[Recurrent tuberculosis in a psychiatric hospital, recurrent outbreaks during 1987-1996].
During 1987-1996, 39 of 720 patients hospitalized (most for severe schizophrenia) were diagnosed as having active pulmonary tuberculosis (5.4%, 975 per 105 per year). In 1992-1993, after a cluster of 5 cases was found, all patients were screened by PPD skin test and chest X-ray and 16 more cases were identified. Diagnosis was confirmed bacteriologically in only 10 of them but there were typical radiological findings in the others. 39 were treated with a multi-drug regimen. In addition, 333 exposed patients and 21% who had converted their skin tests were given isoniazid preventive therapy. A small increase in levels of liver enzymes was common, but significant abnormality (over 4 times the upper limit of normal) was found in only 7 patients, in whom therapy was therefore stopped or changed. During a follow-up period of 4 years, 2 more developed tuberculosis and 33 converted their PPD reactivity status. We conclude that an outbreak of tuberculosis in a psychiatric hospital can be controlled with a relatively low rate of side-effects by using systematic diagnostic and therapeutic measures. However, single step screening is not sufficient. Routine screening of all new patients, a high index of suspicion and contact investigation are needed.
Zeenreich
A
A
Pulmonary Institute, Chaim Sheba Medical Center, Tel Hashomer.
Gochstein
B
B
Grinshpoon
A
A
Miron
M
M
Rosenman
J
J
Ben-Dov
I
I
D000995:Antitubercular Agents / Q000627:therapeutic use; D004196:Disease Outbreaks; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006778:Hospitals, Psychiatric; D006801:Humans; D015994:Incidence; D007538:Isoniazid / Q000627:therapeutic use; D007557:Israel; D011718:Pyrazinamide / Q000627:therapeutic use; D012008:Recurrence; D012293:Rifampin / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control
D000995:Antitubercular Agents; D011718:Pyrazinamide; D007538:Isoniazid; D012293:Rifampin