Jose Cadena1,2,3, Norys A Castro-Pena2, Heta Javeri2, Brian Hernandez4, Joel Michalek4, Ana Fuentes Arzola1,2, Miloni Shroff5, Chetan Jinadatha6, Gustavo Valero3, Jason Bowling2, Jean Przykucki1, Michele Adams3, James Jorgensen7, Jan E Patterson2,7, Pranavi Sreeramoju5,8. 1. South Texas Veterans Health Care System. 2. Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, San Antonio, Texas. 3. Valley Coastal Bend Veterans Health Care System. 4. Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas. 5. University of Texas Southwestern Medical Center, Dallas, Texas. 6. Central Texas Veterans Health Care System. 7. Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. 8. Parkland Health and Hospital System, Dallas, Texas.
Abstract
SETTING: Five health care systems in Texas. OBJECTIVE: To describe the epidemiology of inadequate isolation for pulmonary tuberculosis leading to tuberculosis (TB) exposures from confirmed TB patients and the patient factors that led to the exposures. DESIGN: A retrospective cohort and case-control study of adult patients with TB resulting in exposures (cases) vs those TB patients who did not result in exposures (controls) during January 2005 to December 2012. RESULTS: There were 335 patients with pulmonary TB disease, 199 cases and 136 controls. There was no difference between groups in age (46 ± 14.6 vs 45 ± 17 years; P > .05), race, or substance abuse. Cases were more likely to be transplant recipients (adjusted odds ratio [AOR], 18.90; 95% CI, 1.9-187.76), have typical TB chest radiograph (AOR, 2.23; 95% CI, 1.1-4.51), and have positive acid-fast bacilli stains (AOR, 2.36; 95% CI, 1.31-4.27). Cases were less likely to have extrapulmonary disease (AOR, 0.47; 95% CI, 0.24-0.95). CONCLUSIONS: TB exposure resulting from inadequate isolation is frequent in health care settings. Extrapulmonary involvement resulted in earlier airborne isolation. Being a transplant recipient, having chest radiograph findings typical for TB, and sputum positivity acid-fast bacilli upon staining were associated with increased risk of inadequate isolation.
SETTING: Five health care systems in Texas. OBJECTIVE: To describe the epidemiology of inadequate isolation for pulmonary tuberculosis leading to tuberculosis (TB) exposures from confirmed TB patients and the patient factors that led to the exposures. DESIGN: A retrospective cohort and case-control study of adult patients with TB resulting in exposures (cases) vs those TB patients who did not result in exposures (controls) during January 2005 to December 2012. RESULTS: There were 335 patients with pulmonary TB disease, 199 cases and 136 controls. There was no difference between groups in age (46 ± 14.6 vs 45 ± 17 years; P > .05), race, or substance abuse. Cases were more likely to be transplant recipients (adjusted odds ratio [AOR], 18.90; 95% CI, 1.9-187.76), have typical TB chest radiograph (AOR, 2.23; 95% CI, 1.1-4.51), and have positive acid-fast bacilli stains (AOR, 2.36; 95% CI, 1.31-4.27). Cases were less likely to have extrapulmonary disease (AOR, 0.47; 95% CI, 0.24-0.95). CONCLUSIONS: TB exposure resulting from inadequate isolation is frequent in health care settings. Extrapulmonary involvement resulted in earlier airborne isolation. Being a transplant recipient, having chest radiograph findings typical for TB, and sputum positivity acid-fast bacilli upon staining were associated with increased risk of inadequate isolation.
Authors: J E Sprinson; J Flood; C S Fan; T A Shaw; L Pascopella; J A Young; S E Royce Journal: Int J Tuberc Lung Dis Date: 2003-12 Impact factor: 2.373
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