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Toman's Tuberculosis: Case Detection, Treatment and Monitoring - Questions and Answers

Posted on: Thursday, 8 September 2005, 03:00 CDT

Toman's tuberculosis: Case detection, treatment and monitoring - Questions and answers, 2nd edition, T. Frieden, editor (World Health Organization, Geneva) 2004. 332 pages. Price: Sw.fr.80.00/US $ 72.00; in developing countries: Sw.fr. 40.00 ISBN 92-4-154602

It is strange that a reference work such as 'Tuberculosis case- finding and Chemotherapy' by Kurt Toman, for long considered a Bible for all those dealing with the diagnosis, treatment and control of tuberculosis, initially published more than 25 yr ago, has only now been considered worthy of a second edition. It has now been rechristened Toman's Tuberculosis: case detection, treatment and monitoring. The additional section on 'Monitoring' underlines the importance of this facet of tuberculosis control in the current approach to handling tuberculosis and makes the book of particular relevance to tuberculosis programme managers.

The second edition of this much-valued tome retains the user- friendly question-answer format of the first edition. It is extensively referenced and provides the scientific evidence for many of the practices and principles of tuberculosis control.

The subject of DOTS and the impact of the HIV epidemic on all aspects of tuberculosis required new sections and these have been covered adequately. The book has drawn on the experience of many experts in the field of epidemiology, clinical trials and public health aspects of tuberculosis.

In the section on 'case Detection' there are new chapters on the role of sputum microscopy in patients attending health facilities, the consequences of false-positive and false-negative sputum smear examination results, the role of mycobacterial culture in diagnosis and case detection, the diagnosis of tuberculosis in patients infected with HIV, the significance of tuberculin skin testing in the diagnosis of tuberculosis, the role of diagnostic tests other than sputum microscopy and culture, and public-private partnerships in case detection, treatment and monitoring of tuberculosis. The last two chapters are of particular importance and relevance in the current global scenario and have naturally provoked extensive debate and discussion.

The section on 'Treatment' has been extensively rewritten. The chapter on main landmarks in the development of TB treatment has been strengthened with the various developments in short-course chemotherapy. Similarly the chapter on pathogenesis, prevention and treatment of tuberculosis has been revised to reflect current knowledge on these issues. The chapter on intermittent treatment has also been recast to present the wide body of evidence to support the scientific validity of intermittent treatment. This has particular significance as the WHO recommendation of DOTS for the global control of tuberculosis has offered the option of either thriceweekly or daily treatment for the different treatment regimens and it is appropriate that the scientific evidence for this has been so well reviewed.

In addition, there are new chapters on current recommendations for standard treatment, current diagnostic categories and the rationale for these categories, the scientific basis for dosage of drugs for daily and intermittent treatment, adverse reactions and management of anti-TB drugs, the management of extra-pulmonary tuberculosis, the treatment of tuberculosis in the presence of pregnancy, hepatic or renal disease, treatment of tuberculosis in HIV infected persons, default for treatment, advantages of directly observed treatment, causes for treatment failure and measures to prevent poor treatment outcome, pros and cons of fixed-dose combinations of TB drugs, special precautions for protecting rifampicin, the causes of drug-resistant tuberculosis, measures to prevent the emergence of drug resistance, and the role of treating latent tuberculosis infection in a TB control programme and its epidemiological impact.

There is an entire new section on Monitoring covering the substantial literature on issues such as economic and social burden of tuberculosis. One of the attractions of Toman's Tuberculosis is its portability, in both its paperback and hardback versions, which permit it to be carried handily for ready reference.

This revised edition presents an integrated approach to the control of tuberculosis. Most importantly, it presents the evidence base for the diagnosis, treatment and control of tuberculosis. It is pertinent to bear in mind that tuberculosis presents challenges both to the physician treating an individual patient and to the programme manager dealing with the control of the disease in the community. These two approaches can no longer be divorced from each other. In this context Toman's Tuberculosis is just the right book to serve these different needs. It is also an example of how the fruits of research can be channeled into practice and into policy as it documents extensively, often in chronological order, the various research studies, in the form of randomized clinical trials that have influenced the many changes in the management of this disease over the decades. It should continue to be a 'must-read' for both the student and the expert in tuberculosis with special interest for TB Control Programme Managers and should find a place in the shelf of all major libraries including that of medical colleges.

S. Jawahar

Tuberculosis Research Centre

Spur Tank Road, Chetput

Chennai 600031, India

Copyright Indian Council of Medical Research Jul 2005

Source: Indian Journal of Medical Research

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