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Ending Neglect The Elimination of Tuberculosis in the United States (2000) / Chapter Skim
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1 Fundamentals of Tuberculosis and Tuberculosis Control
Pages 13-22

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From page 13...
... Tuberculosis grew to epidemic proportions in Europe beginning in the early 1600s as populations shifted to expanding cities and population densities increased (Dubos and Dubos, 1952~. Conditions were ideal for 13
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From page 14...
... Despite these calls and plans for eradication or elimination that would have required intensification of control efforts, the continuing decline in tuberculosis resulted, instead, in complacency and neglect. Rather than increasing resources to fund the efforts that would lead to elimination, tuberculosis program funding was progressively reduced and categorical funding was entirely eliminated from the Center for Disease Control budget in 1972.
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From page 15...
... This immunity activates the macrophages and other immune cells, preventing further multiplication and spread of the bacilli. Individuals who have a successful immune response usually will have a positive tuberculin skin test but still harbor live tubercle bacilli in the parts of the body seeded by the early dissemination of the organism, so-called latent tuberculosis infection.
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From page 16...
... It is generally thought that approximately 90 percent of individuals with latent infection will never develop tuberculosis (Comstock et al., 1974~. If active tuberculosis develops in the lungs and becomes sufficiently advanced, tubercle bacilli will be expelled by any maneuver that produces rapid exhalation, such as coughing, sneezing, yelling, or singing.
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From page 17...
... Drug-resistant organisms result from random mutations in the tubercle bacilli, and drug-resistant disease results when an ineffective regimen is used or when an effective regimen is taken irregularly. The threat of drug resistance, and the threat of multiple-drug resistance in particular, is another aspect of tuberculosis that is causing it to be an increasing public health threat.
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From page 18...
... However, in a population with a 35 percent prevalence of infection, a tuberculin skin test with 100 percent sensitivity and 95 percent specificity would produce false-positive results for less than 10 percent of samples tested; thus, tuberculin skin testing should be targeted to groups in which there is a high incidence of tuberculosis because it provides a more accurate result. Treatment of persons with latent tuberculosis infection can greatly reduce the incidence of tuberculosis.
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From page 19...
... In contrast, the use of isoniazid has never been challenged for individuals at a high risk of tuberculosis, including recent tuberculin skin test converters, contacts of individuals with infectious cases of tuberculosis, immigrants from countries with high rates of tuberculosis, and individuals with certain medical conditions, especially HIV infection. A recent report of a 7year study of patients receiving isoniazid for treatment of latent infection showed a rate of clinical hepatitis of only 0.1 percent (11 cases in 11,141 patients)
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From page 20...
... The reviews must include the entire team providing care to the patient, including physicians, nurses, social workers, outreach workers, and so forth. A continuum of increasingly restrictive measures is used beginning with the use of the least restrictive measure (such as monthly monitoring in the outpatient setting)
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From page 21...
... REFERENCES American Lung Association of South Carolina and the Division of Tuberculosis Control, South Carolina Department of Health and Environmental Control.
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From page 22...
... 1994. Restriction fragment length polymorphism analysis detecting a community-based tuberculosis outbreak among persons infected with human immunodeficiency virus.
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Key Terms

  • latent tuberculosis
  • active tuberculosis
  • tuberculosis control
  • skin test
  • tuberculin skin

  • latent infection
  • tubercle bacilli
  • tuberculosis caused
  • respir dis
  • rev respir

  • infected persons
  • health departments
  • immune response
  • restriction fragment
  • polymorphism analysis

  • contact investigation
  • health department
  • fragment length
  • epidemiological data
  • outreach workers

  • complete therapy
  • health threat
  • american thoracic
  • develop active
  • directly observed

  • carolina department
  • length polymorphism
  • restrictive measure
  • tuberc lung
  • observed therapy


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