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TOMAN’S TUBERCULOSIS CASE DETECTION, TREATMENT, AND MONITORING
The second edition of this practical, authoritative reference book provides a rational basis for the diagnosis and management of tuberculosis. Written by a number of experts in the field, it remains faithful to Kurt Toman’s original question-and-answer format, with subject matter grouped under the three headings Case detection, Treatment, and Monitoring.
It is a testament to the enduring nature of the first edition that so much material has been retained unchanged. At the same time, the new edition has had not only to address the huge resurgence of tuber-culosis, the emergence of multidrug-resistant bacilli, and the special needs of HIV-infected individuals with tuberculosis, but also to encompass significant scientific advances. These changes in the profile of the disease and in approaches to management have inevitably prompted many new questions and answers and given a different complexion to others.
Toman’s Tuberculosis remains essential reading for all who need to learn more about every aspect of tuberculosis – case-finding, manage-ment, and effective control strategies. It provides invaluable support to anyone in the front line of the battle against this disease, from programme managers to policy-makers and from medical personnel to volunteer health workers.
QUESTIONS AND ANSWERS
SECOND EDITION
ISBN 92 4 154603 4
WORLD HEALTH ORGANIZATION WHO GENEVA
Toman’s Tuberculosis
Case detection, treatment, and monitoring – questions and answers
SECOND EDITION
Edited by
T. Frieden
WORLD HEALTH ORGANIZATION GENEVA 2004
WHO Library Cataloguing-in-Publication Data
Toman’s tuberculosis case detection, treatment, and monitoring : questions and answers / edited by T. Frieden. – 2nd ed.
1.Tuberculosis, Pulmonary – diagnosis 2.Tuberculosis, Pulmonary – drug therapy 3.Tuberculosis, Multidrug-resistant 4.Antitubercular agents – pharmacology I.Toman, Kurt. II.Frieden, Thomas R. III.Title: Tuberculosis case detection, treatment, and monitoring.
ISBN 92 4 154603 4 (NLM classification: WF 360) WHO/HTM/TB/2004.334
© World Health Organization 2004
All rights reserved.
The designations employed and the presentation of the material in this publication do not imply the expres-sion of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.Errors and omissions excepted,the names of proprietary products are distinguished by initial capital letters.
The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use.
The editor and authors alone are responsible for the views expressed in this publication.
Further information is available at: CDS Information Resource Centre, World Health Organization, 1211 Geneva 27, Switzerland; fax: (+41) 22 791 4285, e-mail: cdsdocs@who.int
Designed by minimum graphics Typeset in Hong Kong
Printed in China
Contents
Preface to the First Edition viii Preface to the Second Edition ix Introduction xi Acknowledgements for the First Edition xiii Acknowledgements for the Second Edition xiv Contributors xvi
Case detection
1. What is the role of case detection in tuberculosis control?1 F. Luelmo 3 2. What is a case of tuberculosis?1 F. Luelmo 5
3. What is the role of sputum microscopy in patients attending
health facilities? F. Luelmo 7
4. How many bacilli are present in a sputum specimen found positive
by smear microscopy? K. Toman 11
5. How reliable is smear microscopy? K. Toman 14
6. What are the main causes of false-positive and false-negative
sputum smears? K. Toman 23
7. What are the main consequences of false-positive and false-negative
sputum smears? T. Frieden 28
8. What are the advantages and disadvantages of fluorescence
microscopy? K. Toman 31
9. What is the role of mycobacterial culture in diagnosis and case
definition?1 A. Van Deun 35
10. What is the probability of obtaining a negative culture from a sputum specimen found positive by smear microscopy? K. Toman 44
1 Based on the chapter in the previous edition by K. Toman.
iii
TOMAN’S TUBERCULOSIS
11. What is the additional yield from repeated sputum examinations
by smear microscopy and culture?1 A. Harries 46
12. How reliable is chest radiography?1 R. Koppaka & N. Bock 51
13. What are the relative merits of chest radiography and sputum examination (smear microscopy and culture) in case detection
among new outpatients with prolonged chest symptoms?1 A. Harries 61
14. How does pulmonary tuberculosis develop and how can it be detected
at an early stage? K. Toman 66
15. What is the role of case detection by periodic mass radiographic
examination in tuberculosis control?1 H. Rieder 72
16. How does the diagnosis of tuberculosis in persons infected with
HIV differ from diagnosis in persons not infected with HIV? A. Harries 80
17. What is the role of tuberculin skin testing in the diagnosis of
tuberculosis? D. Menzies 84
18. What is the current and potential role of diagnostic tests other than
sputum microscopy and culture? D. Menzies 87
19. How can public and private sectors cooperate to detect, treat,
and monitor tuberculosis cases? T. Frieden 92
Treatment
20. What were the main landmarks in the development of tuberculosis
treatment? K. Toman 99
21. How does tuberculosis treatment work? K. Toman 102
22. What is the role of host factors in the pathogenesis, prevention, and
treatment of tuberculosis? M. Iademarco & M. Reichler 106
23. What is the therapeutic effect and what is the toxicity of autituberculosis drugs?1 T. Frieden & M. Espinal 110
24. What is the purpose of the initial intensive phase of two-phase
treatment? K. Toman 122
25. What are the current recommendations for standard regimens?
A. Harries 124
26. What are the diagnostic categories and what is the rationale for these categories? A. Harries 128
27. What is intermittent treatment and what is the scientific basis for intermittency?1 T. Frieden 130
1 Based on the chapter in the previous edition by K. Toman.
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