A Textbook of Clinical Pharmacology and Therapeutics

●Introduction 334

●Principles of management of Mycobacterium

tuberculosisinfections 335

●First-line drugs in tuberculosis therapy 336

●Tuberculosis and the acquired immune deficiency

syndrome 338

●Second-line drugs and treatment of refractory

tuberculosis 338

●Mycobacterium lepraeinfection 339

CHAPTER 44

44 Mycobacterial infections

INTRODUCTION

Tuberculosis (‘consumption’) was the most common cause of
death in Victorian England, but its prevalence fell markedly
with the dramatic improvement in living standards during the
twentieth century. However, the incidence of Mycobacterium
tuberculosisinfection world-wide (including Europe, UK and
USA) is increasing, particularly among immigrants and in
human immunodeficiency virus (HIV)-related cases. Infection

withMycobacterium tuberculosisusually occurs in the lungs,

but may affect any organ, especially the lymph nodes, gut,

meninges, bone, adrenal glands or urogenixtal tract. Other

atypical (non-tuberculous) mycobacterial infections are less

common, but are occurring with increasing frequency in

HIV-1-infected individuals. Mycobacterium tuberculosisis an

intracellular organism, an obligate aerobe in keeping with its

predilection for the well-ventilated apical segments of the

lungs (Figure 44.1).

(a) (b)

Figure 44.1:Chest x-rays showing pulmonary tuberculosis: (a) cavitating tuberculosis; (b) tuberculous empyema.