[Tuberculosis in Switzerland--a millenium problem?].

Abstract

In Switzerland a family physician sees a case of tuberculosis only every 4-6 years. While tuberculosis does not seem to be a major medical challenge in western countries, it is a real problem in the developing world. Nevertheless, special situations do arise in the western hemisphere where the standard therapy needs to be changed. HIV-positive patients are at greater risk of contracting tuberculosis after exposure, and therapy must be adjusted to the patient's immunological status. Multidrug-resistant tuberculosis is a major challenge to the attending physician, and takes us back to the time before antitubercular drugs existed. Standard medication is ineffective and we have to fall back on alternative drugs. Compliance of patient and physician are crucial for effective treatment, as in the case of all long-term therapy. Medical staff, and especially hospital personnel in emergency and tuberculosis departments, are at high risk of infection. Younger staff are no longer immunised by vaccination or earlier infection as they were a few decades ago. Multidrug-resistant bacteria pose a real threat for these groups and effective protection against transmission is important. Discovering a new vaccine which provides adequate immunisation is the only way to tackle the problem of tuberculosis worldwide. New drugs must also be developed to treat those already suffering from the disease.