The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #62716

Syed N. Khalil, PhD, MPH¹, Larry D. Teeter, PhD², Tung Bui, MD², Esmaeil Porsa, MD³, James M. Musser, MD, PhD⁴, and Edward A. Graviss, PhD, MPH². (1) Pathology, Houston Tuberculosis Initiative 209E, Baylor College of Medicine, One Baylor Plaza, Texas Medical Center, Houston, TX 77030, 713 798-8809, skhalil@bcm.tmc.edu, (2) Department of Pathology, Baylor College of Medicine, One Baylor Plaza (209E), Texas Medical Center, Houston, TX 77030, (3) Harris County Sheriff's Department, Medical Division, University of Texas Health Science Center-Houston, 1200 Baker Street, Houston, TX 77002, (4) Rocky Mountain Laboratories, NIAID, NIH, 903 South 4th Street, Hamilton, MT 59840

Background: Incarceration facilities have been implicated as a setting for tuberculosis (TB) transmission. To reduce the risk of TB transmission in the county jail, the Harris County Sheriff’s Department (HCSD) performs chest x-rays on all new inmates and places those with abnormal radiographs in respiratory isolation. Since TB cases diagnosed by HCSD are identified by novel screening procedures, we hypothesized they would have different clinical profiles.

Methods: TB cases diagnosed in Harris County, Texas between 10/1/95 and 9/30/00 were interviewed for TB risk and medical records were reviewed. Attributes of persons with positive Mycobacterium tuberculosis cultures from respiratory specimens collected at HCSD were compared to culture-positive pulmonary TB cases with a history of incarceration, but not diagnosed in HCSD. Logistic regression analyses were performed.

Results: 816 enrolled TB cases met the inclusion criteria, including 92 diagnosed at HCSD. HCSD cases were less likely to be HIV seropositive (OR=0.3, P<0.01), acid-fast bacilli (AFB) smear positive (OR=0.4, P<0.01), present with pulmonary cavities (OR=0.7, P=0.13) and cough (OR=0.4, P<0.01). HCSD cases were more likely to be tuberculin skin test (TST) positive (OR=5.8, P<0.01), consumed alcohol within 6 months of illness (OR=2.8, P<0.01) and use drugs (OR=3.3, P<0.01). In multivariate analyses HIV, AFB, TST, alcohol and drug use remained significant (P<0.05).

Conclusions: HCSD cases had clinical features consistent with early TB diagnosis. The finding that persons diagnosed at HCSD were less likely to be HIV seropositive is not surprising considering that persons with HIV/TB co-infection tend to have atypical radiographs and anergic TST results.

Learning Objectives:

• To learn and recognize different screening procedures for TB and how that helps controlling TB in a public facility.

Keywords: Incarceration, TB

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.