Neil W. Schluger, M.D., chief of the Division of Pulmonary, Allergy and Critical Care Medicine at Columbia University Medical Center is senior author of a paper, "Use of X-Ray to Determine if First or Reactive Case of Tuberculosis," published in JAMA. Results of the study have valuable implications for public health as they show that the origin of an infected person''''s TB cannot be assumed by how the disease appears on their x-ray, as doctors previously believed.

Currently, if someone with TB presents with a "typical" x-ray of TB - where the disease is in the upper part of their lungs with holes forming in lung tissue, it is assumed that the disease had been dormant inside the carrier but is now growing -- known as a "reactivation of pulmonary TB." Conversely, if someone presents with an "atypical" x-ray showing swollen lymph-nodes in their chest, it is assumed that the TB was recently acquired -- known as primary or progressive TB.

Instead, Dr. Schulger and his team found that HIV status, which affects the integrity of the body''''s immune response, is the only independent predictor of how TB will appear on an x-ray. Therefore, when examining a newly diagnosed patient, the meaning for the community at large -- i.e., chance of spreading into a TB outbreak, etc. -- needs to be vastly reconsidered.

Dr. Schulger serves as chairman of the Steering Committee of the Tuberculosis Trials Consortium (TBTC), an international research group funded by the Centers for Disease Control and Prevention (CDC). The consortium is currently operating 30 clinical trials sites in six countries and has nearly 5,000 patients enrolled in studies assessing new treatments for latent and active TB.