Nontuberculous respiratory infections among the homeless

In contrast to the extensive studies of pulmonary tuberculosis among homeless persons, virtually no data are available on nontuberculous respiratory infections in this population. This article reviews the literature on pulmonary infections and homelessness. The clinical experience of the Boston Health Care for the Homeless Program is detailed, with emphasis on the role of multidisciplinary teams of physicians, nurses, and case workers in the integration of hospital- and shelter-based clinics necessary to provide primary care to a fragmented and transient population. The shelters facilitate the transmission of airborne pathogens, and homeless persons are often debilitated and susceptible hosts. Outbreaks of specific respiratory infections are examined, including pneumococcal pneumonia, Haemophilus influenzae type b pneumonia, and influenza.