his coronaviral respiratory infection was first identiied in China in 2002, but no new cases have been reported since 2005. It caused atypical pneumonitis with a case-fatality rate of approximately 10 percent (Dolin, 2012). SARS in pregnancy had a case-fatality rate of up to 25 percent (Lam, 2004; Wong, 2004). Ng and coworkers (2006) reported that the placentas from 7 of 19 cases showed abnormal intervillous or subchorionic ibrin deposition in three, and extensive fetal thrombotic vasculopathy in two.
Tuberculosis is still a major worldwide concern. Indeed, it is estimated that a third of the world population is infected (Getahun, 2015). However, it is uncommon in the United
States. The incidence of active tuberculosis in this country has plateaued since 2000 (Scott, 2015). More than half of active cases are in immigrants (Centers for Disease Control and Pre vention, 2009b). Persons born in the United States have newly acquired infection, whereas foreign-born persons usually have reactivation of latent infection. In this country, tuberculosis is a disease of the elderly, the urban poor, minority groups especially black Americans, and patients with HIV infection (Khan, 2013; Raviglione, 2015).
Infection is via inhalation of Mycobacterium tuberculosis, which incites a granulomatous pulmonary reaction. In more than 90 percent of patients, infection is contained and is dor mant for long periods (Getahun, 2015; Zumla, 2013). In some, especially those who are immunocompromised or who have other diseases, tuberculosis becomes reactivated to cause clini cal disease. Manifestations usually include cough with minimal sputum production, low-grade fever, hemoptysis, and weight loss. Various iniltrative patterns are seen on chest radiograph, ated. Acid-fast bacilli are seen on stained smears of sputum in approximately two thirds of culture-positive individuals. Forms of extrapulmonary tuberculosis include lymphadenitis, pleural, genitourinary, skeletal, meningeal, gastrointestinal, and miliary or disseminated (Raviglione, 2015).
Resistance to antituberculosis drugs in the United States in the early 1990s was associated with emergence of strains of multidrug-resistant tuberculosis (MDR-TB). Because of this, the CDC (2009a) now recommends a multidrug regimen for initial empirical treatment of patients with symptomatic tuberculosis. Isoniazid, rifampin, pyrazinamide, and ethambutol are given until susceptibility studies are performed (Horsburgh, 2015). Cure rates with 6-month short-course directy observed therapy-DOT -approach 90 percent for new infections (Raviglione, 2015). Other second-line drugs may need to be added. Drug susceptibility is performed on all irst isolates.