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Tuberculosis Prevention and Control in Long-Term–Care Facilities for Older Adults

Published online by Cambridge University Press:  02 January 2015

Lauri Thrupp ,
Suzanne Bradley ,
Philip Smith ,
Andrew Simor ,
Nelson Gantz ,
Kent Crossley ,
Mark Loeb ,
Larry Strausbaugh ,
Lindsay Nicolle  and
SHEA Long-Term-Care Committee
Lauri Thrupp*
Affiliation:
Infection Control Department, University of California Irvine Medical Center, Orange, California
Suzanne Bradley
Affiliation:
Department of Internal Medicine, University of Michigan Medical School & Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Philip Smith
Affiliation:
Department of Internal Medicine/Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
Andrew Simor
Affiliation:
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
Nelson Gantz
Affiliation:
Infectious Diseases Department, Boulder Community Hospital, Boulder, Colorado
Kent Crossley
Affiliation:
Departments of Education and Internal Medicine, Minneapolis VA Medical Center and theUniversity of Minnesota Medical School, Minneapolis, Minnesota
Mark Loeb
Affiliation:
Department of Clinical Epidemiology and Biostatistics, McMaster University and Hamilton Regional Laboratory Program, Hamilton, Ontario, Canada
Larry Strausbaugh
Affiliation:
Portland VA Medical Center andOregon Health Sciences University School of Medicine, Portland, Oregon
Lindsay Nicolle
Affiliation:
Department of Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
*
University of California Irvine Medical Center, Bldg. 53, Rm. 220, 101 the City Drive, Orange, CA 92868
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Abstract

In the United States, older adults comprise 22% of cases of tuberculous disease but only 12% of the population. Most cases of tuberculosis (TB) occur in community dwellers, but attack rates are highest among frail residents of long-term–care facilities. The detection and treatment of latent TB infection and TB disease can pose special challenges in older adults. Rapid recognition of possible disease, diagnosis, and implementation of airborne precautions are essential to prevent spread. It is the intent of this evidence-based guideline to assist healthcare providers in the prevention and control of TB, specifically in skilled nursing facilities for the elderly.

Type
SHEA Position Paper
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 12 , December 2004 , pp. 1097 - 1108
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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References

1.Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR 2000;49:1–51.Google Scholar
2.American Thoracic Society, CDC, Infectious Diseases Society of America. Treatment of tuberculosis. MMWR 2003;52:1–77.Google Scholar
3.Rajagopalan, S. Tuberculosis and aging: a global health problem. Clin Infect Dis 2001;33:1034–1039.CrossRefGoogle ScholarPubMed
4.Myers, JA, Anderson, HR. The significance of tuberculosis among the aged. American Review of Tuberculosis 1930;21:541–556.Google Scholar
5.Myers, JA. Tapering off of tuberculosis among the elderly. Am J Public Health 1976;66:1101–1106.CrossRefGoogle ScholarPubMed
6.Frost, WH. The age selection of mortality from tuberculosis in successive decades. Am J Hygiene 1939;30A:91–96.Google Scholar
7.Powell, KE, Farer, LS. The rising age of the tuberculosis patient: a sign of success and failure. J Infect Dis 1980;142:946–948.CrossRefGoogle Scholar
8.Stead, WW, Lofgren, JP. Does the risk of tuberculosis increase with age? J Infect Dis 1983;147:951–955.CrossRefGoogle Scholar
9.Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, Division of Tuberculosis Elimination. Surveillance Reports, 2001. Atlanta, GA: Centers for Disease Control and Prevention; 2001. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm5053a1.htm.Google Scholar
10.Bentley, DW. Tuberculosis in long-term care facilities. Infect Control Hosp Epidemiol 1990;11:42–46.CrossRefGoogle ScholarPubMed
11.Centers for Disease Control and Prevention. Trends in aging: United States and worldwide. MMWR 2003;52:101–106.Google Scholar
12.Stead, WW, To, T. The significance of the tuberculin skin test in elderly persons. Ann Intern Med 1987;107:837–842.CrossRefGoogle ScholarPubMed
13.Stead, WW. Tuberculosis among elderly persons: an outbreak in a nursing home. Ann Intern Med 1981;94:606–610.CrossRefGoogle ScholarPubMed
14.Stead, WW, Lofgren, JP, Warren, E, Thomas, C. Tuberculosis as an epidemic and nosocomial infection among the elderly in nursing homes. N Engl J Med 1985;312:1483–1487.CrossRefGoogle ScholarPubMed
15.Ijaz, K, Dillaha, JA, Yang, Z, Cave, MD, Bates, JH. Unrecognized tuberculosis in a nursing home causing death with spread of tuberculosis to the community. J Am Geriatr Soc 2002;50:1213–1218.CrossRefGoogle Scholar
16.Morris, CDW, Nell, H. Epidemic of pulmonary tuberculosis in geriatric homes. S Afr Med J 1988;74:117–120.Google ScholarPubMed
17.American Thoracic Society, Centers for Disease Control and Prevention. Diagnostic standards and classification of tuberculosis in adults and children. Am J Respir Crit Care Med 2000;161:1376–1395.Google Scholar
18.McDonald, RJ, Mulvihill, MN, Hsu, M-A, Libow, LS, Neufeld, RR. Tuberculosis surveillance in a long-term care facility. Arch Gerontol Geriatr 1992;15:29–34.CrossRefGoogle ScholarPubMed
19.Heaf, FRG. Tuberculosis in geriatrics. Journal of the Royal Institute of Public Health and Hygiene 1955;18:324–341.Google ScholarPubMed
20.Huebner, RE, Schein, MF, Bass, JB. The tuberculin skin test. Clin Infect Dis 1993;17:968–975.CrossRefGoogle ScholarPubMed
21.Stead, WW. The pathogenesis of pulmonary tuberculosis among older persons. Am Rev Respir Dis 1965;91:811–822.Google ScholarPubMed
22.Khan, MA, Kovnat, DM, Bachus, B, Whitcomb, ME, Brody, JS, Snider, GL. Clinical and roentgenographic spectrum of pulmonary tuberculosis in the adult. Am J Med 1977;62:31–38.CrossRefGoogle ScholarPubMed
23.Alvarez, S, Shell, C, Berk, SL. Pulmonary tuberculosis in elderly men. Am J Med 1987;82:602–606.CrossRefGoogle ScholarPubMed
24.Banyai, AL. Pulmonary tuberculosis in the aged. American Review of Tuberculosis 1930;21:568–578.Google Scholar
25.Stead, WW, Kerby, GR, Schlueter, DP, Jordahl, CW. The clinical spectrum of primary tuberculosis in adults: confusion with reinfection in the pathogenesis of chronic tuberculosis. Ann Intern Med 1968;68:731–745.CrossRefGoogle ScholarPubMed
26.Alexander, WJ, Avent, CK, Bailey, WC. Simple primary tuberculosis in an elderly woman. J Am Geriatr Soc 1979;27:123–125.CrossRefGoogle ScholarPubMed
27.Troisier, J, Develay, S, Weiss-Roudinesco, J. Sensibilité à la tuberculine provoque chez le viellard par le BCG. Presse Medicale 1929;37:137–138.Google Scholar
28.Griep, WA, Bleiker, MA. Notes on the tuberculin test. Tubercle 1957;38:259–267.CrossRefGoogle ScholarPubMed
29.Giannini, D, Sloan, RS. A tuberculin survey of 1285 adults with special reference to the elderly. Lancet 1957;1:525–527.CrossRefGoogle Scholar
30.Beresford, OD. Tuberculin skin sensitivity in old age. American Review of Tuberculosis 1958;77:323–328.Google ScholarPubMed
31.Caplin, M, Silver, CP, Wheeler, WE. Tuberculin sensitivity in the middle-aged and elderly. Tubercle 1958;39:84–89.CrossRefGoogle ScholarPubMed
32.Chesrow, EJ, Novak, JB. Tuberculin testing of the aged. Dis Chest 1967;51:635–636.CrossRefGoogle ScholarPubMed
33.Robins, AB, Abeles, H, Aronsohn, MH, et al.Tuberculin-testing studies in New York City. American Review of Tuberculosis 1954;69:1057–1058.Google ScholarPubMed
34.Johnston, RN, Ritchie, RT, Murray, IBF. Declining tuberculin sensitivity with advancing age. Br Med J 1963;2:720–724.CrossRefGoogle ScholarPubMed
35.Miller, SD, Jones, HE. Correlation of lymphocyte transformation with tuberculin skin-test sensitivity. Am Rev Respir Dis 1973;107:530–537.CrossRefGoogle ScholarPubMed
36.Havlir, DV, van der Kuyp, F, Duffy, E, Marshall, R, Horn, D, Ellner, JJ. A 19-year follow up of tuberculin reactors: assessment of skin test reactivity and in vitro lymphocyte responses. Chest 1991;99:1172–1176.CrossRefGoogle ScholarPubMed
37.Fukushima, T, Nakayama, K, Monma, M, Sekizawa, K, Sasaki, H. Depression of T helper-1 and tuberculin responses in older bed-bound patients. J Am Geriatr Soc 1999;47:259–260.CrossRefGoogle ScholarPubMed
38.Nagami, PH, Yoshikawa, TT. Tuberculosis in the geriatric patient. J Am Geriatr Soc 1983;31:356–362.CrossRefGoogle ScholarPubMed
39.Stern, JK, Smith, PW. Tuberculosis in the long-term care facility. Geriatric Focus on Infectious Diseases 1991;1:6–10.Google Scholar
40.Katz, PR, Reichman, W, Dube, D, Feather, J. Clinical features of pulmonary tuberculosis in young and old veterans. J Am Geriatr Soc 1987;35:512–515.CrossRefGoogle Scholar
41.Yoshikawa, TT. Tuberculosis in aging adults. J Am Geriatr Soc 1992;40:178–187.CrossRefGoogle ScholarPubMed
42.Yoshikawa, TT. The challenge and unique aspects of tuberculosis in older patients. Infectious Diseases in Clinical Practice 1994;3:62–66.CrossRefGoogle Scholar
43.Rudd, A. Tuberculosis in a geriatric unit. J Am Geriatr Soc 1985;33:566–569.CrossRefGoogle Scholar
44.Morris, CDW. Pulmonary tuberculosis in the elderly: a different disease? Thorax 1990;45:912–913.CrossRefGoogle ScholarPubMed
45.Leung, CC, Yew, WW, Chan, CK, et al.Tuberculosis in older people: a retrospective and comparative study from Hong Kong. J Am Geriatr Soc 2002;50:1219–1226.CrossRefGoogle ScholarPubMed
46.Perez-Guzman, C, Vargas, MH, Torres-Cruz, A, Villarreal-Velarde, H. Does aging modify pulmonary tuberculosis? A meta-analytical review. Chest 1999;116:961–967.CrossRefGoogle ScholarPubMed
47.Sahn, SA, Neff, TA. Miliary tuberculosis. Am J Med 1974;56:495–505.CrossRefGoogle ScholarPubMed
48.Price, LE, Rutala, WA. Tuberculosis screening in the long-term care setting. Infect Control 1987;8:353–356.CrossRefGoogle ScholarPubMed
49.Robertson, JM, Burtt, DS, Edmonds, KL, et al.Delayed tuberculin reactivity in persons of Indochinese origin: implications for preventative therapy. Ann Intern Med 1996;124:779–784.CrossRefGoogle Scholar
50.Muder, RR, Brennen, CI, Yu, KT. Choosing appropriate criteria for tuberculin positivity and conversion in a long-term care facility. Infect Control Hosp Epidemiol 1993;14:523–526.CrossRefGoogle ScholarPubMed
51.Blumberg, HM, White, N, Parrott, P, Gordon, W, Hunter, M, Ray, S. False-positive tuberculin skin test results among health care workers. JAMA 2000;283:2793.CrossRefGoogle ScholarPubMed
52.Clemens, JD, Choung, JJH, Feinstein, AR. The BCG controversy: a methodological and statistical appraisal. JAMA 1983;249:2362–2369.CrossRefGoogle Scholar
53.Hoft, DF, Tennant, JM. Persistence and boosting of bacille Calmette-Guèrin-induced delayed-fype hypersensitivity. Ann Intern Med 1999;131:32–36.CrossRefGoogle ScholarPubMed
54.Centers for Disease Control. Prevention and control of tuberculosis in facilities providing long-term care to the elderly. MMWR 1990;39:7–20.Google Scholar
55.Slovis, BS, Plitman, JD, Haas, DW. The case against anergy testing as a routine adjunct to tuberculin skin testing. JAMA 2000;283:2003–2007.CrossRefGoogle ScholarPubMed
56.Thompson, NJ, Glassroth, JL, Snider, DE, et al.The booster phenomenon in serial tuberculin testing. Am Rev Respir Dis 1979;119:587–597.Google ScholarPubMed
57.Barry, MA, Regan, AM, Kunches, LM, Harris, ME, Bunce, SA, Craven, DE. Two-stage tuberculin testing with control antigens in patients residing in two chronic disease hospitals. J Am Geriatr Soc 1987;35:147–152.CrossRefGoogle ScholarPubMed
58.Simon, JA, McVicker, SM, Ferrell, CR, Payne, CM. Two-step tuberculin testing in a veterans domiciliary population. South Med J 1983;76:866–869.CrossRefGoogle Scholar
59.Centers for Disease Control and Prevention. Guideline for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection. MMWR 2003;52:15–18.Google Scholar
60.Nelson, SM, Deike, MA, Cartwright, CP. Value of examining multiple sputum specimens in the diagnosis of pulmonary tuberculosis. J Clin Microbiol 1998;36:467–469.CrossRefGoogle ScholarPubMed
61.Kox, LFF. Tests for detection and identification of mycobacteria: how should they be used? Respiratory Medicine 1995;89:399–408.CrossRefGoogle ScholarPubMed
62.Shinnick, TM, Good, RC. Diagnostic mycobacteriology practices. Clin Infect Dis 1995;21:291–299.CrossRefGoogle ScholarPubMed
63.Cucin, RL, Coleman, M, Eckardt, JJ, Silver, RT. The diagnosis of miliary tuberculosis: utility of peripheral blood abnormalities, bone marrow, and liver needle biopsy. J Chronic Dis 1973;26:355–361.CrossRefGoogle ScholarPubMed
64.Strumpf, IJ, Tsang, AY, Sayre, WJ. Re-evaluation of sputum straining for the diagnosis of pulmonary tuberculosis. Am Rev Respir Dis 1979;119:599–602.Google Scholar
65.Gordin, F, Slutkin, G. The validity of acid-fast smears in the diagnosis of pulmonary tuberculosis. Arch Pathol Lab Med 1990;114:1025–1027.Google ScholarPubMed
66.Tenover, FC, Crawford, JT, Huebner, RE, Gefter, LJ, Horsburgh, CR JrGood, RC. The resurgence of tuberculosis: is your laboratory ready? J Clin Microbiol 1993;31:767–770.CrossRefGoogle ScholarPubMed
67.Hanna, BA, Ebrahimzadeh, A, Elliott, LB, et al.Multicenter evaluation of the BACTEC MGIY 960 system for recovery of mycobacteria. J Clin Microbiol 1999;37:748–762.CrossRefGoogle ScholarPubMed
68.Brunello, F, Favari, F, Fontana, R. Comparison of the MB/BacT and BACTEC 460 TB systems for recovery of mycobacteria from various clinical specimens. J Clin Microbiol 1999;37:1206–1209.CrossRefGoogle Scholar
69.Gonzalez, R, Hanna, BA. Evaluation of Gen-Probe DNA hybridization systems for the identification of Mycobacterium tuberculosis and Mycobacterium avium-intracellular. Diagn Microbiol Infect Dis 1987;8:69–77.CrossRefGoogle Scholar
70.Musial, CE, Tice, LS, Stockman, L, Roberts, GD. Identification of mycobacteria from culture by using the Gen-Probe rapid diagnostic system for Mycobacterium avium complex and Mycobacterium tuberculosis complex. J Clin Microbiol 1988;26:2120–2133.CrossRefGoogle ScholarPubMed
71.Alcaide, F, Benitez, MA, Escribe, JM, Martin, R. Evaluation of the BACTEC MGIT 960 and the MB/BacT systems for recovery of mycobacteria from clinical specimens and for species identification by DNA AccuProbe. J Clin Microbiol 2000;38:398–401.CrossRefGoogle Scholar
72.D'Amato, RF, Wallman, AA, Hochstein, LH, et al.Rapid diagnosis of pulmonary tuberculosis by using Roche AMPLIGOR Mycobacterium tuberculosis PCR test. J Clin Microbiol 1995;33:1832–1834.CrossRefGoogle ScholarPubMed
73.Carpentier, E, Drouillard, S, Dailloux, M, et al.Diagnosis of tuberculosis by Amplicor Mycobacterium tuberculosis test: a multicenter study. J Clin Microbiol 1995;33:3106–3110.CrossRefGoogle ScholarPubMed
74.Vuorinen, P, Miettinen, A, Vuento, R, Hiklistrdm, O. Direct detection of Mycobacterium tuberculosis complex in respiratory specimens by GenProbe Amplified Mycobacterium tuberculosis test and Roche Amplicor Mycobacterium tuberculosis test. J Clin Microbiol 1995;33:1859–1866.CrossRefGoogle ScholarPubMed
75.Bennedsen, J, Thomsen, VO, Pfyffer, GE, et al.Utility of PCR in diagnosing pulmonary tuberculosis. J Clin Microbiol 1991;34:1407–1411.CrossRefGoogle Scholar
76.Piersimoni, C, Callegaro, A, Nista, D, et al.Comparative evaluation of two commercial amplification assays for direct detection of Mycobacterium tuberculosis complex in respiratory specimens. J Clin Microbiol 1997;36:193–196.CrossRefGoogle Scholar
77.American Thoracic Society. Rapid diagnostic tests for tuberculosis: what is the appropriate use? Am J Respir Crit Care Med 1997;155:1804–1814.CrossRefGoogle Scholar
78.Kennedy, DJ, Lewis, WP, Barnes, PF. Yield of bronchoscopy for the diagnosis of tuberculosis in patients with HIV infections. Chest 1992;102:1040–1044.CrossRefGoogle Scholar
79.Centers for Disease Control and Prevention. Nucleic acid amplification tests for tuberculosis. MMWR 1996;45:950–952.Google Scholar
80.Barnes, PF, Cave, MD. Molecular epidemiology of tuberculosis. N Engl J Med 2003;349:1149–1156.CrossRefGoogle ScholarPubMed
81.Barnes, PF, Yang, Z, Preston-Martin, S, et al.Patterns of tuberculosis transmission in central Los Angeles. JAMA 1997;278:1159–1163.CrossRefGoogle ScholarPubMed
82.Centers for Disease Control and Prevention. Guidelines for preventing the transmission Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43:1–132.Google Scholar
83.Centers for Disease Control and Prevention. Guidelines for environmental control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR 2003;52:1–44.Google Scholar
84.Centers for Disease Control and Prevention. Screening for tuberculosis and tuberculosis infection in high-risk populations: recommendations of the Advisory Council for the Elimination of Tuberculosis. MMWR 1995;44:19–34.Google Scholar
85.Smieja, MJ, Marchetti, CA, Cook, DJ, Smaill, FM. Isoniazid for preventing tuberculosis in non-HIV infected persons (Cochrane Review). The Cochrane Library Issue 1, 2001.Google Scholar
86.International Union Against Tuberculosis Committee on Prophylaxis. Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of followup in the IUAT trial. Bull WHO 1982;60:555–564.Google Scholar
87.Horsburgh, CR, Feldman, S, Ridzon, R. Practice guidelines for the treatment of tuberculosis. Clin Infect Dis 2000;31:633–639.CrossRefGoogle ScholarPubMed
88.Kopanoff, DE, Snider, DE, Caras, GJ. Isoniazid-related hepatitis: a US Public Health Service cooperative surveillance study. Am Rev Respir Dis 1978;117:991–1001.Google ScholarPubMed
89.Sorresso, DJ, Mehta, JB, Harvill, LM, Bentley, S. Under utilization of isoniazid chemoprophylaxis in tuberculosis contacts age 50 years of age and older: a prospective analysis. Chest 1995;108:706–711.CrossRefGoogle Scholar
90.Van den Brande, P, Van Steenbergen, W, Vervoort, G, Demedts, M. Aging and hepatotoxicity of isoniazid and rifampin in pulmonary tuberculosis. Am J Respir Crit Care Med 1995;152:1705–1708.CrossRefGoogle ScholarPubMed
91.Rose, DN, Schechter, CB, Silver, A. The age threshold for isoniazid chemoprophylaxis. JAMA 1986;256:2709–2713.CrossRefGoogle ScholarPubMed
92.Nolan, CM, Goldberg, SV, Buskin, SE. Hepatotoxicity associated with isoniazid preventative therapy: a seven year survey from a public health tuberculosis clinic. JAMA 1999;281:1014–1018.CrossRefGoogle Scholar
93.Salpeter, SR, Sauders, GD, Salpeter, EE, Owens, DK. Monitored isoniazid prophylaxis for low risk tuberculin reactors older than 35 yrs of age: a risk-benefit and cost-effectiveness analysis. Ann Intern Med 1997;127:1051–1061.CrossRefGoogle Scholar
94.Joint Tuberculosis Committee, British Thoracic Society. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998. Thorax 1998;53:536–548.CrossRefGoogle Scholar
95.Centers for Disease Control and Prevention. Use of short-course tuberculosis preventive therapy regimens in HIV-seronegative persons. MMWR 1998;47:911–912.Google Scholar
96.Jasmer, RM, Saukkonen, JJ, Blumberg, HM, et al.Short-course rifampin and pyrazinamide compared with isoniazid for latent tuberculosis infection: a multicenter clinical trial. Ann Intern Med 2002;137:640–647.CrossRefGoogle ScholarPubMed
97.Centers for Disease Control and Prevention. Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection—United States, 2003. MMWR 2003;52:735–739.Google Scholar
98.Telzak, EE, Sepkowitz, K, Alpert, P, et al.Multi-drug resistant tuberculosis in patients without HIV infection. N Engl J Med 1995;333:907–911.CrossRefGoogle ScholarPubMed
99.Iseman, MD. Treatment of multidrug-resistant tuberculosis. N Engl J Med 1993;329:784–791.Google ScholarPubMed
100.Mahmoudi, A, Iseman, MD. Pitfalls in the care of patients with tuberculosis. JAMA 1993;270:65–68.CrossRefGoogle ScholarPubMed
101.Weis, SE, Slocum, PC, Blais, FX, et al.The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med 1994;330:1179–1184.CrossRefGoogle ScholarPubMed
102.Gilbert, DN, Moellering, RC, Sande, MA. The Sanford Guide to Antimicrobial Therapy, ed. 32. Hyde Park, VT: Antimicrobial Therapy;2002.Google Scholar
103.Yoshikawa, TT, Nagami, PH. Adverse drug reactions in TB therapy: risks and recommendations. Geriatrics 1982;37:61–68.Google ScholarPubMed
104.Gross, PA, Barrett, TL, Dellinger, EP, et al.Purpose of quality standards for infectious diseases. Clin Infect Dis 1994;18:421.CrossRefGoogle ScholarPubMed