Provided treatment is started promptly HIV positive disease apparently responds as well as HIV negative. Lymph Gland TB Migration probably accounts for most of the increase in developed countries including our own. Since the 1960s we have been aware that tuberculosis is 20 to 30 times commoner in South Asians than in the white population. In decreasing order of frequency, there are, lymph nodes, usually cervical bone and join of which spinal disease accounts for half, abdominal abscesses at virtually any site, genito-urinary, menigeal and miliary. Unless the diagnosis of tuberculosis is considered in these cases, appropriate specimens, such as biopsy for smear and culture, may not be collected and the diagnosis missed.
Poverty is back on the agenda.
Lack of awareness that TB is still a problem, as illustrated by the cases, is certainly contributing to the increase. A Stitch in time saving 9 would be an appropriate motto for anyone interested in tuberculosis control. The until now, complacent health policy decision making has resulted in tremendous loss of expertise and resources in fighting the disease. Longevity too is playing a part in the increase. In developed countries, the highest rates are in the elderly, because they are the ones who were infected in early life as they lived through times of high prevalence.