- N Engl J Med 2022; 387:842-843
The development of a highly effective, oral, 6-month regimen for the treatment of multidrug-resistant tuberculosis, which previously took 18 to 24 months to cure, is one of the defining achievements of the tuberculosis research community in this century. The results of the Nix-TB study, which were published in the
- N Engl J Med 2022; 387:850-852
Investigators report findings from the use of an all-oral regimen of bedaquiline, pretomanid, and linezolid in patients in the United States with multidrug-resistant or extensively drug-resistant tuberculosis.
- N Engl J Med 2022; 387:810-823
A randomized trial of bedaquiline–pretomanid–linezolid for highly drug-resistant tuberculosis assessed the use of linezolid at 600 or 1200 mg for 9 or 26 weeks; the 600-mg dose for 26 weeks had a favorable profile.
- N Engl J Med 2022; 386:1490-1493
Amid pandemic-related disruptions in services, tuberculosis case notifications have plummeted and mortality has increased. The path to recovery will require immediate, short-term steps and longer-term actions.
- N Engl J Med 2022; 386:1470-1474
When Paul Farmer died in February, it became clear to the world that he had saved millions of lives. He did so by valuing every life equally and refusing to accept constraints. Many of us enter medicine hoping to change the world; Farmer actually did it.
- N Engl J Med 2022; 386:1380-1382
Tuberculosis continues to be a major public health challenge worldwide. Investigators in Vietnam found that a community-wide case-finding program reduced the incidence of new tuberculosis cases over a 4-year period.
- N Engl J Med 2022; 386:e30
A 36-year-old woman presented with acute-onset abdominal pain and subacute constitutional symptoms. Subdiaphragmatic free air was seen on imaging, and she was taken to the operating room, where ileal perforations were seen. Tissue cultures grew Mycobacterium tuberculosis, confirming a diagnosis of intestinal tuberculosis.
- N Engl J Med 2022; 386:988-989
Well before the Covid-19 pandemic disrupted tuberculosis care,1 long treatment duration has been a weak link in the continuum of care. But the past decade has been a turning point in the pioneering of shorter treatment and differentiated care, as opposed to the traditional, one-size-fits-all approach. Shortening of...
- N Engl J Med 2022; 386:911-922
Completing 6 months of treatment for tuberculosis in children is a challenge. In this open-label trial involving 1204 children in sub-Saharan Africa and India, 4 months of antituberculosis therapy was noninferior to 6 months of therapy.
- N Engl J Med 2022; 386:463-477
FUO despite a high-quality workup after a reasonable amount of time has elapsed to rule out self-limited fevers remains a challenge. The clinician must pay close attention to the patient history, aided by the development of molecular diagnostic tests, to distinguish infections from other causes.
- N Engl J Med 2022; 386:93-94
Bedaquiline use began in 2015 in South Africa to treat drug-resistant tuberculosis. A non–target-based mutation in the mmpR (Rv0678) gene encoding an efflux pump repressor has been identified in the majority of bedaquiline-resistant isolates over the past 5 years.
- N Engl J Med 2021; 385:2441-2450
A cluster-randomized trial in 20 Ugandan health centers compared a multicomponent strategy (on-site molecular testing for TB, restructuring of clinic workflows, and feedback of quality metrics) with routine care (on-site sputum-smear microscopy and referral-based molecular testing). The intervention led to greater numbers of patients being tested for, receiving a diagnosis...
- N Engl J Med 2021; 385:2271-2280
Persons with risk factors for Mycobacterium tuberculosis exposure or for progression to tuberculosis disease should be tested for M. tuberculosis infection, preferably with an interferon-γ release assay. After tuberculosis disease is ruled out, those at increased risk for progression should be treated, preferably with a rifamycin-based...
- N Engl J Med 2021; 384:1705-1718
In this phase 3 trial for the treatment of tuberculosis, a 4-month rifapentine-based regimen containing moxifloxacin was noninferior to a standard 6-month regimen.
- N Engl J Med 2021; 384:1764-1765
One of the great satisfactions of managing infectious diseases is the remarkable and rapid efficacy of antibiotics. The first uses of penicillin in the treatment of pneumococcal pneumonia produced near miraculous results, and most bacterial infections can be cured with a few days of therapy. However, tuberculosis has been an...
- N Engl J Med 2021; 384:e36
A 36-year-old woman presented with cough and shortness of breath. A chest radiograph showed fine micronodular opacities. A transbronchial biopsy revealed microliths, and a diagnosis of pulmonary alveolar microlithiasis was made.
- N Engl J Med 2021; 384:651-662
A 68-year-old man with a history of bladder cancer presented with delirium, renal insufficiency, unintentional weight loss, and leukopenia. Examination was notable for a subtle facial droop on the left side, bibasilar crackles in the lungs, and hepatosplenomegaly. A diagnosis was made.
- N Engl J Med 2021; 384:166-176
A 76-year-old woman with a history of gastric adenocarcinoma and chronic kidney disease presented with lethargy and altered mental status. She had anemia and thrombocytopenia; MRI showed foci of restricted diffusion in the left cerebellar hemisphere and right frontal lobe. A diagnostic test was performed.
- N Engl J Med 2020; 383:2159-2169
A 35-year-old man was admitted to the hospital with lymphadenopathy and thrombocytopenia (platelet count, 0 per microliter). Four months earlier, painless lymphadenopathy had developed in the groin area; a biopsy specimen of an enlarged lymph node showed necrosis, fibrosis, and inflammation but no malignant cells. A diagnostic procedure was performed.
- N Engl J Med 2020; 383:1878-1884
A previously healthy 50-year-old man presented to the emergency department with a 5-day history of sharp pleuritic chest pain on the left side, dry cough, and palpitations and a 4-week history of intermittent fevers, chills, anorexia, weight loss, and fatigue.