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. 1987 May;33:1231–1235.

Tuberculosis in Chronic Care Homes

Vernon H Hoeppner, Edward D Ring
PMCID: PMC2218496  PMID: 21263933

Abstract

Caucasian Canadians are in the tertiary phase of a 300-year tuberculosis epidemic. In this phase, the pattern of disease over the age spectrum is low in the young and middle-aged groups and rises to four times this rate in the elderly. The concentration of the elderly in chronic care homes (CCHs) magnifies the tuberculosis problem by increasing case rates another four times above the rate of elderly persons living separately, and 20 times above the overall Canadian rate. In spite of effective drugs with cure rates of over 95%, tuberculosis in the institutionalized elderly continues at an alarming rate. The difficulty lies in case finding. The prevailing attitude is that tuberculosis is no longer a problem. Surveillance programs are rudimentary. Between 35% and 40% of active cases in CCHs are the result of primary infection, mimicking bacterial pneumonia clinically and radiographically. In this target group of high-incidence tuberculosis, surveillance of residents is necessary, and the diagnosis needs to be considered in antibiotic-unresponsive pneumonia and in fever of unknown origin.

Keywords: tuberculosis, elderly, chronic care homes

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brooks S. M., Lassiter N. L., Young E. C. A pilot study concerning the infection risk of sputum positive tuberculosis patients on chemotherapy. Am Rev Respir Dis. 1973 Oct;108(4):799–804. doi: 10.1164/arrd.1973.108.4.799. [DOI] [PubMed] [Google Scholar]
  2. Dutt A. K., Stead W. W. Chemotherapy of tuberculosis for the 1980's. Clin Chest Med. 1980 May;1(2):243–252. [PubMed] [Google Scholar]
  3. Farer L. S. Tuberculosis--a continuing problem. Am Rev Respir Dis. 1986 Jul;134(1):2–3. doi: 10.1164/arrd.1986.134.1.2. [DOI] [PubMed] [Google Scholar]
  4. GRIGG E. R. The arcana of tuberculosis with a brief epidemiologic history of the disease in the U.S.A. Am Rev Tuberc. 1958 Aug;78(2):151–contd. doi: 10.1164/artpd.1958.78.2.151. [DOI] [PubMed] [Google Scholar]
  5. Grosset J. Bacteriologic basis of short-course chemotherapy for tuberculosis. Clin Chest Med. 1980 May;1(2):231–241. [PubMed] [Google Scholar]
  6. Iseman M. D. Tailoring a time-bomb. Inadvertent genetic engineering. Am Rev Respir Dis. 1985 Oct;132(4):735–736. doi: 10.1164/arrd.1985.132.4.735. [DOI] [PubMed] [Google Scholar]
  7. Mason J. O. Opportunities for the elimination of tuberculosis. Am Rev Respir Dis. 1986 Aug;134(2):201–203. doi: 10.1164/arrd.1986.134.2.201. [DOI] [PubMed] [Google Scholar]
  8. Nagami P. H., Yoshikawa T. T. Tuberculosis in the geriatric patient. J Am Geriatr Soc. 1983 Jun;31(6):356–363. doi: 10.1111/j.1532-5415.1983.tb05747.x. [DOI] [PubMed] [Google Scholar]
  9. Powell K. E., Farer L. S. The rising age of the tuberculosis patient: a sign of success and failure. J Infect Dis. 1980 Dec;142(6):946–948. doi: 10.1093/infdis/142.6.946. [DOI] [PubMed] [Google Scholar]
  10. STEAD W. W. THE PATHOGENESIS OF PULMONARY TUBERCULOSIS AMONG OLDER PERSONS. Am Rev Respir Dis. 1965 Jun;91:811–822. doi: 10.1164/arrd.1965.91.6.811. [DOI] [PubMed] [Google Scholar]
  11. Stead W. W., Bates J. H. Evidence of a "silent" bacillemia in primary tuberculosis. Ann Intern Med. 1971 Apr;74(4):559–561. doi: 10.7326/0003-4819-74-4-559. [DOI] [PubMed] [Google Scholar]
  12. Stead W. W., Lofgren J. P., Warren E., Thomas C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. N Engl J Med. 1985 Jun 6;312(23):1483–1487. doi: 10.1056/NEJM198506063122304. [DOI] [PubMed] [Google Scholar]
  13. Stead W. W. Pathogenesis of a first episode of chronic pulmonary tuberculosis in man: recrudescence of residuals of the primary infection or exogenous reinfection? Am Rev Respir Dis. 1967 May;95(5):729–745. doi: 10.1164/arrd.1967.95.5.729. [DOI] [PubMed] [Google Scholar]
  14. Thompson N. J., Glassroth J. L., Snider D. E., Jr, Farer L. S. The booster phenomenon in serial tuberculin testing. Am Rev Respir Dis. 1979 Apr;119(4):587–597. doi: 10.1164/arrd.1979.119.4.587. [DOI] [PubMed] [Google Scholar]
  15. Welty C., Burstin S., Muspratt S., Tager I. B. Epidemiology of tuberculous infection in a chronic care population. Am Rev Respir Dis. 1985 Jul;132(1):133–136. doi: 10.1164/arrd.1985.132.1.133. [DOI] [PubMed] [Google Scholar]

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