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PubMed1985

Enzyme-linked immunosorbent assay using Mycobacterium tuberculosis antigen 5 and PPD for the serodiagnosis of tuberculosis.

Enzyme-linked immunosorbent assays (ELISA) of immunoglobulin G antibody to Mycobacterium tuberculosis antigen 5 and tuberculin purified protein derivative (PPD) were assessed for the serodiagnosis of tuberculosis in 41 patients with active tuberculosis, 19 patients with inactive tuberculosis, and 59 healthy control subjects. Patients with active tuberculosis were studied serially at monthly intervals following the initiation of therapy. When contrasted with our earlier studies of sera from patients in Bolivia and Argentina, serum titers in Cleveland patients with active tuberculosis were somewhat lower. Geometric mean titer in patients with active tuberculosis was 1:68 with antigen 5 and 1:46 with PPD. Titer was correlated with patient age, male sex, extent of tuberculosis, and history of prior tuberculosis. However, these associations were not statistically significant. During monthly follow-up for 16 months after the initiation of therapy, ELISA titers remained essentially stable. Thus, no convincing evidence was acquired to support the hypothesis that higher titers in sera from South American patients related to more chronic or more extensive disease. Receiver operating characteristics of ELISA with antigen 5 were better than those obtained using PPD and were similar to those reported by others for sputum smear. In a situation where tuberculosis screening is warranted, ELISA with antigen 5 might have a place if it recognizes a different population than does sputum smear.

Adult↗

PubMed2000

Pulmonary mononuclear cell responses to antigens of Mycobacterium tuberculosis in healthy household contacts of patients with active tuberculosis and healthy controls from the community.

Protective immunity against Mycobacterium tuberculosis requires CD4+ lymphocyte-mediated immune responses and IFN-gamma activity. As the primary portal of entry of M. tuberculosis is the lung, pulmonary immune responses against multiple M. tuberculosis Ags were compared between both M. tuberculosis-exposed tuberculin skin test-positive healthy household contacts (HHC) of patients with active sputum smear and culture-positive tuberculosis and tuberculin skin test-positive healthy control individuals from the community (CC). Frequencies of M. tuberculosis Ag-specific IFN-gamma-producing cells, IFN-gamma concentrations in culture supernatants, and DNA synthesis in bronchoalveolar cells (BAC) and PBMC were studied in HHC (n = 10) and CC (n = 15). Using enzyme-linked immunospot assay we found higher frequencies of IFN-gamma-producing cells with specificity to M. tuberculosis-secreted Ag 85 (Ag 85) in BAC from HHC than in BAC from CC (p < 0.022) and relative to autologous PBMC, indicating compartmentalization of Ag 85-specific cells to the lungs. Further, IFN-gamma-producing cells with specificity to components A and B of Ag 85 were specifically compartmentalized to the lungs in HHC (p < 0. 05). IFN-gamma concentrations in culture supernatants of BAC and Ag-specific DNA synthesis were low and comparable in the two subject groups. Increased immune responses to Ag 85 at the site of repeated exposure to M. tuberculosis (the lung) may represent an important component of protective immunity against M. tuberculosis. Correlates of protective immunity against M. tuberculosis are required for assessment of the efficiency of anti-tuberculous vaccines.

Acyltransferases↗

PubMed2000

[Transmission of tuberculosis in Gironde: epidemiologic investigation by genomic analysis of Mycobacterium tuberculosis].

BACKGROUND: Over the past few years, epidemiologic surveys of tuberculosis have been strengthened by new biologic technology, in particularly using RFLP (Restriction Fragment Length Polymorphism). This technique, which identifies Mycobacterium tuberculosis patterns, has allowed to study thoroughly tuberculosis bacilli transmission and pathogenesis. First applied on tuberculosis epidemics in at risk groups, RFLP has now an interest in the epidemiologic molecular survey of urbans populations. The aim of this study is to identify, in a French department, the proportion of clustering cases of tuberculosis, suspected of recent contamination. METHODS: An active surveillance of tuberculosis allows to record systematically the cases of tuberculosis-disease in Gironde. All M. tuberculosis isolates from the patients reported in this surveillance system were processed through IS6110 based RFLP analysis. Patients were interviewed face to face before this analysis, using a standardised data collection instrument. RESULTS: 102 patients were included in 1997; the RFLP analysis of all available strains identifies a high degree of polymorphism with 71 unique patterns; twelve groups with clustering patterns were found, grouping two (nine clusters), three (two clusters) and seven patients (one cluster) each. Those cases suspected of recent transmission were younger (age<60 years) and lived in poorer conditions. Epidemiologic links were confirmed in only 35% of the 31 patients clustered. CONCLUSION: This community survey analysis has allowed to identify at risk groups for tuberculosis transmission and to strengthen tuberculosis control in Gironde.

Adolescent↗

PubMed2000

[Usefulness of detecting Mycobacterium tuberculosis by genome amplification in the diagnosis of childhood pulmonary tuberculosis].

OBJECTIVE: To evaluate the polymerase chain reaction in the diagnosis of pulmonary tuberculosis in children. PATIENTS AND METHODS: 135 samples (68 sputum and 67 gastric aspirates) of 72 patients under 15 years old with suspected tuberculosis and a negative acid-fast stain were included in the study. In all the samples an acid-fast stain and culture in Lowestein-Jensen with and without piruvate were performed. Also, a specific detection of Mycobacterium tuberculosis complex (MT) was made by PCR (Amplicor-MT-Roche Diagnostic). Tuberculosis was certainly diagnosed when M. tuberculosis was isolated or clinical evidence of tuberculosis in positive-PCR cases with negative culture was achieved. RESULTS: Ten samples of six patients were positive culture. Four of these samples were positive PCR. In addition, two samples of two patients with negative culture were positive PCR. Both patients had a clinical diagnosis of pulmonary tuberculosis with effective anti-tuberculosis treatment, one of them had also another positive PCR and culture sample. The results of sensitivity, specificity, positive predictive value and negative predictive value by patient according to the reference methodology were 57.1, 100, 100 and 95.4%, respectively, and by sample 66.6%, 100, 100 and 96.8%, respectively. Other 15 patients presented pulmonary tuberculosis with negative PCR and culture; so the sensitivity of the culture and the PCR regarding a clinical diagnosis were 27.3% (6/22) and 18% (4/22) respectively. CONCLUSION: Due to the diagnosis by culture takes a long time and the low percentage of samples of pediatric patients with positive acid-fast rain stain, the PCR would be useful in order to achieve quickly and specific diagnosis of tuberculosis in a high-prevalence population.

Adolescent↗

PubMed2001

Clinical utility of polymerase chain reaction in the detection of Mycobacterium tuberculosis in different types of cutaneous tuberculosis and tuberculids.

INTRODUCTION: The role of polymerase chain reaction (PCR) in the diagnosis of cutaneous tuberculosis in clinical practice has not been defined as no PCR assay has been tested in a large-scale clinical study. The objective of this study was to test the clinical utility of a PCR assay in the diagnosis of different types of cutaneous tuberculosis and tuberculids. MATERIALS AND METHODS: Analysis of archival biopsy specimens by a nested PCR assay targeting IS6110 of Mycobacterium tuberculosis (M. tb) DNA was performed in a tertiary-care skin hospital in Singapore. PCR results were compared with cultures and concordance with final diagnosis. PATIENTS AND SPECIMENS: One hundred and nineteen skin biopsies from 105 patients comprising 58 cases of confirmed or highly probable cutaneous tuberculosis, ranging from multibacillary infections to paucibacillary forms and 47 cases of possible tuberculids were analysed. Twenty-four subjects with non-tuberculous granulomas and normal skin controls were included. RESULTS: In 14 immunocompromised patients with multibacillary mycobacterial infections (AFB+ on biopsy), PCR was positive in 9 patients. Correlating PCR results with the final diagnosis, the PCR technique was 100% sensitive and specific in this group. In paucibacillary tuberculosis, PCR positivity rates were 55% for tuberculosis verrucosa cutis (38 cases) and 60% for lupus vulgaris (5 cases). When confirmed cases of tuberculosis were considered, the overall sensitivity was 73%. In 26 cases of erythema induratum, PCR was positive in 54% and correlated with a documented response to anti-tuberculous treatment in 80%. CONCLUSIONS: The use of PCR in the routine diagnostic panel for cutaneous tuberculosis should take into consideration the differential sensitivities for different clinical types. In the setting of an immunocompromised patient with AFB+ lesions, PCR has a definite role in rapid diagnosis and in differentiating atypical mycobacterial infection from tuberculosis. Where paucibacillary tuberculosis is suspected, clinical decision should not be based on PCR results alone. In erythema induratum, we found some correlation between PCR results and response to anti-tuberculous therapy.

Base Sequence↗

PubMed2002

Drug resistance of Mycobacterium tuberculosis strains isolated from patients with pulmonary tuberculosis in Archangels, Russia.

SETTING: The Archangels oblast, Russia, 1998-2000. OBJECTIVE: To study Mycobacterium tuberculosis resistance to anti-tuberculosis drugs in the Archangels oblast, and to reveal risk factors for the development of drug-resistant tuberculosis. DESIGN: The drug susceptibility of strains isolated from 119 patients with pulmonary tuberculosis was studied using the BACTEC method. Medical records of the patients were reviewed, retrospectively, to identify factors associated with drug resistance. RESULTS: Sixty-seven strains (56.3%) were resistant to at least one anti-tuberculosis drug. The highest rates of resistance were observed for streptomycin and isoniazid: respectively 40.4% and 66.7% of strains isolated from newly and previously treated patients were resistant to streptomycin, and respectively 37.1% and 73.3% of strains isolated from newly and previously treated patients were resistant to isoniazid. Thirty of the 119 strains (25.2%) were multidrug-resistant. Multidrug resistance was four times higher among previously treated patients than among new patients. A history of previous or interrupted treatment for tuberculosis and being female were significantly associated with drug resistance. CONCLUSION: Drug-resistant tuberculosis is an important problem in the Archangels oblast, Russia. The spread of drug resistance is attributed to several risk factors. Being female and evidence of previous treatment for tuberculosis are risk factors for the development of drug-resistant tuberculosis in the Archangels oblast. Patients with drug-resistant tuberculosis also showed a higher risk of interrupting their treatment.

Adolescent↗

PubMed2004

[Drug-resistant tuberculosis: resistance mechanisms and drug susceptibility of Mycobacterium tuberculosis].

Mycobacterium (M.) tuberculosis is the most common individual causative agent of infectious disease in the world. It is responsible for 26% of preventable deaths in adulthood. Because the number of new cases grows at an annual rate of 2%, in 1993 WHO proclaimed tuberculosis a global health problem. The immediate cause for this was coinfection with causative agents of tuberculosis and human immunodeficiency virus, and spread of resistant and multiresistant strains of M. tuberculosis (MDR TB). It is estimated that 50 million people are infected with resistant strains of M. tuberculosis. Tuberculosis has emerged as a major public health problem for its high mortality (50%-80%) in the first 4-16 weeks of the disease and 100 times more expensive therapy for drug-resistant than for drug-susceptible tuberculosis. Mycobacteriologic laboratories play a fundamental role in the detection, combat and control of tuberculosis, especially in preventing the spread of drug-resistant tuberculosis. In this connection, there is an increased need of a rapid and reliable determination of the susceptibility of isolated strains of M. tuberculosis to the first- and second-line antituberculotic drugs.

Antitubercular Agents↗

PubMed2005

[The in-vitro interferon-gamma release assay for the diagnosis of tuberculosis and Mycobacterium tuberculosis infections].

OBJECTIVE: To investigate the in-vitro interferon-gamma (IFN-gamma) release assay based on three different Mycobacterium tuberculosis antigens in the diagnosis of tuberculosis and Mycobacterium tuberculosis infections. METHODS: The peripheral blood mononuclear cells (PBMC) were collected from the patients with tuberculosis (tuberculosis group, n = 57), patients with lung cancer (lung cancer group, n = 29), and healthy controls (healthy control group 2, n = 27). The PBMCs were co-cultured for 5 days with different antigens: purified protein derivatives (PPD) of tuberculin, early secretary antigenic target 6,000 protein (ESAT6) and 38,000 antigen. The protein levels of IFN-gamma were detected by ELISA, and the results were compared to those with the tuberculin skin test (TST). RESULTS: (1) For healthy controls, the TST was positively related to the history of BCG vaccination and the closeness of contact with sputum-positive tuberculosis patients (P = 0.047, P = 0.041 respectively). The ESAT6 based IFN-gamma release assay was only significantly related to the closeness of contact with sputum-positive tuberculosis patients (P = 0.005), but not to the history of BCG vaccination. (2) There was no significant difference of the TST results among the three groups (P > 0.05). (3) The receiver operating characteristic (ROC) curve analysis indicated that the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the IFN-gamma release assay based on 38,000 antigen were 64.9%, 89.3%, 77.0%, 86.0%, and 71.0% respectively for the diagnosis of tuberculosis. CONCLUSIONS: IFN-gamma release assay based on ESAT6 appears to be better than TST in the diagnosis of infection of Mycobacterium tuberculosis, while IFN-gamma release assay based on 38,000 may be helpful for the diagnosis of tuberculosis.

Adult↗

PubMed1995

[Clinical investigation of severe pulmonary tuberculosis and miliary tuberculosis].

Although the incidence of pulmonary tuberculosis had been rapidly decreased in Japan, it is pointed out that the rate of decrease in annual incidence became smaller in recent years. This slowing down of the rate of decrease is considered to be resulted from an increase in number of individuals who are more susceptible to tuberculous infection; such as the elderly, young people who are not exposed to TB bacilli previously and therefore not immunized, patients with malignant disease or with organ transplantation and HIV-infected persons. Pulmonary tuberculosis still remained as a pulmonary infectious disease of highly ranked importance. Especially, miliary tuberculosis is life-threatening and occasionally fatal unless early intensive antituberculosis chemotherapy was started on the basis of a rapid and definite diagnosis. We made a retrospective survey to clarify the characteristic clinical features of miliary tuberculosis. For this purpose, we compared the characteristics and clinical features of 10 patients with miliary tuberculosis and those of 18 patients with severe pulmonary tuberculosis, not due to hematogenous dissemination. The mean ages of miliary tuberculosis group and that of severe pulmonary tuberculosis group were 62.6 and 63.8 years old, respectively, with no significant difference. Nine out of ten patients with miliary tuberculosis had fever as one of initial symptoms, whereas, all the patients with severe pulmonary tuberculosis had cough and sputa but they seldom developed fever (high fever) at the initial stage of their diseases. Duration from onset of symptom to the admission was 1.2 months on average in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

[Basic studies on tuberculosis and tubercle bacilli in U.S.-Japan medical cooperative program tuberculosis panel].

The U.S.-Japan Medical Cooperative Program has been started in 1965 and Tuberculosis Panel is one of the most important field of the programs. In this lecture, the recent advances in the basic studies on tuberculosis researches which were reported in Tuberculosis panel of the program were summarized. The host defence mechanisms against M. tuberculosis infection were the most important subject. The role of Th1-mediated cytokins such as IL-2, IFN gamma and TNF beta in the host-defence mechanism against mycobacterial infection was extensively discussed. Bcg gene of the mice is the example case for the genetic background of host against mycobacterial infection. The virulence factor, however of M. tuberculosis is still unknown. The technique of molecular biology was applied to the diagnosis of tuberculosis. The PCR and RFLP methods are the useful strategies for the rapid diagnosis and analysis of the mode of infection with M. tuberculosis. The development of detection techniques of drug-resistant tubercle bacilli is also urgently required. Another approach by molecular biology to tuberculosis research is the cloning of gene of tuberculin protein and the production recombinant protein of M. tuberculosis. The amino acid sequences of several proteins have been determined and their immunological properties of recombinant proteins were investigated. The immunological functions of lipid fractions of tubercle bacilli such as cord factor (TDM) and lipoarabinomannan (LAM) have been described. Especially the immunomodulating activities and the role of TDM as diagnostic antigen in the tuberculosis patients were described. The adjuvant activity of mycobacterial cell wall was well established and the minimum structural requirement was reported to be N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP). The several MDP derivatives were selected as the cytokine inducers. Especially MDP-Lys (L18) was widely used as drug for the increasing the number of white blood cells and platelets in cancer patients. The effectiveness of MDP derivatives on the stimulating of mucosal immunity was also recently reported. The preventing activities of virus infection and cancer metastasis of MDP derivatives were shown in mice models.

Humans↗

PubMed1997

Modulation of IL-12 by transforming growth factor-beta (TGF-beta) in Mycobacterium tuberculosis-infected mononuclear phagocytes and in patients with active tuberculosis.

In humans, tuberculosis is associated with suppression of T-cell responses to antigens of Mycobacterium tuberculosis. Recently, the macrophage product, transforming growth factor-beta (TGF-beta) has been implicated in suppression of T-cell proliferation and cytokine production during tuberculosis. We studied the effect of TGF-beta on production of IL-12, and on the augmentation of M. tuberculosis-induced IFN gamma production by IL-12, in patients with pulmonary tuberculosis and by M. tuberculosis. Induction of IL-12 p35, but not IL-12 p40, by M. tuberculosis in monocytes was dependent on prior priming of the cells with IFN gamma. Expression of both IL-12 p40 and p35, however, was suppressed by TGF-beta. Further, TGF-beta interfered with the bioactivity of IL-12 in the enhancement of M. tuberculosis-induced IFN gamma mRNA expression and cytokine production. However, in mononuclear cells from patients with tuberculosis the main effect of TGF-beta on IL-12 appeared to be counter action to IL-12 induced IFN gamma production in response to M. tuberculosis.

Gene Expression Regulation↗

PubMed1998

[Neglect of tuberculosis in medical education. How medical students perceive the incidence of tuberculosis in Germany].

BACKGROUND: Tuberculosis is still a health problem. Due to an increasing number of immunosuppressed patients the probability of getting infected with tuberculosis in the hospital rises up. SUBJECTS AND METHODS: For prevention of infections, medical students play a critical role: Firstly, because of bedside-teaching in the hospital, medical students are at risk of getting infected with tuberculosis. Secondly, immediately after university training, it is expected that they are capable to diagnose tuberculosis. The following study analysed the incidence-estimation of medical students (n = 278) of tuberculosis-morbidity and tuberculosis-mortality in Germany. RESULTS: It becomes obvious, that medical students still have gaps in their knowledge about tuberculosis. They underestimated the incidence of tuberculosis and they overestimated the mortality of tuberculosis. CONCLUSION: The study indicates a misperception of relevant health problems which may be due to the study situation at German Medical Schools. Medical students need more information and counselling about epidemiology of infectious diseases including tuberculosis.

Adult↗

PubMed2000

Risk of infection with Mycobacterium tuberculosis in travellers to areas of high tuberculosis endemicity.

BACKGROUND: No data exist on risks of infection with Mycobacterium tuberculosis in travellers. We studied incidences of and risk factors for tuberculin skin-test conversion among Dutch long-term travellers to countries of high tuberculosis endemicity. METHODS: In a multicentre, prospective cohort study based in travel and tuberculosis clinics in the Netherlands, 1072 BCG-naive immunocompetent travellers to countries with an estimated annual risk of M. tuberculosis infection of at least 1% were skin tested before departure with 1 tuberculin unit purified protein derivative (PPD) of M. tuberculosis in Tween-80. Those with results less than 2 mm were retested 2-4 months after their return with simultaneous testing for cross-sensitivity to environmental mycobacteria (1 tuberculin unit PPD of M. scrofulaceum in Tween-80). M. tuberculosis infection was defined as a post-travel M. tuberculosis tuberculin skin-test result of at least 10 mm that was 3 mm or more larger than the M. scrofulaceum result. FINDINGS: Post-travel skin-test results were available for 656 (66%) of 988 individuals who were eligible for follow-up. Among these, 12 M. tuberculosis infections were identified (1.8%). The overall incidence rate was 3.5 per 1000 person-months of travel (95% CI 2.0-6.2), and 2.8 per 1000 person-months of travel (1.2-5.5) after exclusion of health-care workers. Two had active tuberculosis at the time of testing (incidence rate 0.6 per 1000 person-months of travel [0.3-2.3]). Work in patient care abroad was an independent risk factor (adjusted rate ratio 5.34, p=0.015). INTERPRETATION: The risk of M. tuberculosis infection in long-term travellers to high-endemicity countries, even if not engaged in health-care work, is substantial and of similar magnitude to the average risk for the local population. BCG vaccination or post-travel tuberculin skin-testing of high-risk travellers should be considered.

Adult↗

PubMed1997

An epidemic of tuberculosis with a high rate of tuberculin anergy among a population previously unexposed to tuberculosis, the Yanomami Indians of the Brazilian Amazon.

A survey of an emerging tuberculosis epidemic among the Yanomami Indians of the Amazonian rain forest provided a unique opportunity to study the impact of tuberculosis on a population isolated from contact with the tubercle bacillus for millennia until the mid-1960s. Within the Yanomami population, an extraordinary high prevalence of active tuberculosis (6.4% of 625 individuals clinically examined) was observed, indicating a high susceptibility to disease, even among bacille Calmette-Guérin-vaccinated individuals. Observational studies on cell-mediated and humoral immune responses of the Yanomami Indians compared with contemporary residents of the region suggest profound differences in immunological responsiveness to Mycobacterium tuberculosis infection. Among the Yanomami, a very high prevalence of tuberculin skin test anergy was found. Of patients with active tuberculosis, 46% had purified protein derivative of tuberculosis reactions <10 mm; similarly 58% of recent bacillus Calmette-Guérin vaccines exhibited skin test reactions <5 mm. The Yanomami also had higher titers of antibodies against M. tuberculosis glycolipid antigens (>70%) than the control subjects comprised of Brazilians of European descent (14%). The antibodies were mostly of the IgM isotype. Among the tuberculosis patients who also produced IgG antibodies, the titers of IgG4 were significantly higher among the Yanomami than in the control population. Although it was not possible to analyze T-cell responses or patterns of lymphokine production in vitro because of the remoteness of the villages from laboratory facilities, the results suggest that the first encounter of the Yanomami Indian population with tuberculosis engenders a diminished cell-mediated immune response and an increased production antibody responses, relative to other populations with extensive previous contact with the pathogen. These findings suggest that tuberculosis may represent a powerful selective pressure on human evolution that over centuries has shaped the nature of human immune responses to infection.

Antibodies, Bacterial↗

PubMed2000

Risk factors for developing tuberculosis in HIV-1-infected adults from communities with a low or very high incidence of tuberculosis.

OBJECTIVE: To estimate the incidence rate of tuberculosis in HIV-1-infected adults resident in a region with a high tuberculosis prevalence and to identify clinical and laboratory parameters associated with increased risk of developing tuberculosis. METHODS: Adult patients going to the University of Cape Town HIV clinics between January 1986 and May 1996. The following variables were assessed for the risk of developing tuberculosis: ethnicity, employment and education status, World Health Organization (WHO) clinical stage, erythrocyte sedimentation rate (ESR), CD4+ count, and total lymphocyte count. Tuberculin skin test data were not available. RESULTS: There were 198 prevalent and 144 incident cases of tuberculosis in the cohort of 1206 patients. The incidence rate of tuberculosis risk was 10.4/100 person years. WHO clinical stages 3 and 4 (risk ratio [RR], 3.4; 95% confidence interval [CI], 1.8-6.4), ESR >75 mm/hour (RR, 3.5; CI, 1.8-6.5) and being a member of a high-prevalence tuberculosis community (RR, 2.5; CI, 1.2-5.1) were independently associated with the risk of developing tuberculosis. CONCLUSIONS: HIV-infected adults in Cape Town are at high risk of developing tuberculosis irrespective of tuberculin skin testing. The risk increases markedly with HIV disease progression. Patients at extremely high risk can be identified on the basis of demographic and clinical features. Such individuals would be suitable for targeted tuberculosis prophylaxis.

Adult↗

PubMed1994

Control and prevention of tuberculosis in the United Kingdom: Code of Practice 1994. Joint Tuberculosis Committee of the British Thoracic Society.

BACKGROUND: The guidelines on control and prevention of tuberculosis in the United Kingdom have been reviewed and updated. METHODS: A subcommittee was appointed by the Joint Tuberculosis Committee (JTC). Each member of this group drafted one or more sections of the guidelines, and drafts were made available to all members of the group. In the course of several meetings drafts were altered and incorporated into a final text. The guidelines were approved by the full JTC and by the Standards of Care Committee of the British Thoracic Society. In revising the guidelines the authors took account of new published evidence and recent concerns about drug resistance and possible effects of HIV on tuberculosis. CONCLUSIONS: (1) All cases of tuberculosis must be notified. (2) A few patients need hospital admission. (3) Patients with positive sputum smears and sensitive organisms should be considered infectious until they have received two weeks' chemotherapy. (4) Treatment of all tuberculosis patients should be supervised by a respiratory physician employing standard medication guidelines and monitoring compliance at least monthly. (5) Health care workers at risk should be protected by BCG vaccination and appropriate infection control measures, and evidence of infectious tuberculosis should be sought among prospective NHS staff, school teachers, and others. (6) Prison staff should be protected. (7) Tuberculosis should be considered in the elderly in long stay care with persistent chest symptoms. (8) Contact tracing should be vigorously pursued with chemoprophylaxis, BCG vaccination, or follow up where applicable. (9) Entrants to the UK from high risk countries (tuberculosis incidence more than 40/100,000 population per year) should be screened. (10) BCG vaccination should be offered where appropriate but not in subjects with known or suspected HIV infection. (11) The local organisation of tuberculosis services should be strengthened and should include adequate nursing and support staff. (12) Contracts between purchasers and providers should specify management of tuberculosis in line with this and other JTC guidelines.

BCG Vaccine↗

PubMed2000

[Management of pulmonary tuberculosis patients complicated with diabetes mellitus before diagnosis as pulmonary tuberculosis and feasibility of chemoprophylaxis].

We studied whether diabetics who are one of the high risk groups of developing pulmonary tuberculosis had undergone chest X-ray examination periodically. The feasibility of chemoprophylaxis in diabetics was also studied by investigating whether fibrotic lesions of tuberculosis can be found on previous chest X-ray films of these patients. Of the pulmonary tuberculosis patients admitted to our hospital for treatment, 78 patients complicated with diabetes mellitus were enrolled in this study. As to the mode of detection, the majority, 63 cases, are discovered, by undergoing medical examination because of respiratory symptoms, followed by 8 patients in whom pulmonary tuberculosis was found by health examination and only 1 patient was found by the periodic observation of diabetes mellitus. Of the 57 patients receiving the original treatment for pulmonary tuberculosis preceded by the discovery of diabetes mellitus, only 15 (26%) had undergone chest X-ray examination periodically. This fact shows that physicians treating diabetes mellitus have only a little concern on tuberculosis, thus the re-training of physicians dealing with diabetics on tuberculosis is considered to be necessary. According to chest X-ray films of 21 patients who had undergone chest X-ray examination and in whom the previous films were available, there were 6 patients without any lesion of pulmonary tuberculosis, 8 patients with fibrotic lesions and 7 patients with active lesions. The 8 patients showing fibrotic lesions have developed pulmonary tuberculosis on the average 15 years after they were diagnosed with diabetes mellitus, and the fact suggests that the prevention of the development of pulmonary tuberculosis among diabetics could be possible by chemoprophylaxis.

Chemoprevention↗

PubMed1990

Tuberculosis among foreign-born persons entering the United States. Recommendations of the Advisory Committee for Elimination of Tuberculosis.

In 1989, the Department of Health and Human Services Advisory Committee for Elimination of Tuberculosis published a plan for eliminating tuberculosis from the United States by the year 2010. This plan gives a top priority to implementing strategies to prevent tuberculosis in high-incidence groups. Foreign-born persons (as a group) residing in the United States have higher rates of tuberculosis than persons born in the United States. In 1989, the overall U.S. tuberculosis rate was 9.5 per 100,000 population; for foreign-born persons arriving in the United States, the estimated case rate was 124 per 100,000. In the period 1986-1989, 22% (20,316) of all reported cases of tuberculosis occurred in the foreign-born population. A majority of foreign-born persons who develop tuberculosis do so within the first 5 years after they enter the United States. The ACET recommends that all foreign-born persons applying for permanent entry into the United States continue to be screened for disease. Deficiencies in the current screening methods should be corrected. The policy requiring that persons found to have infectious tuberculosis (known or suspected) be prevented from entering the country until treatment has rendered them noninfectious should be continued; however, persons with noninfectious tuberculosis should be permitted to enter the United States. Tuberculin skin testing and preventive therapy programs for foreign-born persons must be expanded both overseas and domestically if the goal of eliminating tuberculosis from the United States by the year 2010 is to be met.

Adolescent↗