A longitudinal study of transmission of tuberculosis in a large prison population.

Abstract

The purpose of this study was to determine the extent of transmission of tuberculosis in a large prison population over an 18-mo period. Restriction-fragment-length polymorphism (RFLP) analysis of isolates of Mycobacterium tuberculosis was performed, using the insertion sequence IS6110 and the plasmid pTBN12. Patients infected with strains having the same fingerprint were grouped in clusters. Medical records were reviewed and movement of inmates among prisons was examined for selected patients. Tuberculosis was diagnosed in 216 inmates (case rate = 2,283 per 100,000 per year). Isolates from 210 (97%) patients were fingerprinted, 155 (74%) were grouped in 25 clusters, and 55 (26%) showed a unique fingerprint. Recent infection was inferred in 62% of these patients. Eighty-four percent (161 of 192) of patients tested were human immunodeficiency virus (HIV)-positive, of whom 121 were in clusters and 40 were not (p = 0.74). Patients in clusters were less adherent with tuberculosis treatment than those not in clusters (p < 0.05), and prison transmission of resistant strains was observed. It is crucial that infection control guidelines be fully implemented in the prison setting to prevent tuberculosis transmission.

Estimated Costs of False Laboratory Diagnoses of Tuberculosis in Three Patients

“…This rate is within the range demonstrated in other population-based studies (1-3,7-11). In our study, 60% of the patients with cross-contaminated cultures received misdiagnoses and were treated for active TB disease, yielding a rate of TB misdiagnoses caused by laboratory cross-contamination of 0.9% of patients with culture-confirmed TB.…”

“…The rate of patients having false-positive M. tuberculosis cultures resulting from laboratory cross-contamination may be up to 33% of culture-confirmed TB patients (1-3,7-11). Reportedly two thirds of patients with false-positive cultures are treated for active TB disease (4) and may undergo unnecessary, potentially toxic anti-TB therapy.…”

Multidrug-Resistant Tuberculosis in Prison Inmates, Azerbaijan

“…Multidrug resistance, always involving isoniazid and rifampin, was seen in 34 (52.3%) of 65 isolates, with 28 belonging to the Beijing genotype. (1), where factors such as poor general health of inmates, overcrowding, increased risk factors, delayed case finding, and incomplete or inadequate therapeutic intervention contribute to rapid spread (2) and high prevalence (e.g., 500 cases per 100,000 inmates in New York City jails [3] and 2,283 per 100,000 inmates in the General Penitentiary Hospital in Madrid, Spain [4]). In prisons of the former Soviet Union, TB incidence is even higher (e.g., in Siberia [5] or Russia as a whole [6,7]).…”

Búsqueda Activa de Individuos con Tuberculosis Pulmonar y Extrapulmonar en Calarcá-Quindío, Colombia-2005

“…La baja detección de pacientes es uno de los problemas más comunes en muchos municipios del país, hecho que amerita la búsqueda activa de sintomáticos respiratorios, especialmente en lugares con alto índices de tuberculosis, asentamientos donde algunos factores asociados a la proliferación de la bacteria tales como el hacinamiento, la ventilación inadecuada, abuso en el consumo de drogas, desnutrición, la alta proporción de habitantes de minorías étnicas y raciales (frecuentemente inmigrantes de zonas endémicas o de alto riesgo) la escasez de recursos difícilmente permite acceder a los servicios de salud y contribuyen significativamente al aumento en el número de casos (18,19). Esta diversidad geográfica no solo se puede presentar en actividades laborales, agropecuarias y turísticas sino también por convivencia por largo tiempo en lugares como hoteles, fincas cafeteras y centros de reclusión.…”