DOCSLIB.ORG

The Epidemiology of Spinal Tuberculosis in the United States: an Analysis of 2002–2011 Data

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Epidemiology of Spinal Tuberculosis in the United States: an Analysis of 2002–2011 Data CLINICAL ARTICLE J Neurosurg Spine 26:507–512, 2017 The epidemiology of spinal tuberculosis in the United States: an analysis of 2002–2011 data *Rafael De la Garza Ramos, MD, C. Rory Goodwin, MD, PhD, Nancy Abu-Bonsrah, BS, Ali Bydon, MD, Timothy F. Witham, MD, Jean-Paul Wolinsky, MD, and Daniel M. Sciubba, MD Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland OBJECTIVE The aim of this study was to investigate the incidence of spinal tuberculosis (TB) in the US between 2002 and 2011. METHODS The Nationwide Inpatient Sample database from 2002 to 2011 was used to identify patients with a discharge diagnosis of TB and spinal TB. Demographic and hospital data were obtained for all admissions, and included age, sex, race, comorbid conditions, insurance status, hospital location, hospital teaching status, and hospital region. The inci- dence rate of spinal TB adjusted for population growth was calculated after application of discharge weights. RESULTS A total of 75,858 patients with a diagnosis of TB were identified, of whom 2789 had a diagnosis of spinal TB (3.7%); this represents an average of 278.9 cases per year between 2002 and 2011. The incidence of spinal TB decreased significantly—from 0.07 cases per 100,000 persons in 2002 to 0.05 cases per 100,000 in 2011 (p < 0.001), corresponding to 1 case per 2 million persons in the latter year. The median age for patients with spinal TB was 51 years, and 61% were male; 11.6% were patients with diabetes, 11.4% reported recent weight loss, and 8.1% presented with paralysis. There were 619 patients who underwent spinal surgery for TB, with the most common location being the thoracolumbar spine (61.9% of cases); 50% of patients had instrumentation of 3 or more spinal segments. CONCLUSIONS During the examined 10-year period, the incidence of spinal TB was found to significantly decrease over time in the US, reaching a rate of 1 case per 2 million persons in 2011. However, the absolute reduction was rela- tively small, suggesting that although it is uncommon, spinal TB remains a public health concern and most commonly affects male patients approximately 50 years of age. Approximately 20% of patients with spinal TB underwent surgery, most commonly in the thoracolumbar spine. https://thejns.org/doi/abs/10.3171/2016.9.SPINE16174 KEY WORDS tuberculosis; spine; Pott’s disease; epidemiology; incidence; surgery; infection PINAL tuberculosis (TB) is a known cause of spinal phosis, and paraplegia.12 Whereas spinal TB affects mostly deformity and paraplegia. First described in the children in developing nations, it is a disease of the elderly modern era by English surgeon Percival Pott in 1779 in the developed world.7 Pott’s disease develops after he- S(i.e., Pott’s disease),20 it is currently regarded as a disease matogenous spread of Mycobacterium tuberculosis from a affecting people in the developing world.7 Nevertheless, primary site (typically the lungs), which leads to destruc- TB remains a problem in developed regions such as Eu- tion of the intervertebral disc and vertebral body.11 This rope and the US.6,16,25 In 2014 alone, a total of 9421 new results in a pathological compression fracture, vertebral cases of TB were reported in the US, corresponding to an wedging, and kyphoscoliosis, which in turn may lead to incidence of 2.96 cases per 100,000 persons.5 neurological deficits due to spinal cord compression.2,14,17 Pott was the first to recognize the link between TB, ky- Despite multiple epidemiological studies examining ABBREVIATIONS ICD-9 = International Classification of Diseases, 9th Revision; LOS = length of stay; NIS = Nationwide Inpatient Sample; TB = tuberculosis. SUBMITTED February 22, 2016. ACCEPTED September 2, 2016. INCLUDE WHEN CITING Published online December 16, 2016; DOI: 10.3171/2016.9.SPINE16174. * Drs. De la Garza Ramos and Goodwin contributed equally to this work. ©AANS, 2017 J Neurosurg Spine Volume 26 • April 2017 507 Unauthenticated | Downloaded 10/01/21 11:09 PM UTC R. De la Garza Ramos et al. FIG. 1. Graph showing the population growth–adjusted incidence rate of FIG. 2. Bar graph showing the proportion of patients with spinal TB patients with a discharge diagnosis of spinal TB in the US from 2002 to among all TB cases. The proportion was found to decrease significantly, 2011. After a peak in 2003, the incidence was found to decrease signifi- from 4.1% in 2002 to 2.6% in 2011 (p < 0.001). Figure is available in cantly over time (p < 0.001). Figure is available in color online only. color online only. TB, there are limited data on the prevalence of Pott’s dis- 9,13 complication; surgical site infection; meningitis; pneumo- ease in the US. The aim of this study is to investigate nia; and incidental durotomy. Hospital charges (excluding the incidence of spinal TB in the American population be- professional fees) were also recorded and reported in 2016 tween 2002 and 2011, using a large nationwide database. US dollars. Methods Statistical Methods Study Design National estimates for spinal TB cases were calculat- This epidemiological study used the Nationwide Inpa- ed after application of discharge weights supplied by the tient Sample (NIS) database records of patients treated be- NIS. Given that this database is a 20% sample, roughly tween 2002 and 2011. Developed by the Healthcare Cost a 5-fold multiplication will give the total number of es- and Utilization Project, the NIS is the largest inpatient timated cases in the US per year. US population data for database in the US, containing hospital admission infor- each year were obtained from the website of the US Cen- mation from a 20% sample of community hospitals across sus Bureau (http://www.census.gov/popest/data/historical/ the country. This 20% sample corresponds to more than index.html). Incidences for any given year were adjusted 8 million hospital stays annually and contains diagnostic for population growth by dividing the estimate of each di- and procedure data in the form of International Classifi- agnosis (from the NIS) by the total population estimate cation of Diseases, 9th Revision (ICD-9) codes. from the US Census Bureau.4 A simple linear regression was done to analyze trends over time. Statistical analyses Patient Sample and Inclusion Criteria were performed in STATA 12 SE (StataCorp). A probabil- All patients with a diagnosis of “tuberculosis” were ity value < 0.05 was considered statistically significant. identified using the Clinical Classifications Software code #1. Patients with spinal TB were then identified via use Results of ICD-9 codes 015.00, 015.01, 015.02, 015.03, 015.04, Between 2002 and 2011, a total of 75,858 patients with 015.05, and 015.06. Patients who underwent spinal fusion a diagnosis of TB were identified, of whom 2789 had a di- were identified via ICD-9 procedural codes 81.00–81.09. agnosis of spinal TB (3.7%). The average annualized rate of spinal TB was 278.9 cases per year. During the 10-year Recorded Variables period examined, the incidence of spinal TB decreased Documented admission information included the fol- significantly, from 0.07 cases per 100,000 persons in 2002 lowing: patient age; sex; race; comorbid conditions; pri- to 0.05 per 100,000 in 2011 (Fig. 1). In 2011, this incidence mary payer (insurance); hospital region (Northeast, Mid- corresponded to 1 case per every 2 million persons. west or North Central, South, or West); hospital teaching The proportion of spinal TB cases among all TB cas- status; hospital location (urban vs rural); in-hospital mor- es was 4.1%, 5.6%, 3.3%, 3.8%, 2.6%, 3.7%, 4.0%, 4.0%, tality rate; and length of stay (LOS). For patients who un- 3.0%, and 2.6% yearly between 2002 and 2011 (Fig. derwent spinal surgery, the following complications were 2). A summary of spinal TB cases is shown in Table 1. recorded: neurological complications; iatrogenic stroke; The median age of patients was 51 years, and 61% were respiratory complications (including respiratory failure); male. There was an almost equal proportion of Caucasian pulmonary embolism; deep venous thrombosis; myocardi- (24.0%), African American (23.8%), and Hispanic pa- al infarction; acute kidney injury; urinary tract infection; tients (23.2%), and a smaller proportion of Asian/Pacific Clostridium difficile; paralytic ileus; other gastrointestinal Islanders (18.8%) and others (10.2%). The 5 most common 508 J Neurosurg Spine Volume 26 • April 2017 Unauthenticated | Downloaded 10/01/21 11:09 PM UTC Epidemiology of spinal tuberculosis in the US: 2002–2011 data TABLE 1. Summary of characteristics in 2789 patients with a TABLE 2. Summary characteristics of 619 patients who diagnosis of spinal TB underwent surgery for spinal TB between 2002 and 2011 Parameter Value Parameter Value No. of cases 2789 No. of cases 619 Median age in yrs (IQR) 51 (35–65) Median age in yrs (IQR) 52 (35–66) Age >65 yrs (%) 24.4 Age >65 yrs (%) 26.2 Sex (%) Sex (%) Female 39.0 Female 44.4 Male 61.0 Male 55.6 Race (%) Surgery location (%) Caucasian 24.0 Cervical 11.1 African American 23.8 Thoracolumbar 61.9 Hispanic 23.2 Lumbosacral 27.0 Asian or Pacific Islander 18.8 Approach (%) Other 10.2 Posterior only 38.9 Comorbidities (%) Anterior only 26.6 Alcohol abuse 3.0 Combined 34.5 Chronic lung disease 7.7 No. of instrumented levels (%) Diabetes 11.6 1–2 50.0 Drug abuse 5.5 3–7 42.0 Hypertension 28.6 ≥8 8.0 Liver disease 4.9 Complication rate (%) 38.8 Obesity 2.8 In-hospital mortality (%) 3.2 Renal failure 5.6 Median LOS in days (IQR) 16 (10–24) Paralysis 8.1 Weight loss 11.4 HIV positive 4.0 (39.9%), followed by the West (27.4%), the Northeast Malnutrition 11.6 (22.6%), and the Midwest or North Central (10.1%).
Load more

Recommended publications
  • Faqs 1. What Is a 2-Step TB Skin Test (TST)? Tuberculin Skin Test (TST
    FAQs 1. What is a 2-step TB skin test (TST)? Tuberculin Skin Test (TST) is a screening method developed to evaluate an individual’s status for active Tuberculosis (TB) or Latent TB infection. A 2-Step TST is recommended for initial skin testing of adults who will be periodically retested, such as healthcare workers. A 2 step is defined as two TST’s done within 1month of each other. 2. What is the procedure for 2-step TB skin test? Both step 1 and step 2 of the 2 step TB skin test must be completed within 28 days. See the description below. STEP 1 Visit 1, Day 1 Administer first TST following proper protocol A dose of PPD antigen is applied under the skin Visit 2, Day 3 (or 48-72 hours after placement of PPD) The TST test is read o Negative - a second TST is needed. Retest in 1 to 3 weeks after first TST result is read. o Positive - consider TB infected, no second TST needed; the following is needed: - A chest X-ray and medical evaluation by a physician is necessary. If the individual is asymptomatic and the chest X-ray indicates no active disease, the individual will be referred to the health department. STEP 2 Visit 3, Day 7-21 (TST may be repeated 7-21 days after first TB skin test is re ad) A second TST is performed: another dose of PPD antigen is applied under the skin Visit 4, 48-72 hours after the second TST placement The second test is read.
    [Show full text]
  • Latent Tuberculosis Infection
    © National HIV Curriculum PDF created September 27, 2021, 4:20 am Latent Tuberculosis Infection This is a PDF version of the following document: Module 4: Co-Occurring Conditions Lesson 1: Latent Tuberculosis Infection You can always find the most up to date version of this document at https://www.hiv.uw.edu/go/co-occurring-conditions/latent-tuberculosis/core-concept/all. Background Epidemiology of Tuberculosis in the United States Although the incidence of tuberculosis in the United States has substantially decreased since the early 1990s (Figure 1), tuberculosis continues to occur at a significant rate among certain populations, including persons from tuberculosis-endemic settings, individual in correctional facilities, persons experiencing homelessness, persons who use drugs, and individuals with HIV.[1,2] In recent years, the majority of tuberculosis cases in the United States were among the persons who were non-U.S.-born (71% in 2019), with an incidence rate approximately 16 times higher than among persons born in the United States (Figure 2).[2] Cases of tuberculosis in the United States have occurred at higher rates among persons who are Asian, Hispanic/Latino, or Black/African American (Figure 3).[1,2] In the general United States population, the prevalence of latent tuberculosis infection (LTBI) is estimated between 3.4 to 5.8%, based on the 2011 and 2012 National Health and Nutrition Examination Survey (NHANES).[3,4] Another study estimated LTBI prevalence within the United States at 3.1%, which corresponds to 8.9 million persons
    [Show full text]
  • Quantiferon-TB Gold In-Tube Blood Test, Tuberculosis
    OFFICE OF DISEASE PREVENTION AND EPIDEMIOLOGY QuantiFERON™-TB Gold In-Tube How do people catch tuberculosis? What is a Tuberculosis (TB) is spread through the air from one person to another. The TB germs go into the air QuantiFERON test? whenever someone with TB disease in their lungs QuantiFERON (also called QFT) coughs or sneezes. People nearby may breathe in is a blood test to detect infection these germs and become infected. with tuberculosis. For the test, a health care worker will take some blood (less than a teaspoon) from your vein. The blood is then sent to a lab for testing. How soon will I have my test result? The test result will be available in 5–7 days. What is the difference between latent How are the test TB infection and TB disease? results interpreted? If the test is positive, it is likely People with latent TB infection (also called LTBI) you were exposed to tuberculosis are infected with the TB germ, but they do not feel and that you have latent sick or have any symptoms. They cannot spread tuberculosis infection (LTBI). TB to others because the TB germ is sleeping and not active. The only sign of LTBI is a positive A chest X-ray should be done reaction to the TB skin test or a TB blood test, to make sure you do not have such as QuantiFERON. TB disease in your lungs. QuantiFERON, like the TB Without treatment, LTBI can sometimes become skin test, can sometimes give TB disease. This occurs when the “sleeping” germs false results.
    [Show full text]
  • Quantiferon®-TB Gold
    QuantiFERON®-TB Gold ERADICATING TUBERCULOSIS THROUGH PROPER DIAGNOSIS AND DISEASE PREVENTION TUBERCULOSIS Tuberculosis (TB) is caused by exposure to Mycobacterium tuberculosis (M. tuberculosis), which is spread through the air from one person to another. At least two billion people are thought to be infected with TB and it is one of the top 10 causes of death worldwide. To fight TB effectively and prevent future disease, accurate detection and treatment of Latent Tuberculosis Infection (LTBI) and Active TB disease are vital. TRANSMISSION M. tuberculosis is put into the air when an infected person coughs, speaks, sneezes, spits or sings. People within close proximity may inhale these bacteria and become infected. M. tuberculosis usually grows in the lungs, and can attack any part of the body, such as the brain, kidney and spine. SYMPTOMS People with LTBI have no symptoms. People with Other symptoms can include: TB disease show symptoms depending on the infected area of the body. TB disease in the lungs ■ Chills may cause symptoms such as: ■ Fatigue ■ Fever ■ A cough lasting 3 weeks or longer ■ Weight loss and/or loss of appetite ■ Coughing up blood or sputum ■ Night sweats ■ Chest pain SCREENING To reduce disparities related to TB, screening, prevention and control efforts should be targeted to the populations at greatest risk, including: ■ HEALTHCARE ■ INTERNATIONAL ■ PERSONS WORKERS TRAVELERS LIVING IN CORRECTIONAL ■ MILITARY ■ RESIDENTS OF FACILITIES PERSONNEL LONG-TERM CARE OR OTHER FACILITIES CONGREGATE ■ ELDERLY PEOPLE SETTINGS ■ PEOPLE WITH ■ ■ STUDENTS WEAKENED CLOSE CONTACTS IMMUNE SYSTEMS OF PERSONS KNOWN OR ■ IMMIGRANTS SUSPECTED TO HAVE ACTIVE TB BIOCHEMISTRY T-lymphocytes of individuals infected with M.
    [Show full text]
  • Chapter 2, Transmission and Pathogenesis of Tuberculosis (TB)
    Chapter 2 Transmission and Pathogenesis of Tuberculosis Table of Contents Chapter Objectives . 19 Introduction . 21 Transmission of TB . 21 Pathogenesis of TB . 26 Drug-Resistant TB (MDR and XDR) . 35 TB Classification System . 39 Chapter Summary . 41 References . 43 Chapter Objectives After working through this chapter, you should be able to • Identify ways in which tuberculosis (TB) is spread; • Describe the pathogenesis of TB; • Identify conditions that increase the risk of TB infection progressing to TB disease; • Define drug resistance; and • Describe the TB classification system. Chapter 2: Transmission and Pathogenesis of Tuberculosis 19 Introduction TB is an airborne disease caused by the bacterium Mycobacterium tuberculosis (M. tuberculosis) (Figure 2.1). M. tuberculosis and seven very closely related mycobacterial species (M. bovis, M. africanum, M. microti, M. caprae, M. pinnipedii, M. canetti and M. mungi) together comprise what is known as the M. tuberculosis complex. Most, but not all, of these species have been found to cause disease in humans. In the United States, the majority of TB cases are caused by M. tuberculosis. M. tuberculosis organisms are also called tubercle bacilli. Figure 2.1 Mycobacterium tuberculosis Transmission of TB M. tuberculosis is carried in airborne particles, called droplet nuclei, of 1– 5 microns in diameter. Infectious droplet nuclei are generated when persons who have pulmonary or laryngeal TB disease cough, sneeze, shout, or sing. Depending on the environment, these tiny particles can remain suspended in the air for several hours. M. tuberculosis is transmitted through the air, not by surface contact. Transmission occurs when a person inhales droplet nuclei containing M.
    [Show full text]
  • Mycobacterium Tuberculosis: Assessing Your Laboratory
    A more recent version of this document exists. View the 2019 Edition. Mycobacterium tuberculosis: Assessing Your Laboratory APHL Tool 2013 EDITION The following individuals contributed to the preparation of this edition of Mycobacterium tuberculosis: Assessing Your Laboratory Phyllis Della-Latta, PhD Columbia Presbyterian Medical Center Loretta Gjeltena, MA, MT(ASCP) National Laboratory Training Network Kenneth Jost, Jr. Texas Department of State Health Services Beverly Metchock, DrPH Centers for Disease Control and Prevention Glenn D. Roberts, PhD Mayo Clinic Max Salfinger, MD Florida Department of Health, Florida Bureau of Laboratories Dale Schwab, PhD, D(ABMM) Quest Diagnostics Julie Tans-Kersten Wisconsin State Laboratory of Hygiene Anthony Tran, MPH, MT(ASCP) Association of Public Health Laboratories David Warshauer, PhD, D(ABMM) Wisconsin State Laboratory of Hygiene Gail Woods, MD University of Texas Medical Branch Kelly Wroblewski, MPH, MT(ASCP) Association of Public Health Laboratories This publication was supported by Cooperative Agreement Number #1U60HM000803 between the Centers for Disease Control and Prevention (CDC) and the Association of Public Health Laboratories (APHL). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. © Copyright 2013, Association of Public Health Laboratories. All Rights Reserved. Table of Contents 1.0 Introduction ...................................................4 Background ...................................................4 Intended
    [Show full text]
  • Diagnosis of Tuberculosis in Adults and Children David M
    Clinical Infectious Diseases IDSA GUIDELINE Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children David M. Lewinsohn,1,a Michael K. Leonard,2,a Philip A. LoBue,3,a David L. Cohn,4 Charles L. Daley,5 Ed Desmond,6 Joseph Keane,7 Deborah A. Lewinsohn,1 Ann M. Loeffler,8 Gerald H. Mazurek,3 Richard J. O’Brien,9 Madhukar Pai,10 Luca Richeldi,11 Max Salfinger,12 Thomas M. Shinnick,3 Timothy R. Sterling,13 David M. Warshauer,14 and Gail L. Woods15 1Oregon Health & Science University, Portland, Oregon, 2Emory University School of Medicine and 3Centers for Disease Control and Prevention, Atlanta, Georgia, 4Denver Public Health Department, Denver, Colorado, 5National Jewish Health and the University of Colorado Denver, and 6California Department of Public Health, Richmond; 7St James’s Hospital, Dublin, Ireland; 8Francis J. Curry International TB Center, San Francisco, California; 9Foundation for Innovative New Diagnostics, Geneva, Switzerland; 10McGill University and McGill International TB Centre, Montreal, Canada; 11University of Southampton, United Kingdom; 12National Jewish Health, Denver, Colorado, 13Vanderbilt University School of Medicine, Vanderbilt Institute for Global Health, Nashville, Tennessee, 14Wisconsin State Laboratory of Hygiene, Madison, and 15University of Arkansas for Medical Sciences, Little Rock Downloaded from Background. Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuber- culosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain.
    [Show full text]
  • Testing for Diagnosis of Active Or Latent Tuberculosis
    Corporate Medical Policy Testing for Diagnosis of Active or Latent Tuberculosis AHS – G2063 File Name: testing_for_diagnosis_of_active_or_latent_tuberculosis Origination: 4/1/2019 Last CAP Review: 2/2021 Next CAP Review: 2/2022 Last Review: 2/2021 Description of Procedure or Service Description Infection by Mycobacterium tuberculosis (Mtb) results in a wide range of clinical presentations dependent upon the site of infection from classic signs and symptoms of pulmonary disease (cough >2 to 3 weeks' duration, lymphadenopathy, fevers, night sweats, weight loss) to silent infection with a complete absence of signs or symptoms(Lewinsohn et al., 2017). Culture of Mtb is the gold standard for diagnosis as it is the most sensitive and provides an isolate for drug susceptibility testing and species identification (Bernardo, 2019). Nucleic acid amplification tests (NAAT) use polymerase chain reactions (PCR) to enable sensitive detection and identification of low density infections ( Pai, Flores, Hubbard, Riley, & Colford, 2004). Interferon-gamma release assays (IGRAs) are blood tests of cell-mediated immune response which measure T cell release of interferon (IFN)-gamma following stimulation by specific antigens such as Mycobacterium tuberculosis antigens (Lewinsohn et al., 2017; Dick Menzies, 2019) used to detect a cellular immune response to M. tuberculosis which would indicate latent tuberculosis infection (LTBI) (Pai et al., 2014). Scientific Background Tuberculosis (TB) continues to be a major public health threat globally, causing an estimated 10.0 million new cases and 1.5 million deaths from TB in 2018 (WHO, 2016, 2019), with the emergence of multidrug resistant strains only adding to the threat (Dheda et al., 2014). The lungs are the primary site of infection by Mtb and subsequent TB disease.
    [Show full text]
  • Tuberculosis Verrucosa Cutis Presenting As an Annular Hyperkeratotic Plaque
    CONTINUING MEDICAL EDUCATION Tuberculosis Verrucosa Cutis Presenting as an Annular Hyperkeratotic Plaque Shahbaz A. Janjua, MD; Amor Khachemoune, MD, CWS; Sabrina Guillen, MD GOAL To understand cutaneous tuberculosis to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Recognize the morphologic features of cutaneous tuberculosis. 2. Describe the histopathologic characteristics of cutaneous tuberculosis. 3. Explain the treatment options for cutaneous tuberculosis. CME Test on page 320. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. October 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Janjua, Khachemoune, and Guillen report no conflict of interest. The authors discuss off-label use of ethambutol, isoniazid, pyrazinamide, and rifampicin. Dr. Fisher reports no conflict of interest. Tuberculosis verrucosa cutis (TVC) is a form evolving cell-mediated immunity. TVC usually of cutaneous tuberculosis that results from acci- begins as a solitary papulonodule following a dental inoculation of Mycobacterium tuberculosis trivial injury or trauma on one of the extremi- in a previously infected or sensitized individ- ties that soon acquires a scaly and verrucous ual with a moderate to high degree of slowly surface.
    [Show full text]
  • India Tuberculosis Roadmap Overview, Fiscal Year 2021
    INDIA TUBERCULOSIS ROADMAP OVERVIEW, FISCAL YEAR 2021 This is an overview of the USAID/India FY 2021 Tuberculosis (TB) Roadmap, implemented with FY 2020 budget. It was developed in consultation with the National TB Elimination Program (NTEP) and with the participation of national and international partners involved in TB prevention and care in the country. India accounts for about one quarter of the global TB burden. Among the 30 high TB and high multidrug-resistant TB (MDR-TB) burden countries, India is ranked first.1 In 2019, the estimated TB incidence was 2,640,000, and an estimated 436,000 people died from TB, including about 10,000 HIV-positive people with TB.2 In 2019, India notified 2,162,323 TB cases3—a 13 percent increase from 2018—with a large proportion (31 percent) coming from private sector notifications.4 While significant progress has been made, if India is to eliminate TB and detect the approximately 478,000 ‘missing’ cases, it will need to accelerate that progress even further. In order to achieve this, the global public health and larger TB community, including the NTEP, is shifting its focus from controlling to ending TB. A revised National Strategic Plan to End TB, 2020-2025 (NSP) (currently under development, draft copy available)5 aims to collaborate intensively across various ministries to promote a multisectoral response to eliminate TB, while continuing to implement the program and deliver impact. Through this NSP, the NTEP aims to undertake necessary structural and procedural changes to ensure a robust, responsive, and agile TB response that can safeguard and address the concerns of TB patients and providers during times of complex emergencies and unprecedented crisis.
    [Show full text]
  • Information Sheet Immunization and TB Requirements for Health Career Programs
    Information Sheet Immunization and TB Requirements For Health Career Programs Why is immunization important for students in health career programs? Health care providers are at risk of exposure to, and possible transmission of, preventable diseases. Risk of communicable diseases in the workplace is due to health care providers contact with infected patients or infective material from patients. Maintenance of immunity is therefore an essential part of prevention and infection control. Vaccinating health care providers helps protect their health and prevent disease transmission between patients and providers and among providers and their family and friends outside the workplace. What routine immunizations and screenings are required? The vaccines required are Tetanus, Diphtheria, and Pertussis (Tdap), Measles (Rubeola), Mumps and Rubella (MMR), Varicella, and Influenza. Positive Rubella Titer is required in addition to MMR vaccination. Students must also be tested for TB on an annual basis. Tetanus, Diphtheria and Pertussis (required) Diphtheria is a serious communicable disease, causing death in 5-10 percent of cases with the highest rates among the very young and the elderly. Diphtheria disease is most common and most severe in non-immunized or partially immunized individuals. Protection from vaccine decreases over time unless periodic boosters are given. Tetanus is an acute and often fatal disease. While rare, cases have been reported that are associated with injection drug use, animal bites and wounds contaminated with dirt, feces or saliva. Pertussis (whooping cough) is very contagious and can cause serious illness―especially in infants too young to be fully vaccinated. Pertussis vaccines are recommended for children, teens, and adults, including pregnant women Immunization against tetanus, diphtheria, and pertussis is recommended for all adults in the USA and required for students in health career programs at HACC.
    [Show full text]
  • The T-SPOT.TB Test Brochure
    AVAILABLE THROUGH QUEST DIAGNOSTICS® The cell enumeration technology in the proprietary T-SPOT.TB test allows clinicians to confidently screen and detect tuberculosis (TB) infection. The reliability of the T-SPOT.TB test design, which includes washing and standardizing patient specimens, is supported by clinical data obtained even in challenging patient populations.1 Accurate across patient populations An accurate test is critical for the effectiveness of your TB screening program Effective in challenging patient populations1 • Immunocompromised • BCG-vaccinated Only TB test with sensitivity and specificity > 95%1 • Sensitivity: 95.6% • Specificity: 97.1% FDA-approved borderline zone provides test resolution for results around the cut-off point2,3 Consistent results A consistent test means you can feel confident in your result 98.9% concordance and 0.8% mean conversion rate in a study of > 42,000 healthcare worker serial tests4 Invalid rate of 0.6% in a study of > 645,000 tests2 One tube with no refrigeration An efficient process frees up your time to complete other critical priorities Standard phlebotomy One visit No on-site pre-analytical steps No on-site incubation or refrigeration A MOMENT OF TRUTH Unique CPT® code5 The T-SPOT.TB test is the only commercially available TB blood test appropriate to be submitted under CPT code 86481.1,6,7 The T-SPOT.TB test is a standardized test that requires cell enumeration.1 CPT code 86481* 86480* 86480* Applicable test The T-SPOT.TB test QuantiFERON®-TB LIAISON® QFT-Plus Gold Plus (QFT®-Plus) Description Tuberculosis test, Tuberculosis test, Tuberculosis test, cell mediated cell mediated cell mediated immunity antigen immunity immunity response measurement of measurement of measurement; gamma interferon gamma interferon enumeration of producing antigen producing antigen gamma interferon- response response producing T-cells in cell suspension * The listed CPT codes reflect Oxford Immunotec’s general interpretation of CPT coding requirements and are provided for informational purposes only.
    [Show full text]