Challenges in Diagnosis and Contact Investigating Potential Active Tuberculosis Disease in Military Trainees
Journal Article - Embargoed Full-Text,01 Mar 2017,01 Mar 2017
59th Medical Wing San Antonio United States
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Fourteen U.S. and international military personnel training at Joint Base San Antonio-Lackland, Texas, were hospitalized due to potential pulmonary tuberculosis TB between January 2010 and December 2016, of whom 5 were diagnosed with active disease. The incidence rate in the training population was 1.89 per 100,000 95 confidence interval 0.81, 4.42, with a higher rate when restricting to international military students attending the Defense Language Institute English Language Center. Given a variety of atypical presentations and the diagnostic and public health challenges they created, we performed a retrospective review of all hospitalized cases with the exception of one published previously. This case series highlights the importance of a high index of clinical suspicion when TB is being considered in closely congregated settings, and the risk of over reliance on acid fast bacilli staining and nucleic acid amplification testing for ruling out active pulmonary disease in young, otherwise healthy trainees. Practical solutions are suggested.
- Medicine and Medical Research