Mycobacterium tuberculosis: assessing your laboratory

The number of people with active tuberculosis in the United States steadily increased from 1985 until 1992. The population groups in the United States that are at increased risk for infection with M. tuberculosis include the medically underserved, low-income populations, immigrants from countries with a high prevalence of tuberculosis, and residents of long-term-care facilities. Those at increased risk for developing disease following infection include individuals with human immunodeficiency virus (HIV) infection; close contacts of infectious cases; children less than 5 years old; patients with renal failure, silicosis, and diabetes mellitis; and individuals receiving treatment with immunosuppressive medications. If the diagnosis of tuberculosis is delayed, subsequent steps to confine contagious patients are likewise delayed and nosocomial infections may result. As multidrug resistant tuberculosis (MDR-TB) increasingly becomes a public health problem, the impact on the medical community can be alarming. Investigations of four MDR-TB outbreaks in hospitals in Florida and New York City demonstrated that most cases of MDR-TB occurred among individuals known to be infected with HIV. The case fatality rate was high (72-89%) and the median interval between diagnosis and death was short (4-16 weeks). Laboratory methods to promote growth and reduce the turnaround time for reporting test results on mycobacterial specimens are now available. It is the responsibility of the laboratory to respond by implementing these methods. This self-assessment will provide encouragement and information to assist you in this effort. The commitment is yours.March 1995Technical reviews by: National Center for Infectious Diseases... [et al].Includes bibliography