California recorded 4,520 new tuberculosis cases in 1981, for a
rate of 18.7 per 100,000 population, compared with a national rate
of
11.9/100,000. Since special tuberculosis hospitals and sanitoria
no
longer exist, tuberculosis may now be seen by any health care
provider
or clinic. Following are two examples in which the disease was not
initially considered.
Case 1: On November 19, 1982, a 39-year-old Chinese-speaking
housewife was discovered to have laboratory-confirmed (sputum and
culture positive) pulmonary tuberculosis. She had immigrated from
Burma in 1972, and, at that time, her chest x-ray was normal.
Throughout the summer of 1982, she felt unwell and developed fever
and
some weight loss. She sought medical advice in July, but no
diagnosis
was established. Her symptoms persisted, and she presented again
in
September with an eight-pound weight loss, a frequent cough, and
fatigue. Again no diagnosis was established, and she was given
vitamins. In early November, her cough became productive of heavy
sputum. She returned to her physician later that month after a
2-year-old child she was tending was found on routine examination
to
have a significant tuberculin skin test. This child was
subsequently
admitted to a hospital with pleurisy and x-ray findings compatible
with tuberculosis; the child was started on therapy.
Investigation revealed that the woman tended four or five
children
each day. Three other children in this group (ages 2 1/2 years, 3
years, and 21 months) were found to have significant skin test
reactions and had x-ray findings compatible with pulmonary
tuberculosis. All three are being treated as patients. One other
child also under her care had a significant reaction to purified
protein derivative (PPD) and was placed on isoniazid (INH). In
addition, her own children (ages 5, 11, and 15 years) and her
husband
had significant reactions to PPD and were placed on INH.
Case 2: The second patient is a 38-year-old native of the
Philippines whose father had died of tuberculosis during the
patient's
childhood. This patient had a significant PPD reaction before his
arrival in the United States in 1969. He underwent a renal
transplant
20 months ago, and because of problems with chronic rejection,
continues on immunosuppressive medication. He did not take INH at
the
time of surgery. On December 5, 1982, he was admitted to a
hospital
with productive cough, night sweats, fever and chills, and a
progressive weight loss of 25 pounds during the past 2-3 months.
On
admission, his posterior pharynx was erythematous, and the tonsils
were ulcerated and covered with a whitish exudate. Chest x-ray
showed
several cavities, and numerous acid-fast bacilli (AFB) were found
on
sputum smear. Culture was subsequently positive. AFB were also
recovered in large numbers from the tonsils. He was placed on
triple
drug therapy and a week later, was discharged home as improved.
In the 2 months before his hospitalization, the patient had
sought
medical attention several times. Antibiotics for 'flu' were
prescribed on one visit, and on a subsequent visit in November, he
received Nystatin for a presumed fungus infection of mouth and
tonsils.
Editorial Note
Editorial Note: Refugees from Southeast Asia and other immigrants
from Asia, Latin America, and the Pacific Basin are coming to
California in large numbers. This trend can be expected to
continue.
Tuberculosis must be considered in these patients who come from
high
incidence areas and present with cough and fever. Although the
risk
of developing current tuberculosis is greatest during the first few
years after arrival, these persons remain at higher risk of
developing
current tuberculosis than the general population.
Reported in California Morbidity, January 14, 1983.
Disclaimer
All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.
**Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.
