Onset of tuberculosis disease: New converters in long-term care settings

Abstract

Elders living in communal settings, such as nursing homes or other types of long-term care facilities have a tuberculosis (TB) incidence rate of 39.2 per 1,000, nearly four times the rate of TB in the general population. This fact mandates routine screening, reporting, and strict follow-up of TB in long-term care facilities as well as recognizing and addressing barriers to worker and resident protection. As healthcare in this country evolves from acute care facilities to alternative ambulatory care settings, the focus for infection control personnel is to develop effective TB control plans appropriate to the care setting using current clinical guidelines set forth by the Centers for Disease Control and Prevention (CDC) or other agencies, the main goal of which is to reduce the number of infections and exposures to this disease. As the incidence of TB continues in long-term care settings, away from acute care facilities, public health officials, administrators, and infection control personnel need to develop TB control plans, risk assessment procedures, and appropriate follow-up on positive converters among the workers and the residents. The case study presented herein is a good example of an individual being offered a screening test for an infectious airborne disease and positive test results being disregarded.

A model on the influence of age on immunity to infection with Mycobacterium tuberculosis

“…The elderly are more susceptible to many infectious diseases, including tuberculosis [2], [17], [18], [21], [25]. Increasing susceptibility is highly associated with the loss or delay in the generation of antigen specific CD4 + T cell mediated immunity [8], [11].…”

“…Indeed, the elderly make up approximately one fifth of all tuberculosis cases in the US [17]. Tuberculosis in the elderly can occur through reactivation of a previously latent infection or from primary infection [18], [21]. Primary infection occurs when elderly individuals encounter M. tuberculosis for the first time, an event that often occurs in the nursing home environment.…”

“…Primary infection occurs when elderly individuals encounter M. tuberculosis for the first time, an event that often occurs in the nursing home environment. Under these circumstances, with waning immunity, the elderly are highly susceptible to developing tuberculosis [18], [21]. This study will model primary tuberculosis in young and old mice, as a model of primary infection in human.…”