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Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.
This work contains updated and clinically relevant information about tuberculosis. It is aimed at providing a succinct overview of history and disease epidemiology, clinical presentation and the most recent scientific developments in the field of tuberculosis research, with an emphasis on diagnosis and treatment. It may serve as a practical resource for students, clinicians and researchers who work in the field of infectious diseases.
There have been calls to revisit the experiences of TB screening campaigns that were widely applied in Europe and North America in the mid-20th century, as well as more recent experiences with TB screening in countries with a high burden of the disease, and to assess their possible relevance for TB care and prevention in the 21st century. In response, WHO has developed guidelines on screening for active TB. An extensive review of the evidence has been undertaken. The review suggests that screening, if done in the right way and targeting the right people, may reduce suffering and death, but the review also highlights several reasons to be cautious. As discussed in detail in this book, there is a need to balance potential benefits against the risks and costs of screening; this conclusion is mirrored by the history of TB screening. This publication presents the first comprehensive assessment by WHO of the appropriateness of screening for active TB since the recommendations made in 1974 by the Expert Committee. However, the relative effectiveness and cost effectiveness of screening remain uncertain, a point that is underscored by the systematic reviews presented in this guideline. Evidence suggests that some risk groups should always be screened, whereas the prioritization of other risk groups as well as the choice of screening approach depend on the epidemiology, the health-system context, and the resources available. This book sets out basic principles for prioritizing risk groups and choosing a screening approach; it also emphasizes the importance of assessing the epidemiological situation, adapting approaches to local situations, integrating TB screening into other health-promotion activities, minimizing the risk of harm to individuals, and engaging in continual monitoring and evaluation. It calls for more and better research to assess the impact of screening and to develop and evaluate new screening tests and approaches.
With contributions by numerous experts
Before effective treatments were introduced in the 1950s, tuberculosis was a leading cause of death and disability in the United States. Health care workers were at particular risk. Although the occupational risk of tuberculosis has been declining in recent years, this new book from the Institute of Medicine concludes that vigilance in tuberculosis control is still needed in workplaces and communities. Tuberculosis in the Workplace reviews evidence about the effectiveness of control measuresâ€"such as those recommended by the Centers for Disease Control and Preventionâ€"intended to prevent transmission of tuberculosis in health care and other workplaces. It discusses whether proposed regulations from the Occupational Safety and Health Administration would likely increase or sustain compliance with effective control measures and would allow adequate flexibility to adapt measures to the degree of risk facing workers.
The WHO consolidated guidelines on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease is an updated and consolidated summary of WHO recommendations on systematic screening for tuberculosis (TB) disease, containing 17 recommendations for populations in which TB screening should be conducted and tools to be used for TB screening. TB screening is strongly recommendations for household and close contacts of individuals with TB, people living with HIV, miners exposed to silica dust, and prisoners. In addition, screening is conditionally recommended for people with risk factors for TB attending health care, and for communities with risk factors for TB and limited access to care (e.g. homeless, urban poor, refugees, migrants). General population screening is recommended in high-burden settings (0.5% prevalence or higher). Symptoms, chest radiography (CXR), and molecular WHO-recommended rapid diagnostic tests for TB are recommended as screening tools for all adults eligible for screening. Computer-aided detection programmes are recommended as alternatives to human interpretation of CXR in settings where trained personnel are scarce. For people living with HIV, C-reactive protein is also a good screening tool. This guideline document is accompanied by an operational handbook, the WHO operational handbook on tuberculosis. Module 2: screening – systematic screening for tuberculosis disease, that presents principles of screening, steps in planning and implementing a screening programme, and algorithm options for screening different populations.
Immunoregulation is one of the areas which has witnessed the most explosive advances of immunology during the past decade. It is in this area that the current view of the immune system has arisen and developed. There is indeed little doubt that immune reactions are primarily determined by messages which are genera ted within the immune system and passed among different types of immunologie cells. This cell communication not only determines the type, intensity and duration of the response after perturbation of the immune system by exogenous antigens, but it is also essential for preventing autoimmune reactions and their clinical conse quences. In order to assure aperfect balance within the enormous com plexity of the immune system, it is not surprising that multiple self-regulatory mechanisms are organized at different levels, such as antibody feedback, idiotypic-anti-idiotypic responses, suppres sor and helper T cells, lymphokine signals and genetic require ments. A nu mb er of observations in recent years have, however, demonstrated that consistent contributions to the immunological homeostasis are given also by signals generated outside of the immune system, namely,in the central and autonomous nervous system as weIl as in the endocrine apparatus. Furthermore, the interactions between the immune system and the other body homestatic mechanisms seem to be bidirectional: if immunological cells may be targets of neuroendocrinological factors, immunological products seem in turn to contribute to the neuro endocrine homeostasis.