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Re-emergence of tuberculosis: epidemiology of TB at an urban medical center in the 1990s.




 

Int Conf Emerg Infect Dis. 1998 Mar 8-11;:71. Unique Identifier :

The resurgence of TB in the U.S. in the late 1980s and early 1990s has been focused in urban areas. We examined the epidemiology of TB over a 6.5 year period (1/91-6/97) at a inner-city hospital (GMH) and assessed population-based rates of disease in inner-city zip code areas. During the 6.5 yrs, there was a total of 1433 different TB admissions to GMH by 1293 different patients (mean=220 admissions/yr; 199 patients/yr). TB diagnosis was culture confirmed in 1218 patients (94.2%) and was a clinical diagnosis in 75 (5.8%). 88% of TB admissions were in newly diagnosed patients and 12% were previously diagnosed with TB at GMH. HIV infection was common; 511 (39.5%) patients were HIV+ (median CD4=72.5), 581 (44.9%) were HIV-, and 201 (15.5%) had unknown HIV status. Mean age was 40.3 yrs; 36 (2.8%) were less than 18 yrs. 73.8% of patients were male. Most were members of a minority group (88% Black, 7% White, 5% other). Between 1991-96, 1264 or 23.4% of all TB cases in Georgia (n=5402) were reported from GMH. Of 1206 different patient isolates for which susceptibility testing was done, 92% were fully susceptible, 4.6% were resistant to INH, 1.4% to rifampin (RIF), 1.2% to both INH and RIF (MDR) and 0.7% to greater than 2 drugs (but not both INH and RIF). HIV+ were more likely to have a drug resistant isolate recovered than HIV- patients (OR=1.81, 95% CI 1.14-2.90, P less than 0.01). HIV infection was strongly associated with RIF mono-resistance (OR=11.00, 95% CI 2.46-68.69, P less than 0.001); 17 of 19 patients with RIF-resistance were HIV+. IS6110-RFLP typing of 9 available RIF resistant isolates revealed each had a unique banding pattern. Of 1149 patient admissions for pulmonary TB, 74.6% were AFB smear positive. HIV+ patients were more likely than others to be smear negative (OR=1.90 95% CI 1.40-2.57, P less than .001). 4 inner-city zip code areas had TB rates greater than 100 cases/100,000 and 5 inner city zip code areas had TB rates of 40-75 cases/100,000 between 1993-1995. In summary, our inner-city hospital care for large number of TB patients. If GMH were a state, it would have ranked 28th in the number of cases reported between 1991-6. TB rates in inner-city areas served by GMH were greater than 10 times the national average. The presence of isolated RIF resistance was strongly associated with HIV and RFLP analysis indicated the emergence of RIF resistance among multiple strains rather than transmission of a single resistant clone. Finally, despite a high incidence of TB and HIV co-infection, MDR-TB was uncommon.

*Hospitals, Urban *Tuberculosis/EPIDEMIOLOGY



 




Information in this article was accurate in July 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.