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Recent experience in the control and management of tuberculosis in a mental handicap hospital
Abstract:
Sixteen cases of tuberculosis (14 in inmates, only one of whom was female) occurred in a mental handicap hospital of some 400 inmates during the period 1973-85. This represents an annual incidence of 269 per 100,000, substantially higher than that in the surrounding community. In 1980, 29% of inmates had Grade 3 or 4 positive Heaf tests. Widespread chemoprophylaxis was successfully undertaken in 1980/81, the only problem encountered being interaction of isoniazid with carbamazepine. One Down's syndrome patient had recurrent disease, and a second developed disease despite chemoprophylaxis. Immunological investigation of a small number of Down's syndrome patients with tuberculosis showed no consistent defect.
Insights
Tuberculosis (TB) incidence was high in a mental handicap hospital, necessitating widespread chemoprophylaxis. The treatment was successful, with only minor drug interactions and no consistent immune defects found in Down
Area of Science:
- Public Health
- Infectious Diseases
- Clinical Medicine
Background:
- Tuberculosis (TB) poses a significant risk in institutional settings.
- Mental handicap hospitals may have unique challenges regarding TB transmission and control.
- Previous TB incidence and risk factors in such populations require detailed investigation.
Purpose of the Study:
- To determine the incidence of tuberculosis in a mental handicap hospital.
- To evaluate the effectiveness of a widespread chemoprophylaxis program.
- To investigate potential immunological factors in patients with Down's syndrome and TB.
Main Methods:
- Retrospective analysis of tuberculosis cases in a mental handicap hospital from 1973-1985.
- Calculation of annual TB incidence rates and comparison with the general community.
- Implementation and monitoring of a widespread chemoprophylaxis program.
- Assessment of Heaf test results and drug interactions.
- Immunological investigations in a subset of patients with Down's syndrome.
Main Results:
- An annual tuberculosis incidence of 269 per 100,000 inmates was recorded, significantly exceeding community rates.
- A widespread chemoprophylaxis program in 1980/81 was successfully implemented.
- The primary complication noted was the interaction between isoniazid and carbamazepine.
- One patient with Down's syndrome experienced recurrent TB, and another developed TB despite prophylaxis.
- No consistent immunological defects were identified in Down's syndrome patients with TB.
Conclusions:
- Mental handicap hospitals can experience high tuberculosis burdens requiring targeted interventions.
- Widespread chemoprophylaxis is an effective strategy for TB control in institutionalized populations.
- Careful monitoring for drug interactions is crucial during TB chemoprophylaxis.
- Down's syndrome may not be associated with a consistent defect predisposing to tuberculosis.