The prevalence and characteristics of adults with latent tuberculous infection in the United States and the implications for healthcare in Texas

The Centers for Disease Control and Prevention reported 8,916 cases of tuberculosis in 2019. Reducing the number of cases of active tuberculosis requires identification of patients with latent tuberculous infections (LTBI). Optimal screening for LTBI requires information about the demographics and characteristics of people who are more likely to have had tuberculous infection. Information from the 2011–2012 National Health and Nutrition Examination Survey (NHANES) was used to determine the number and characteristics of adults from a representative sample of the United States who had LTBI. Latent tuberculous infection was identified either by a positive skin test or by a positive QuantiFERON blood test. Information about the number of patients with active tuberculosis in Texas was determined from reports from the Texas State Department of Health Services. The NHANES database for the years 2011-2012 included 5,684 adults. Participants with a positive QuantiFERON blood test were more likely in the age group 45-64, male, foreign born, and have less than a high school education. Participants with a positive skin test had similar characteristics. Participants who had both a positive skin test and positive QuantiFERON test were more likely to be in the age group 45-64, males, foreign born, and Hispanic. In addition, they had diabetes, self-reported fair/poor health, and an educational level less than high school. In the State of Texas tuberculosis occurred more frequently in individuals older than 75 who were male and were not US born Texas residents. Important clinical diagnoses included diabetes, alcohol abuse, correctional facility residence, non-injection drug use, positive HIV status, and homelessness. Information from the NHANES study and from the State Department of Health Services in Texas provides information needed to develop screening programs for latent tuberculosis and active tuberculosis.

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Tuberculin Skin Test Screening in Schoolchildren in the United States

PEDIATRICS ◽

10.1542/peds.98.1.97 ◽

1996 ◽

Vol 98 (1) ◽

pp. 97-102 ◽

Cited By ~ 4

Author(s):

Cynthia R. Driver ◽

Sarah E. Valway ◽

Michael F. Cantwell ◽

Ida M. Onorato

Keyword(s):

United States ◽

Tuberculin Skin Test ◽

Skin Test ◽

Local Level ◽

District Of Columbia ◽

The United States ◽

Tuberculous Infection ◽

Foreign Born ◽

School Based

Objective. To determine the current practices and results of tuberculin skin test (TST) screening of schoolchildren in the United States. Methods. Tuberculosis program staff in all states and the District of Columbia were asked about current requirements, practices, and results of school-based TST screening. Results. Thirty-four states and the District of Columbia (69%) reported no current statewide statutes or policies for tuberculin screening of schoolchildren, and 10 (19%) reported having statewide requirements. In 6 states (12%), requirements were instituted at the local level, and 24 localities in these states were known to require screening. Of the 34 areas requiring screening, 18 (53%) screened all new entrants, 7 (21%) screened children in specific grades, and 9 (26%) used other criteria for screening. TST results were collected for 26 (76%) of 34 areas, and 6 areas collected results of follow-up evaluation of tuberculin-positive children. Additionally, 8 localities in 7 states with no screening requirements conducted tuberculin surveys. Sixteen areas provided results. In 7 of the 8 areas that collected information about birthplace, less than 2% of US-born children were tuberculin positive; foreign-born children had rates 6 to 24 times higher than US-born children. TST screening identified few cases of tuberculosis, less than 0.02% of the children screened. Conclusion. School-based tuberculin screening identified low rates of positive TST results in US-born children. Resources should be directed toward screening children at high risk for tuberculous infection, as recommended by the American Academy of Pediatrics and the Advisory Committee for Elimination of Tuberculosis.

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Sequential degranulation of eosinophils induced by antigen or autocoids in allergic humans

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100143390 ◽

1986 ◽

Vol 44 ◽

pp. 354-355

Author(s):

Kate W. Sjoerdsma ◽

W. James Metzger

Keyword(s):

Allergic Rhinitis ◽

Bronchoalveolar Lavage ◽

Allergic Asthma ◽

Skin Test ◽

Positive Skin Test ◽

Positive Skin ◽

Human Eosinophil ◽

Asthmatic Patients ◽

Allergic Asthmatic ◽

History Of

Eosinophils are important to the pathogenesis of allergic asthma, and are increased in bronchoalveolar lavage within four hours after bronchoprovocation of allergic asthmatic patients, and remain significantly increased up to 24 hours later. While the components of human eosinophil granules have been recently isolated and purified, the mechanisms of degranulation have yet to be elucidated.We obtained blood from two volunteers who had a history of allergic rhinitis and asthma and a positive skin test (5x5mm wheal) to Alternaria and Ragweed. Eosinophils were obtained using a modification of the method described by Roberts and Gallin.

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Unresolved Issues in Controlling the Tuberculosis Epidemic Among the Foreign-Born in the United States

American Journal of Law & Medicine ◽

10.1017/s009885880001193x ◽

1996 ◽

Vol 22 (4) ◽

pp. 503-536

Author(s):

Guido S. Weber

Keyword(s):

Public Health ◽

The United States ◽

Laboratory Research ◽

Treatment Programs ◽

State Governments ◽

Foreign Born ◽

Health Crisis ◽

Department Of Health ◽

Public Health Officials ◽

Year 2000

Tuberculosis (TB), “the world’s most neglected health crisis,” has returned after decades of decline, but has only gradually caught the attention of governments as a formidable threat to public health. By 1984, when TB cases hit an all-time low, federal and state governments stopped supporting the medical infrastructure that once served to contain the disease. State officials around the nation began dismantling laboratory research programs and closing TB clinics and sanitoria. Since 1985, however, TB rates have steadily increased to 26,673 reported cases in 1992, and some have estimated that by the year 2000, there could be a twenty percent increase. By 1993, Congress, realizing that TB could pose a major public health threat, allocated over $100 million to the Department of Health and Human Services for TB prevention and treatment programs. Those funds, however, were sorely needed years before and amounted to only a fraction of what public health officials believe necessary to control TB today.

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Penicillin Hypersensitivity

Pediatrics in Review ◽

10.1542/pir.1.5.132 ◽

1979 ◽

Vol 1 (5) ◽

pp. 132-158

Keyword(s):

Skin Test ◽

Multicenter Study ◽

Positive Skin Test ◽

Penicillin Allergy ◽

Skin Tests ◽

Penicillin G ◽

Positive Skin ◽

Positive History ◽

History Of

A (massive) multicenter study of 3,000 patients has demonstrated that skin tests to penicillin G and penicilloyl-polylysine (PPL-now commercially available) predict and confirm penicillin allergy. Of patients with a history of penicillin reaction, 19% were positive to either, compared to 7% of controls. A history of anaphylaxis led to 46% positive. Of those with a history of urticaria 17% were positive, and those with maculopapular eruptions did not differ from controls (7% positive). Challenge with penicillin led to a reaction in 6% with a positive history (compared to 2% with a negative) and 67% with a combined positive history and positive skin test (to either).

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THE CUTANEOUS REACTION TO EGGWHITE

PEDIATRICS ◽

10.1542/peds.24.6.1009 ◽

1959 ◽

Vol 24 (6) ◽

pp. 1009-1015

Author(s):

Richard L. London ◽

Jerome Glaser

Keyword(s):

Skin Test ◽

Skin Testing ◽

Intradermal Test ◽

Skin Tests ◽

Etiologic Factor ◽

Initial Reaction ◽

Age Group ◽

Positive Skin ◽

Clinical Sensitivity ◽

Number Of Patients

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known. In all age groups the family history was positive in about 65% of cases. It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor. In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity. In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test. Only about half the patients of all ages who react to eggwhite are also clinically sensitive. Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied. There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.

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