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Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis

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Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis. By Lee B. Reichman and Janice Hopkins Tanne. (McGraw-Hill Companies: 2003. Pg. 320.) ISBN: 0071422501.

Reviewed by Rochelle Caviness - June 25, 2004

The battle against tuberculosis (Tubercle Bacillus) has been long and deadly, but just a few years ago it looked like we were about to win. Our jubilation was short lived. Tuberculosis (TB) has emerged from its near defeat, strong and more virulent than before. To make matters worse, multi-drug-resistant strains of tuberculosis are growing more numerous. The reasons for the growing prevalence of multi-drug resistant strains are discussed in detail in Lee B. Reichman and Janice Hopkins Tanne's book, Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis.

In this eye-opening book, the authors explain the origin and spread of tuberculosis, and how drug-resistant varieties are cultivated. Reichman is well placed to author this book, as the director of New Jersey Medical School's National Tuberculosis Center, he has traveled the globe investigating epidemics of TB, advising on treatments, and offering advice on how to minimize the risks posed by this potentially deadly disease. Particular attention is devoted to the catastrophic rise of drug resistant TB in the countries of the former Soviet Union, and how the Russian prison system helps to foster the spread of the disease by housing infected and non-infected inmates together in cramped, overcrowded cells that often lack adequate ventilation. They also focus on how the spread of AIDS and HIV have contributed to the development of drug resistant strains of tuberculosis. Most alarming, they explain just how easy it is to become infected, and the arduous and time-consuming regiment that must be followed if there is any hope of a cure. Should patients fail to follow through with the prescribed treatment regiment, there is a risk that the strain of TB that they carry might become drug resistant.

According to the authors, more than a third of the world population is infected with latent TB - they carry it but are not currently infectious. This equals to about 15 million Americans. A person carrying latent TB can become infectious at anytime - especially if their immune system becomes compromised by disease, malnutrition, or stress. Only about 10% of those with latent TB ever become infectious. As TB is a highly contagious, airborne bacterium, the infection can easily be passed from one person to another, hence it has been called "Ebola with wings." The disease is spread via airborne droplets that are expelled by the infectious individual by sneezing, coughing, or just speaking. If the droplets are inhaled by a susceptible individual, they may develop TB. Multi-drug-resistant tuberculosis (MDR-TB) is a timebomb in the offing. Small, costly epidemics have erupted from time to time, but a major outbreak has not yet occurred - but it may only be a matter of time before small outbreaks, such as the one in New York City in 1991-92, begin to merge into a global pandemic.

Written for a general audience, Timebomb: The Global Epidemic of Multi-Drug-Resistant Tuberculosis contains very little medical jargon and it lacks a detailed statistical analysis of the threat posed by TB. However, there are sufficient statistics cited to, justifiably, alarm any reader. This book will also serve as a wake-up call to political leaders and public health officials as to the importance of funding research on Tuberculosis and the necessity of being ever vigilant in identifying and effectively treating those who are infected with the disease.

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