Document 0421
 DOCN  M9610421
 TI    Inner-city tuberculosis in the USA.
 DT    9601
 AU    McGowan JE Jr; Blumberg HM; Department of Pathology and Laboratory
       Medicine, Emory University; School of Medicine, Atlanta, Georgia.
 SO    J Hosp Infect. 1995 Jun;30 Suppl:282-95. Unique Identifier : AIDSLINE
       MED/96035357
 AB    Tuberculosis (TB) has become more common during the past five years in
       several areas of the USA. Occurrence has been facilitated by the
       increasing number of patients with concurrent HIV infection, by cases
       due to multiple-drug-resistant strains, by incomplete TB therapy among
       homeless and non-compliant patients, and by cases in immigrants from
       other countries where TB prevalence is high. These features mean that
       the major burden of TB today is being borne by inner-city health care
       facilities that care for the poor. This is illustrated by data from
       Atlanta, Georgia, where a large proportion of the new cases recognized
       in the metropolitan area are reported by Grady Memorial Hospital, the
       public hospital serving the indigent and working poor of the inner city.
       Similar patterns are recognized in the other USA cities where TB has
       again become a blight. In view of these epidemiological features,
       minimizing inner-city TB will require careful attention to diagnosis and
       isolation procedures in the hospital. Engineering changes at hospitals
       providing acute care of TB have recently been ordered by the federal
       government. These promise to be very expensive, and primarily affect the
       public hospitals, which can least afford them. Innovative treatment
       programmes are essential, as follow-up after acute care is difficult in
       this setting. Directly observed therapy can help, but for some cases the
       era of the TB hospital may have returned. Current attention focuses on
       legal and ethical issues associated with detaining non-compliant and
       recalcitrant patients to complete their therapy. Bacille Calmette Guerin
       (BCG) vaccine is not a priority for this setting at this time.(ABSTRACT
       TRUNCATED AT 250 WORDS)
 DE    Antitubercular Agents/THERAPEUTIC USE  AIDS-Related Opportunistic
       Infections  BCG Vaccine  Community-Acquired
       Infections/*EPIDEMIOLOGY/PREVENTION & CONTROL  Cross
       Infection/PREVENTION & CONTROL  Georgia/EPIDEMIOLOGY  Homeless Persons
       Hospitals, Public/ECONOMICS  Human  Patient Compliance
       Tuberculosis/*EPIDEMIOLOGY/PREVENTION & CONTROL  Tuberculosis,
       Multidrug-Resistant/EPIDEMIOLOGY  *Urban Population  JOURNAL ARTICLE
       REVIEW  REVIEW, TUTORIAL

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