Increase In Incidence Of Tuberculosis Research Articles

HIV-1 seroprevalence in chest clinic and hospital tuberculosis patients in New York City, 1989–1991

To describe more fully HIV-1 and tuberculosis (TB) coinfection in TB patients attending New York City Department of Health chest clinics (1989-1991) and one inner-city hospital (1990-1991). An unlinked serosurvey using HIV-1-antibody testing of remnant blood specimens collected for routine medical purposes. A total of 1414 clinic and 856 hospital patients. HIV seropositivity and TB infection/disease. A total of 327 (23%) of the clinic patients were HIV-1-positive, with a significantly higher seroprevalence in men (29 versus 15%, P < 0.001) and in young and middle-aged adults aged 30-50 years (P < 0.001). HIV-1 prevalence by TB diagnostic class was: class 2 (purified protein derivative-positive and chest radiograph-negative), 11% (64 out of 570); class 3 (active disease), 34% (197 out of 582); class IV (old/inactive disease), 30% (39 out of 130). Of the hospital patients 487 (57%) were HIV-1-positive. HIV-1 seroprevalence was 55% for those who were identified or believed to be HIV-1-negative on admission as indicated on the medical chart. HIV-1 seroprevalence in the clinic population decreased initially, but later increased, although not to study onset levels. There is considerable overlap between the TB and HIV epidemics in New York City; a part of the increasing TB incidence may be independent of HIV coinfection. The control of TB will necessitate prompt diagnosis of TB and HIV-1, appropriate TB treatment and/or chemoprophylaxis, and a greater commitment to tackle the social conditions associated with the spread of the disease.

Failure of Tuberculosis Control

The dramatic increase in tuberculosis (TB) incidence¹is testimony to the failure of the United States to coordinate its medical care provision, disease surveillance, and societal will to consistently provide TB therapy and monitor TB control.²In this issue ofThe Journal, Bloch and colleagues³demonstrate a remarkable shift in the epidemiology of TB in the United States. In the 1970s, US health officials believed that indigenous TB was coming under control, its ultimate elimination possible with only an occasional case reactivating in the elderly. Transient increases in TB incidence were attributed to immigrants, such as the Indochinese refugees in the mid 1970s⁴and Philippine national World War II veterans in Hawaii in the 1990s.⁵These foreign cases brought with them the peril of drug resistance as a result of the indiscriminate and inconsistent use of TB medications in the immigrants' countries of origin. Bloch

Childhood tuberculosis in Sweden: An epidemiological study made six years after the cessation of general BCG vaccination of the newborn

General BCG vaccination of the newborn was started in Sweden in the 1940s and was stopped on April 1, 1975. The effect of this change in policy has been analysed in a study of children born in Sweden in 1969 or later and whose names were entered in the Central Tuberculosis Register from 1969 to 1980. A comparison was made between two groups of children: 1. children born in Sweden between April 1, 1969 and December 31, 1974 and who contracted tuberculosis during that period; all the children in this group were BCG-vaccinated ; 2. children born between April 1, 1975 and December 31, 1980 and who contracted tuberculosis during that period. Only one child in this group had been vaccinated. In the first group of vaccinated children 4 cases of pulmonary tuberculosis, one case of meningitis and one case of lymphadenitis were recorded. Among the unvaccinated children in the second group, 20 cases of pulmonary tuberculosis, one fatal case of miliary tuberculosis and two cases of meningitis were recorded. In addition 13 cases of mycobacterial lymph node disease and one case of skin granuloma were found, but these were considered likely to be caused by non-tuberculous mycobacterial infection. The incidence of pulmonary, miliary and meningeal tuberculosis was 8 times higher among children born to foreign parents (6.4 per 100 000 person-years) than among unvaccinated Swedish children (0.8 per 100 000). Despite the increase in incidence of tuberculosis which occurred after the cessation of vaccination of the newborn, the continued low incidence of tuberculosis in Swedish children up to and including 1980 does not justify the reintroduction of general BCG vaccination of the newborn in Sweden.

Glucose intolerance in pulmonary tuberculosis.

Although the increased incidence of tuberculosis in persons with diabetes mellitus has been well documented, there is scant information on the incidence of diabetes in patients with tuberculosis. Accordingly, every consecutive patient admitted to the tuberculosis ward during a 5.5-year period had a blood glucose determination 2 hours after 100 g of glucose orally. In 41 per cent of the 256 patients, the blood glucose concentrations at 2 hours were in a diabetic range for the age of the patients. The greater incidence of glucose intolerance in a tuberculous population probably reflects an increased association between the 2 diseases. The older age of the group of patients with tuberculosis represents the successes of chemotherapy and is also the age at which maturity-onset diabetes occurs. Thus viewed, diabetes might well be a factor that precipitates endogenous reactivation of tuberculosis.