Tuberculosis: the global epidemic.

The modern era of tuberculosis(TB) began in the mid 1980s. In 1993, WHO took the unique step of declaring TB to be a world emergency. Despite this intervention it is estimated that deaths from TB will increase from 3 million a year currently to 5 million by the year 2050. There are 4 principal reasons: World population's increase, co-infection with HIV/AIDS, poverty and programme decline. Other causes contributing to the global epidemic are multidrug resistant TB, immigration, and indifference. The practical solution must concentrate on the completed correct treatment of the disease particularly in those who are sputum smear positive. For this reason WHO is vigorously promoting the Directly Observed Therapy Short course (DOTS) campaign. Doctors treating TB should ideally be part of the public health system. They should have access to first class bacteriological services, good quality of drugs and should make sure that the patient receives the drugs under supervision. Though the reasons for increasing TB are multifactorial it is within the capability of the world to re-exert control providing that the political will is present.

Hypercalcemia in active pulmonary tuberculosis and its occurrence in relation to the radiographic extent of disease.

The prevalence of hypercalcemia in tuberculosis in Hong Kong and its occurrence in relation to the radiographic extent of disease were studied in 57 patients with sputum smear (n = 44) and/or culture positive (n = 13) pulmonary tuberculosis and in five patients with military tuberculosis prior to treatment. Only one (1.6%) patient had a corrected plasma calcium level above the reference range for our laboratory. There was a positive relationship between the corrected plasma calcium levels and the radiographic extent of disease (r = 0.37), p < 0.01). As the occurrence of hypercalcemia in tuberculosis is known to be influenced by the calcium intake, our finding of a low prevalence of "absolute" hypercalcemia in Hong Kong could be related to the low dietary calcium intake in these subjects.