Health Advisory
ACTIVE TUBERCULOSIS IN DELAWARE

Summary

Since the beginning of February 2014, several cases of active tuberculosis (TB) have been diagnosed in Delaware. Of these, three cases were in a highly infectious stage of the disease and diagnosis should have been made months earlier, when the individuals first become symptomatic.  Earlier diagnosis is vital as it significantly reduces the chance for potential exposures and possible transmission of the disease to healthcare providers and visitors/patients to healthcare facilities, as well as the general public.

Although Delaware has enjoyed a low incidence of TB for many years, the Division of Public Health wishes to remind health care providers that TB continues to be a threat, and urges providers to consider TB when evaluating patients.

Active TB is a legally reportable illness in Delaware. To report a case of active TB, please contact the TB Clinic in your county. Phone numbers are provided below under “Additional Information”.

Background

Risk Factors for Tuberculosis

TB should be considered early if individuals in the following categories present with a compatible clinical picture. (Note: this is not an exhaustive list, for further information visit www.cdc.gov/tb.)

• Close contacts (household members, family) of  individuals with active pulmonary or laryngeal TB disease;
• Persons infected with HIV;
• Foreign-born individuals from highly endemic countries (For list of endemic countries, see link under “References”);
• US-born individuals who have travelled or lived for one month or longer in highly endemic countries;
• Those who abuse illicit drugs or alcohol;
• Persons residing in congregate living situations, including but not limited to homeless shelters, prisons, and nursing homes;
• Persons with other immune-compromising health issues, including those with a history of long-term use of medications such as high dose steroids and TNF-alpha Inhibitors;  those receiving cancer chemotherapy; and/or those with chronic diseases such as diabetes;
• Chronically underweight individuals (10% of more below recommended weight), or those who have undergone gastric bypass surgery.

Symptoms of Active TB

• Chronic, non-remitting cough lasting more than two weeks
• Fever, night sweats, chills
• Fatigue or weakness
• Unintended weight loss
• Abnormal chest x-ray; especially (but not limited to) upper-lobe abnormalities. These may include presence of cavities, consolidation, pleural effusion, hilar adenopathy, and nodules.

Whenever TB is considered on the differential diagnosis for a patient based on a clinically compatible picture (signs, symptoms, radiology), such patients should be placed in an Airborne Infection Isolation room (AII) pending exclusion of TB.  Providers are reminded that pre-emptive placement of such patients in airborne isolation is safer and less time consuming in the long term for staff and patients than is retroactively locating, testing, and treating infected individuals after TB exposure has occurred.

Treatment/Next Steps

The vast majority of active TB is treated by specialists in DPH’s three TB Clinics, and individuals should be referred to them, unless patient condition indicates immediate hospitalization is necessary. If this is the case the TB clinics should be notified of the patient’s diagnosis as soon as possible and while the patient is still in the hospital. The TB Clinics’ referral numbers are listed below. Treatment of culture-positive cases should always be based on the results of drug sensitivity testing.  Drug-sensitive TB is generally treated with a combination of 4 medications given by directly observed therapy (DOT) over a period of several months. DOT is legislated in Delaware for all active TB cases.

For Patient Referrals or Additional Information:

• Delaware Division of Public Health TB Elimination Program (302) 744-1050.
• DPH TB Clinics by County:
  • New Castle: (302) 283-7588
  • Kent (302) 857-5130
  • Sussex (302) 856-5119.

References:

1. CDC Division of TB Elimination:  www.cdc.gov/tb
2. List of TB endemic countries http://www.mass.gov/eohhs/docs/dph/cdc/tb/endemic-country-list.pdf

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