Hostname: page-component-848d4c4894-v5vhk Total loading time: 0 Render date: 2024-06-22T23:46:43.817Z Has data issue: false hasContentIssue false
  • English
  • Français

Gender Differences in Early Suspicion of Tuberculosis in Hospitalized High-Risk Patients During 4 Epidemic Years, 1987 to 1990

Published online by Cambridge University Press:  02 January 2015

J. Peter Cegielski ,
Matthew B. Goetz ,
Jeffrey M. Jacobson ,
Susan E. Cohn ,
Robert A. Weinstein ,
Jack A. DeHovitz  and
Charles L. Bennett
J. Peter Cegielski*
Affiliation:
Center for Pulmonary Infectious Disease Control and Department of Medicine, University of Texas Health Center, Tyler, Texas
Matthew B. Goetz
Affiliation:
Department of Medicine, West Los Angeles Veterans' Administration Medical Center, Los Angeles, California
Jeffrey M. Jacobson
Affiliation:
Department of Medicine, Bronx Veterans' Administration Medical Center and Mount Sinai School of Medicine, New York City, New York
Susan E. Cohn
Affiliation:
Department of Medicine, University of Rochester, Rochester, New York
Robert A. Weinstein
Affiliation:
Department of Medicine, Rush Medical College and Cook County Hospital, Chicago, Illinois
Jack A. DeHovitz
Affiliation:
Department of Medicine, State University of New York Health Science Center, Brooklyn, New York
Charles L. Bennett
Affiliation:
Department of Medicine, Lakeside Veterans' Administration Medical Center and, Northwestern University, Chicago, Illinois, and RAND, Santa Monica, California
*
Johns Hopkins University, School of Hygiene and Public Health, Department of Epidemiology, 615 N Wolfe St, Room E-7132, Baltimore, MD 21205
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To assess the degree to which, from 1987 to 1990, physicians suspected tuberculosis (TB) in the first 2 hospital days in human immunodeficiency virus (HIV)-infected patients with pulmonary disease.

Design:

Retrospective cohort study.

Setting:

96 hospitals in five US cities.

Patients:

2,174 adult patients with acquired immunodeficiency syndrome discharged with a diagnosis of Pneumocystis carinii pneumonia from 1987 to 1990. The diagnosis generally was not known on admission.

Results:

Physicians suspected TB in the first 2 hospital days in 66% of these patients in 1987, a rate that increased steadily to 74% in 1990. However, the extent to which physicians considered TB among female patients decreased from 76% to 71% over the 4 years. Controlling for confounding variables by multiple logistic regression, the odds that TB would be suspected early increased 1.8-fold among men (odds ratio [OR], 1.8; 95% confidence interval [CI95], 1.4-2.4), but not in women (OR, 0.6; CI95, 0.2-1.9). Among the five cities, the odds of early suspicion of TB increased most in New York City (OR, 3.9; CI95, 2.0-7.9).

Conclusions:

Physicians considered TB in a timely manner in an increasing majority of male, but not female, high-risk patients during the first years of TB resurgence in the United States. Physicians must be aware of the changing epidemiology of HIV and TB, as well as their practice patterns, to prevent nosocomial transmission of this disease

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 4 , April 1997 , pp. 237 - 243
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.Google Scholar
2. Centers for Disease Control and Prevention. Mycobacterium tuberculosis transmission in a health clinic—Florida, 1988. MMWR 1989;38:256-258, 263–264.Google Scholar
3. Beck-Sague, C, Dooley, SW, Hutton, MD, et al. Outbreak of multidrug-resistant Mycobacterium tuberculosis infections in a hospital: transmission to patients with HIV infection and staff. JAMA 1992;268:1280–1286.CrossRefGoogle Scholar
4. Centers for Disease Control and Prevention. Nosocomial transmission of multidrug-resistant tuberculosis to healthcare workers and HIV-infected patients in an urban hospital—Florida. MMWR 1990;39:718–722.Google Scholar
5. Centers for Disease Control and Prevention. Nosocomial transmission of multidrug-resistant tuberculosis among HIVinfected persons—Florida and New York, 1988-1991. MMWR 1990;40:585–591.Google Scholar
6. Pearson, ML, Jereb, JA, Frieden, TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis: a risk to patients and health care workers. Ann Intern Med 1992;117:191–196.CrossRefGoogle ScholarPubMed
7. Bellin, EY, Fletcher, DD, Safyer, SM. Association of tuberculosis infection with increased time in or admission to the New York City jail system. JAMA 1993;269:2228–2231.CrossRefGoogle ScholarPubMed
8. Nardell, E, McInnis, B, Thomas, B, Weidhaas, S. Exogenous reinfection with tuberculosis in a shelter for the homeless. N Engl J Med 1986;315:1570–1575.Google Scholar
9. Bastian, L, Bennett, CL, Adams, J, Waskin, H, Divine, G, Edlin, BR. Differences between men and women with HIV-related Pneumocystis carinii pneumonia. J Acquir Immune Defic Syndr 1993;6:617–623.Google Scholar
10. Hellinger, FJ. The use of health services by women with HIV infection. Health Serv Res 1993;28:534–561.Google Scholar
11. Lagakos, S, Fischl, MA, Stein, DS, Lim, L, Volberding, P. Effects of zidovudine therapy in minority and other subpopulations with early HIV infection. JAMA 1991;266:2709–2712.CrossRefGoogle ScholarPubMed
12. Fleming, PL, Ciesielski, CA, Byers, RH, Castro, KG, Berkman, RL. Gender differences in reported AIDS-indicative diagnoses. J Infect Dis 1993;168:61–67.CrossRefGoogle ScholarPubMed
13. Carpenter, CC, Mayer, KH, Stein, MD, Leibman, BD, Fisher, A, Fiore, TC. HIV infection in North American women: experience with 200 cases and a review of the literature. Medicine 1991;70:307–325.Google Scholar
14. Melnick, SL, Sherer, R, Louis, TA, et al. Survival and disease progression according to gender of patients with HIV infection. JAMA 1994;272:1915–1921.Google Scholar
15. Bennett, CL, Horner, RD, Weinstein, RA, et al. Racial differences in care among hospitalized patients with Pneumocystis carinii pneumonia in Chicago, New York, Los Angeles, Miami, and Raleigh-Durham. Arch Intern Med 1995;155:1586–1592.Google Scholar
16. Oken, C, Archibald, N, Cvitanic, M, Biddle, A, Shapiro, MF, Bennett, CL. Multi-city study of quality of care for HIV-related Pneumocystis carinii pneumonia: successfully collecting highly sensitive information. Clinical Performance and Quality Health Care 1995;3:140–146.Google ScholarPubMed
17. Fleiss, JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley & Sons; 1981:138–188.Google Scholar
18. Bennett, CL, Weinstein, RA, Shapiro, MF, et al. A rapid preadmission method for predicting inpatient course of disease for patients with HIV-related Pneumocystis carinii pneumonia. Am J Respir Crit Care Med 1994;150:1503–1507.Google Scholar
19. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994. MMWR 1994;43(RR-13):23.Google Scholar
20. Mathur, P, Sacks, L, Auten, G, Sall, R, Levy, C, Gordin, F. Delayed diagnosis of pulmonary tuberculosis in city hospitals. Arch Intern Med 1994;154:306–310.Google Scholar
21. Counsell, SR, Tan, JS, Dittus, RS. Unsuspected pulmonary tuberculosis in a community teaching hospital. Arch Intern Med 1989;149:1274–1278.CrossRefGoogle Scholar
22. Kramer, FK, Modilevsky, T, Waliany, AR, Leedom, JM, Barnes, PF. Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection. Am J Med 1990;89:451–456.Google Scholar
23. Kantor, HS, Poblete, R, Pusateri, SL. Nosocomial transmission of tuberculosis from unsuspected disease. Am J Med 1988;84:833–838.CrossRefGoogle ScholarPubMed
24. Katz, I, Rosenthal, T, Michaeli, D. Undiagnosed tuberculosis in hospitalized patients. Chest 1985;87:770–774.CrossRefGoogle ScholarPubMed
25. Scott, B, Schmid, M, Nettleman, MD. Early identification and isolation of inpatients at high risk for tuberculosis. Arch Intern Med 1994;154:326–330.CrossRefGoogle ScholarPubMed
26. Cantwell, MF, Snider, DEJ, Cauthen, GM, Onorato, IM. Epidemiology of tuberculosis in the United States, 1985 through 1992. JAMA 1994;272:535–539.CrossRefGoogle ScholarPubMed
27. Comstock, GW. Variability of tuberculosis trends in a time of resurgence. Clin Infect Dis 1994;19:1015–1022.CrossRefGoogle Scholar
28. Bloom, BR, Murray, CJL. Tuberculosis: commentary on a reemergent killer. Science 1992;257:1055–1064.CrossRefGoogle ScholarPubMed
29. Barnes, PF, Barrows, SA. Tuberculosis in the 1990s. Ann Intern Med 1993;119:400–410.CrossRefGoogle ScholarPubMed
30. Centers for Disease Control and Prevention. Update: AIDS among women—United States, 1994. MMWR 1995;44:81–83.Google Scholar
31. Ellerbrock, TV, Bush, TJ, Chamberland, ME, Oxtoby, MJ. Epidemiology of women with AIDS in the United States, 1981 through 1990. JAMA 1991;265:2971–2975.CrossRefGoogle ScholarPubMed
32. Centers for Disease Control and Prevention. Tuberculosis Statistics in the United States, 1990. Atlanta, GA: Department of Health and Human Services, Public Health Service; 1992.Google Scholar
33. Centers for Disease Control and Prevention. Tuberculosis Statistics in the United States, 1991. Atlanta, GA: Department of Health and Human Services, Public Health Service; 1993.Google Scholar
34. Shafer, RW. Tuberculosis. In: Broder, S, Merigan, TC Jr, Bolognesi, D, eds. Textbook of AIDS Medicine. Baltimore, MD: Williams & Wilkins; 1994:259–282.Google Scholar
35. Chaisson, RE, Schecter, GF, Theuer, CP, Rutherford, GW, Echenberg, DF, Hopewell, PC. Tuberculosis in patients with the acquired immunodeficiency syndrome. Am Rev Respir Dis 1987;136:57–74.CrossRefGoogle ScholarPubMed
36. Pitchenik, AE, Rubinson, HA. The radiographic appearance of tuberculosis in patients with the acquired immunodeficiency syndrome (AIDS) and pre-AIDS. Am Rev Respir Dis 1985;131:393–396.Google ScholarPubMed
37. Havlir, DV, Ellner, JJ. Mycobacterium avium complex. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. New York, NY: Churchill Livingstone; 1995:2250–2264.Google Scholar
38. Tenholder, MF, Moser, RJ, Tellis, CJ. Mycobacteria other than tuberculosis: pulmonary involvement in patients with acquired immunodeficiency syndrome. Arch Intern Med 1988;148:953–955.Google Scholar
39. Ruf, B, Schuermann, D, Brehmer, W. Pulmonary manifestations due to Mycobacterium avium-Mycobacterium intracellulare (MAI) in AIDS patients. Am Rev Respir Dis 1990:141(suppl):A611. Abstract.Google Scholar