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Occult Endemic Tuberculosis in a Chronic Care Facility

Published online by Cambridge University Press:  21 June 2016

Carole Brennen ,
Robert R. Muder  and
Paul W. Muraca
Carole Brennen
Affiliation:
Infectious Disease Section, Department of Medicine, Pittsburgh, Pennsylvania
Robert R. Muder*
Affiliation:
Infectious Disease Section, Department of Medicine, Pittsburgh, Pennsylvania Veterans Administration Medical Center, and the Department of Medicine, The Mercy Hospital of Pittsburgh, Pittsburgh, Pennsylvania
Paul W. Muraca
Affiliation:
Special Pathogens Laboratory, Pittsburgh, Pennsylvania
*
Infection Control, VA Medical Center, University Drive C, Pittsburgh, PA 15240
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Abstract

During the course of a tuberculosis skin testing program at a chronic care Veterans Administration Medical Center, we uncovered evidence of occult transmission of endemic tuberculosis. Skin test conversion of eight patients (one of whom had unsuspected progressive primary tuberculosis) and two employees was ultimately traced to a patient in whom tuberculosis was first diagnosed at autopsy three years earlier. Identification of employee skin test conversions was a key factor in recognizing and terminating disease transmission. Throughout the institution, 33% of patients were tuberculin-positive; 10.8% demonstrated the booster phenomenon after initial negative skin tests. Prevalence of tuberculin positivity among employees was 28%. Twelve percent of initially tuberculin-negative employees converted during employment. Our experience documents the value of tuberculin testing of both patients and staff in a chronic care environment, and the necessity of vigorous investigation of skin test conversions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 9 , Issue 12 , December 1988 , pp. 548 - 552
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1988

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