TB : the forgotten plague.

AIDS and homelessness, often in combination, are bringing tuberculosis back to the western world. Sanatoria were closed in the 1960s in the belief that TB had been defeated but London and New York are facing a resurgence of the disease. The history of TB treatment is summed up and a new chapter is added - the challenge of drug-resistant TB, brought about through uncompleted treatment. This problem is highlighted by a report from New York where homeless sufferers have to be sought out and persuaded to accept regular medication. In the Third World, also, TB is a frequent result of HIV infection. However, the AIDS epidemic in Zambia has prompted good primary TB care with the aid of the London School of Hygiene and Tropical Medicine ZAMBART project. Asia, too, has a great TB drug- resistance problem due to the proliferation of private practice together with chaotic prescribing. In Britain, the greatest danger of TB is to elderly and HIV positive people and drug addicts. It must be diagnosed fast to ensure effective treatment. With an annual world figure of 3 million TB deaths the West is belatedly investing in TB research once more.