BACKGROUND: The incidence of tuberculosis (TB) in the United States has declined following a logarithmic pattern, with few exceptions. One exception was during the acquired immunodeficiency syndrome (AIDS) epidemic, which was thought to have caused the deviation. However, since then, alternative explanations have been proposed, including the increased burden of chronic diseases, immigration, and the increase in the use of immune suppressant medications.CONCLUSIONS: The HIV/AIDS epidemic likely played a significant role in the 1979-1985 deviation, but not subsequently. Furthermore, EPTB as a proportion of total TB cases has remained high. Further studies to delineate the etiologies of these findings are needed.METHODS : Epidemiological data of the Center for Disease Control and Prevention (CDC) and the Bureau of the Census were analyzed regarding TB incidence, human immunodeficiency virus (HIV) infection, immigration status, and age for the period 1953-2011.RESULTS : Data analysis identified a deviation from the logarithmic decline in TB cases that started in the mid- 2000s. This divergence did not appear to be related to HIV status. The overall decline in TB cases since 1953 has been almost exclusively due to a reduction in pulmonary TB (PTB) and not to extra-pulmonary TB (EPTB).

Magister Scientiae Dentium - MSc(Dent) / Tuberculosis is the world’s leading cause of death from a single infective agent. The World Health Organisation has declared the disease a “global emergency”. Extrapulmonary presentations form a major proportion of new cases, especially since the advent of the acquired immunodeficiency syndrome epidemic. Therefore, it is important that oral health care workers are aware of tuberculosis in the head and neck region and its varied manifestations. This study reports on one hundred and four patients diagnosed with tuberculosis and with head and neck tuberculosis lesions.The aim of the study was to determine the extent to which tuberculosis presents in the head and neck region. It was a descriptive, retrospective, record-based study on a cohort of tuberculosis patients that presented with head and neck tuberculosis at private practices in the Durban area over a fourteen month period. A structured data capture sheet was the method chosen for recording the data.The majority of the sample (89.4%) had tuberculosis of the head and neck lymph nodes, five (4.8%) had tuberculosis of the tonsil, two (1.9%) had tuberculosis of the larynx, two (1.9%) had tuberculosis of the ear, one (1%) had parotid gland tuberculosis and one (1%) had tuberculosis of the nose. The records indicate that excision biopsy and histopathological examinations were used to make a diagnosis. A third (33.7%) of the patients were confirmed with human immunodeficiency virus infection.A high index of suspicion of tuberculosis is important in the differential diagnosis of neck swellings, hoarseness and otorrhoea and in human immunodeficiency virus positive patients with an enlarging neck mass. A biopsy is usually necessary for diagnosis. Successful outcome depends upon appropriate chemotherapy and timely surgical intervention when necessary. Oral health care workers need to be fully cognizant of all the various presentations of head and neck tuberculosis to allow early diagnosis and quick commencement of appropriate treatment.

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