have been studied in welldesigned<br />
clinical trials: tuberculosis of peripheral lymph nodes <strong>and</strong> tuberculosis<br />
of the spine. The treatment of tuberculosis of the central nervous<br />
system has been subject to numerous investigations, but because of the<br />
small cases in each study, the certainty about the optimum treatment is limited.<br />
<strong>Tuberculosis</strong> of peripheral lymph nodes<br />
In many populations, tuberculosis of peripheral lymph nodes (particularly<br />
cervical <strong>and</strong> axillary) is the most frequent extrapulmonary manifestation of<br />
tuberculosis. 530 While in the past, in milk-consuming cultures, tuberculosis<br />
of peripheral lymph nodes may frequently have been caused by M. bovis,<br />
particularly in children, it is now almost universally caused by M. tuberculosis,<br />
531 it is found in all age groups, but with a predilection <strong>for</strong> the<br />
young 532,533 <strong>and</strong> <strong>for</strong> females. 530<br />
It appears that treatment of lymphatic tuberculosis was long considered<br />
to be a surgical domain, due to a misunderst<strong>and</strong>ing of it as a localized<br />
disease process. This concept was demonstrated to be erroneous in a<br />
retrospective study conducted among cases diagnosed between 1965 <strong>and</strong><br />
1973 in the United Kingdom. 534<br />
A prospective study of the treatment of tuberculosis of peripheral lymph<br />
nodes was carried out in the United Kingdom, comparing two 18-month<br />
regimens, one with isoniazid plus ethambutol, the other with isoniazid plus<br />
rifampicin throughout, <strong>and</strong> both supplemented by streptomycin during the<br />
first two months. 476 No difference in treatment results between the two<br />
groups was found.<br />
In a second prospective study, conducted by the British Thoracic Society,<br />
an 18-month regimen was compared with a nine-month regimen. 535,536 Both<br />
regimens were based on isoniazid plus rifampicin throughout <strong>and</strong> supplemented<br />
by ethambutol during a two-month intensive phase. No difference<br />
in treatment outcome was identified between the two regimens.<br />
71
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