Challenges in assessing transmission of Mycobacterium tuberculosis in long-term-care facilities

Jackson, David A.; Mailer, Karen; Porter, Kimberly A.; Niemeier, Richard W.; Fearey, Donna; Pope, L.; Lambert, Lauren A.; Mitruka, Kiren; Perio, Marie A. de

doi:10.1016/j.ajic.2015.03.035

Cited by 8 publications

(6 citation statements)

References 27 publications

(63 reference statements)

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“…TB delayed diagnosis or misdiagnosis and high mortality rates in the elderly are attributed to their increased likelihood of absent, altered, or delayed clinical symptoms, presence of ageassociated conditions such as cognitive impairment, and clinical symptoms shared by active TB and old age such as fatigue, and weight loss [5,30,52,53]. In our elderly cohort, we found clinical differences such as a lower prevalence of fever and chills, and longer duration of cough and weight loss.…”

Section: Plos Onementioning

confidence: 65%

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A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

Scordo

Aguillón-Durán²,

Ayala³

et al. 2021

PLoS ONE

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Background Aging increases the risk of tuberculosis (TB) and its adverse outcomes, but most studies are based on secondary analyses, and few are in Hispanics. Diabetes is a risk factor for TB in adults, but its contribution in the elderly is unknown. We aimed to identify the role of diabetes and other risk factors for TB in elderly Hispanics. Methods Cross-sectional study among newly-diagnosed TB patients, recent contacts (ReC), or community controls (CoC) totaling 646 participants, including 183 elderly (>60 years; 43 TB, 80 ReC, 60 CoC) and 463 adults (18 to 50 years; 80 TB, 301 ReC and 82 CoC). Host characteristics associated with TB and latent Mycobacterium tuberculosis infection (LTBI) were identified in the elderly by univariable and confirmed by multivariable logistic regression. Results LTBI was more prevalent among the elderly CoC (55% vs. 23.2% in adults; p<0.001), but not in ReC (elderly 71.3% vs. adult 63.8%); p = 0.213). Risk factors for TB in the elderly included male sex (adj-OR 4.33, 95% CI 1.76, 10.65), smoking (adj-OR 2.55, 95% CI 1.01, 6.45) and low BMI (adj-OR 12.34, 95% CI 4.44, 34.33). Unexpectedly, type 2 diabetes was not associated with TB despite its high prevalence (adj-OR 0.38, 95% CI 0.06, 2.38), and BCG vaccination at birth was protective (adj-OR 0.16, 95% CI 0.06, 0.45). Conclusions We report novel distinctions in TB risk factors in the elderly vs. adults, notably in diabetes and BCG vaccination at birth. Further studies are warranted to address disparities in this vulnerable, understudied population.

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Section: Plos Onementioning

confidence: 65%

“…Since the diagnosis of TB can be challenging in the elderly [30], we also evaluated whether the elderly differed in their microbiological or clinical presentation of active TB when compared…”

Section: Clinical Characteristics Of the Elderly With Tbmentioning

confidence: 99%

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

Scordo

Aguillón-Durán²,

Ayala³

et al. 2021

PLoS ONE

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“…Homeless case characteristics in prior research are comparable to our study population, including young adult males, a high prevalence of alcohol and drug abuse, and being born in the USA. The elderly population represents the largest reservoir of TB infection; an analysis of 1993–2008 cases reported in the United States showed that the rate of TB among elderly adults was as much as 30% higher than among younger adults [ 31 ]. Research has also shown that people over 65 years of age residing in long-term care facilities are at a 4–50-times higher risk of developing TB disease and experiencing reactivation of latent TB than elderly persons living in the community [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Sociodemographic Factors with Tuberculosis Outcomes in Mississippi

et al. 2023

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Tuberculosis (TB) is one of the leading causes of death worldwide. In the US, the national incidence of reported TB cases was 2.16 per 100,000 persons in 2020 and 2.37 per 100,000 persons in 2021. Furthermore, TB disproportionately affects minorities. Specifically, in 2018, 87% of reported TB cases occurred in racial and ethnic minorities in Mississippi. Data from TB patients from the Mississippi Department of Health (2011–2020) were used to examine the association between sociodemographic subgroups (race, age, place of birth, gender, homelessness, and alcohol use) with TB outcome variables. Of the 679 patients with active TB cases in Mississippi, 59.53% were Black, and 40.47% were White. The mean age was 46 ± ten years; 65.1% were male, and 34.9% were female. Among patients with previous TB infections, 70.8% were Black, and 29.2% were White. The rate of previous TB cases was significantly higher among US-born (87.5%) persons compared with non-US-born persons (12.5%). The study suggested that sociodemographic factors play a significant role in TB outcome variables. This research will help public health professionals to develop an effective TB intervention program that addresses sociodemographic factors in Mississippi.

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“…1 Tuberculosis transmission involving health care workers has been seen in hospitals, clinics, and long-term care facilities. 2–4 The adoption of tuberculosis infection control measures has decreased the number of tuberculosis outbreaks and incidents of tuberculosis transmission to patients and health care workers. Proven tuberculosis control practices, such as infection control measures and active tuberculosis case finding and treatment, are essential elements of a tuberculosis elimination strategy.…”

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confidence: 99%

Ce

Parmer

Allen

Walton

2017

AJN, American Journal of Nursing

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Nurses play a critical role in the diagnosis and treatment of tuberculosis and in the prevention of tuberculosis transmission through infection control practices. To eliminate tuberculosis in the United States, however, an expanded approach to testing and treating people with latent tuberculosis infection must be implemented. Recently, the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation statement on latent tuberculosis infection testing that expands nurses’ opportunities to identify at-risk populations for tuberculosis prevention. In combination with newer testing methodologies and shorter treatment regimens, implementation of the USPSTF recommendation has the potential to remove previously existing barriers to screening and treatment of both patients and health care providers. This article provides a general overview of tuberculosis transmission, pathogenesis, and epidemiology; presents preventive care recommendations for targeted testing among high-risk groups; and discusses the USPSTF recommendation’s applicability to public health and primary care practice in the United States.

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Challenges in assessing transmission of Mycobacterium tuberculosis in long-term-care facilities

Cited by 8 publications

References 27 publications

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor

Association of Sociodemographic Factors with Tuberculosis Outcomes in Mississippi

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