Despite the existence of curative therapy for disease, effective treatment for infection, and the fact that the bacillus Calmette-Guerin (BCG) vaccination has been given to approximately 4 billion people, Mycobacterium tuberculosis remains the single pathogen causing the most disease and death in the world today. The World Health Organization (WHO) has estimated that during the 1990s, there will be 90 million cases of tuberculosis and 30 million deaths caused by tuberculosis throughout the world.<sup>44 Raviglione M.C., Snider D.E., Kochi A. Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic JAMA 1995 ;  273 : 220

Cliccare qui per andare alla sezione Riferimenti</sup> Approximately 15 million cases and 4.5 million deaths will occur among children.<sup>33 Kochi A. The global tuberculosis situation and the new control strategy of the World Health Organization Tubercle 1991 ;  72 : 1  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The true tragedy of tuberculosis is that the medical tools exist to address the problem, yet they have not reached the people most in need of them.

Many industrialized countries, including the United States, have experienced a resurgence of tuberculosis during the past 10 years. Although the burden of infection and disease has been far less in these countries than in the developing world, this resurgence has received attention because it reflects a weakening of the public health system in these countries. The pool of persons infected with M. tuberculosis in the United States has increased dramatically during the past decade. Many primary care practitioners who previously had little experience with tuberculosis-related issues now find themselves facing these problems fairly regularly.

The purpose of this article is to address tuberculosis from the point of view of the busy primary care practitioner who cares for children in the United States. During the past few years, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP)<sup>2 American Academy of Pediatrics Report of the Committee on Infectious Diseases Elk Grove, Illinois: American Academy of Pediatrics (1994).  480500

Cliccare qui per andare alla sezione Riferimenti, 3 American Academy of Pediatrics, Committee on Infectious Diseases Chemotherapy for tuberculosis in infants and children Pediatrics 1992 ;  89 : 161

Cliccare qui per andare alla sezione Riferimenti, 4 American Academy of Pediatrics, Committee on Infectious Diseases Screening for tuberculosis in infants and children Pediatrics 1994 ;  93 : 131

Cliccare qui per andare alla sezione Riferimenti, 5 American Academy of Pediatrics, Committee on Infectious Diseases Update on tuberculosis skin testing of children Pediatrics 1996 ;  97 : 282

Cliccare qui per andare alla sezione Riferimenti</sup> have issued many new and, at times, seemingly conflicting recommendations about the evaluation and testing of children for tuberculosis infection and disease. Although these recommendations are based on good science and public health principles, they are sometimes difficult to apply in an office practice. With some fairly simple changes in approach,

however, the primary care practitioner can address tuberculosis-related issues in a fairly simple and straightforward manner.