Tuberculosis in Health Care Professionals: Assessing and Accepting the Risk
Authors: Charles M. Nolan
Journal: Annals of Internal Medicine (1994)

Editorials1 June 1994Tuberculosis in Health Care Professionals: Assessing and Accepting the RiskCharles M. Nolan, MDCharles M. Nolan, MDSeattle-King County Department of Public Health, Seattle, WA 98104.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-11-199406010-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Tuberculosis has long been an accepted hazard of work in the health professions [1]. For decades, however, physicians of the era after World War II did not take the hazard seriously. I recall an attending physician who, during hospital rounds on a patient with pulmonary tuberculosis in the late 1960s, stated that he would rather have tuberculosis than a broken arm, so easy and painless had the curative treatment of tuberculosis become.That casual attitude changed abruptly in the early 1990s. Multidrug-resistant tuberculosis, the most ominous sequel to the now decade-long resurgence of tuberculosis in the United States, arrived on ...References1. Sepkowitz KA. Tuberculosis and the health care worker: a historical perspective. Ann Intern Med. 1994; 120:71-9. Google Scholar2. Beck-Sague C, Dooley SW, Hutton MD, Otten J, Breeden A, Crawford JT, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA. 1992; 268:1280-6. Google Scholar3. Pearson ML, Jereb JA, Frieden TR, Crawford JT, Davis BJ, Dooley SW, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med. 1992; 117:191-6. Google Scholar4. Goble M, Iseman MD, Madsen LA, Waite D, Ackerson L, Horsburgh CR Jr. Treatment of 171 patients with pulmonary tuberculosis resistant to isoniazid and rifampin. N Engl J Med. 1993; 328:527-32. Google Scholar5. Jereb J, Dooley S, Klevens R, Pearson M, Frieden T, Davis B, et al. Nosocomial transmission of multidrug-resistant tuberculosis to health care workers, New York City (Abstract). In: Program and Abstracts of the World Congress on Tuberculosis, November 16-19, 1992; Bethesda, Maryland. Abstract 51-A. Google Scholar6. Fagan MJ, Poland GA. Tuberculin skin testing in medical students: a survey of U.S. medical schools. Ann Intern Med. 1994; 120:930-1. Google Scholar7. Use of BCG vaccines in the control of tuberculosis: a joint statement by the ACIP and the Advisory Committee for the Elimination of Tuberculosis. MMWR Morb Mortal Wkly Rep. 1988; 37:663-4, 669-75. Google Scholar8. Rieder HL, Cauthen GM, Comstock GW, Snider DE Jr. Epidemiology of tuberculosis in the United States. Epidemiol Rev. 1989; 11: 79-98. Google Scholar9. Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis. 1993; 17:968-75. Google Scholar10. American Thoracic Society. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis. 1990; 142:725-35. Google Scholar11. Markowitz N, Hansen NI, Wilcosky TC, Hopewell PC, Glassroth J, Kvale PA, et al. Tuberculin and anergy testing in HIV-seropositive and HIV-seronegative persons. Pulmonary complications of HIV Infection Study Group. Ann Intern Med. 1993; 119:185-93. Google Scholar12. Menzies R. Vissandjee B, Rocher I, St Germain Y. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med. 1994; 120:190-8. Google Scholar13. Lifson AR, Watters JK, Thompson S, Crane CM, Wise F. Discrepancies in tuberculin skin test results with two commercial products in a population of intravenous drug users. J Infect Dis. 1993; 168: 1048-51. Google Scholar14. Bass JB Jr. Tuberculin test, preventive therapy, and elimination of tuberculosis (Editorial). Am Rev Respir Dis. 1990; 141:812-3. Google Scholar15. Bass JB, Sanders RV, Kirkpatrick MB. Choosing an appropriate cutting point for conversion in annual tuberculin skin testing. Am Rev Respir Dis. 1985; 132:379-81. Google Scholar16. Wenger P, Beck-Sague C, Otten J, Breeden A, Orfas D, Jarvis W. Efficacy of control measures in preventing nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among patients and health care workers (Abstract). In: Program and Abstracts of the World Congress on Tuberculosis, November 16-19, 1992; Bethesda, Maryland. Abstract 53-A. Google Scholar17. Pearson ML, Nosocomial TB Investigations Team. Prevention of transmission of multidrug-resistant tuberculosis to HIV-infected patients in health-care facilities (Abstract). In: Program and Abstracts of the 9th International Conference on AIDS, June 6-11, 1993; Berlin. Abstract WS-C05-3. Google Scholar18. Landsberg L. Altruism in medicine: prescription for the nineties. Pharos. 1993; 56:9-10. Google Scholar19. Zuger A, Miles SH. Physicians, AIDS, and occupational risk. Historic traditions and ethical obligations. JAMA. 1987; 258:1924-8. Google Scholar Author, Article, and Disclosure InformationAffiliations: Seattle-King County Department of Public Health, Seattle, WA 98104.Corresponding Author: Charles M. Nolan, MD, Seattle-King County Department of Public Health, 207 Public Safety Building, Seattle, WA 98104. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTuberculin Skin Testing in Medical Students: A Survey of U.S. Medical Schools Mark J. Fagan and Gregory A. Poland Metrics Cited ByTuberculosis as an Occupational DiseaseTuberculosis como enfermedad profesionalRisco de infecção pelo Mycobacterium tuberculosis entre alunos da Faculdade de Medicina da Universidade Federal do Rio de JaneiroTuberculosis en personal sanitario de un hospital generalMultidrug-resistant tuberculosis and the health care workerEvaluation of the Two-Step Tuberculin Skin Test in Health Care Workers at an Inner-City Medical CenterIn Support of Bacillus of Calmette and Guérin for Healthcare WorkersTuberculosis in Health Care Settings and the Estimated Benefits of Engineering Controls and Respiratory ProtectionInstitutional Control Measures for Tuberculosis in the Era of Multiple Drug Resistance 1 June 1994Volume 120, Issue 11Page: 964-965KeywordsHealth careMultidrug resistant tuberculosisPathogensPrevention, policy, and public healthResearch designSkin infectionsSkin testsTuberculinTuberculin testsUpper respiratory tract infections Issue Published: 1 June 1994 CopyrightCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...