title: [An outbreak of mostly extrapulmonary tuberculosis in a family practice].
abstract: An outbreak of mainly extrapulmonary tuberculosis (TB) in a group of about 550 patients with rheumatoid arthritis (RA) is described. These patients had been attending the practice of a former general practitioner who treated cases of rheumatoid arthritis with phenylbutazone and steroids. The number of diagnosed TB cases was 55. Six cases had a contagious lung localisation. The possible sources of the outbreak were analysed. Both a visit on a same day as a sputum positive patient (chi 2-trend: 20.4; p < 0.001) and the administration of steroids (odds ratio (OR): 36.2; 95% confidence interval (CI): 8.8-313) were independent risk factors. There also appeared to be a relationship between TB and RA (OR: 4.4; 95%-BI: 2.2-9.1). Exogenous re(infection) and endogenous reactivation are possible causes of this outbreak.
authors: Geneeskundige Hoofdinspectie van de Volksgezondheid, Rijswijk.
authors: C A
authors: CA
authors: Postema
authors: M A
authors: MA
authors: Bilkert-Mooiman
authors: K
authors: K
authors: Heesbeen
authors: D G
authors: DG
authors: Groothuis
authors: L H
authors: LH
authors: Lumey
authors: H
authors: H
authors: Houweling
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D016001:Confidence Intervals; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005194:Family Practice; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D012044:Regression Analysis; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology* / Q000635:transmission
chemical_list: D000305:Adrenal Cortex Hormones
vernacular_title: Een explosie van voornamelijk extrapulmonale tuberculose in een artsenpraktijk.