It's more than 30 years since the tuberculosis sanitarium made its exit from the American landscape, and about as long since public health authorities talked confidently about the "white plague's" disappearing once and for all.
Antibiotics, the miracle of the 1950s, seemed likely to make that possible. It would have been the ultimate triumph of modern medicine: eradicating from this country an illness that, at the turn of the century, killed more people than heart disease, cancer or any other disease.
Not so fast.
As tuberculosis rates in the United States seemed headed toward the vanishing point, they made a surprising about-face. In 1989, TB rates increased 4.7 percent over the previous year. In 1990, the rate jumped another 9.4 percent.
The 25,700 people diagnosed with tuberculosis in the United States last year are one-tenth the numbers reported in the 1930s. But TB's sudden resurgence, in Maryland as elsewhere -- and the fertile breeding ground it has found among AIDS patients, immigrants and the poor -- have authorities concerned.
Particularly worrisome is the appearance of strains that have proved resistant to standard medications. This has some physicians fuming over what they consider the U.S. government's failure to anticipate the problem by funding research into new drugs when the disease was at its low point.
"We honestly thought TB was solved," says Dr. Lee Reichman, president of the American Lung Association, who accuses the federal government of forgetting about TB once it no longer seemed a crisis. "There was no need to develop new medicines when other diseases were pre-eminent."
Tuberculosis is caused by an airborne bacteria that infects the lungs and other organs. The infection usually lies dormant, held in check by the immune system. But it can erupt into a potentially deadly disease marked by intense coughing, chest pain, shortness of breath, fever and sweating.
Antibiotics are highly effective against TB, although the infection is more difficult to treat when it strikes people with immune system disorders such as AIDS.
Several forces are behind the re-emergence of tuberculosis:
* The disease is infecting large numbers of AIDS patients, people whose shattered immune systems are nearly defenseless against the TB bacteria.
