[A survey on the onset of tuberculosis in nursing homes]

To obtain the informations how to promote early detection and prevention of nosocomial infection of tuberculosis in nursing homes for the elderly.

Fifteen elderly patients who developed tuberculosis from 1998 to 2002 at nursing homes within a certain health center jurisdiction area which has a total of 23 nursing homes were investigated.

We collected informations on these 15 patients concerning the clinical conditions, details of contact examinations and status of chemoprophylaxis by using TB registration card in the health center and interviewing with the members of staff of the nursing homes and hospitals, and case conferences conducted at the health center.

Four patients died within 10 days after the diagnosis due to the delay in referring them to doctors. The most common symptoms leading to the detection was fever, followed by cough.

Early diagnosis is the key to prevent early death and nosocomial infection of tuberculosis in nursing homes. A similar study will be useful at each health center or region to improve the tuberculosis control in nursing homes.

Tuberculosis control programs in nursing homes should be strengthened. The staff of nursing homes should be trained for closer observations of the elderly about their health conditions such as fever and cough, and their early reference to physicians when such symptoms were observed. Two step tuberculin skin tests to the staff is also important for the contact investigations.