ABSTRACT
BACKGROUND: In New York City, the incidence of tuberculosis has more than doubled during the past decade. We examined the incidence of tuberculosis and the acquired immunodeficiency syndrome (AIDS) and the rate of death from all causes in a very-high-risk group--indigent subjects who abuse drugs, alcohol, or both. METHODS: In 1984 we began to study prospectively a cohort of welfare applicants and recipients 18 to 64 years of age who abused drugs or alcohol. The incidence rates of tuberculosis, AIDS, and death for this group were ascertained through vital records and New York City's tuberculosis and AIDS registries. RESULTS: The cohort was followed for eight years. Of the 858 subjects, tuberculosis developed in 47 (5.5 percent), 84 (9.8 percent) were given a diagnosis of AIDS, and 183 (21.3 percent) died. The rates of incidence per 100,000 person-years were 744 for tuberculosis, 1323 for AIDS, and 2842 for death. In this group of welfare clients, the rate of newly diagnosed tuberculosis was 14.8 times that of the age-matched general population of New York City; the rate of AIDS was 10.0 times as high; and the death rate was 5.2 times as high. There was no significant difference in the rate of new cases of tuberculosis between subjects with positive skin tests and those with negative skin tests at examination in 1984. CONCLUSIONS: Among indigent alcohol and drug abusers in New York City, the rates of tuberculosis, AIDS, and death are extremely high. In this population, a single positive or negative skin test does not predict the development of tuberculosis, probably because both anergy and new infections are common. If programs to control tuberculosis and AIDS are to be effective in groups of indigent substance abusers, health services must be integrated into the welfare delivery system.
Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Alcoholism/mortality , Substance-Related Disorders/mortality , Tuberculosis, Pulmonary/epidemiology , Acquired Immunodeficiency Syndrome/complications , Adolescent , Adult , Alcoholism/complications , Cause of Death , Cross-Sectional Studies , Female , Humans , Incidence , Male , Middle Aged , New York City/epidemiology , Odds Ratio , Prospective Studies , Public Assistance , Substance-Related Disorders/complications , Tuberculin Test , Tuberculosis, Pulmonary/complicationsABSTRACT
Enzyme-linked immunosorbent assays (ELISA) have enabled earlier identification of Mycobacterium tuberculosis (TB) in clinical settings by utilizing both TB antibody and antigen detection. We studied the sensitivity and specificity of ELISA detection of TB antigen by using a commercially available anti-BCG antibody in conjunction with BACTEC 7H12B culture bottles. We compared these results against those obtained with cultures of Mycobacterium avium-intracellulare and Mycobacterium kansasii. All BACTEC bottles were inoculated with known concentrations of organisms. TB antigen was detected by ELISA in BACTEC culture bottles of TB 12 days before the BACTEC system could itself identify the species. A growth index of greater than or equal to 10 reliably indicated that tuberculosis antigen was detectable by ELISA. The correlation between growth index and antigen concentration was extremely high (r = 0.95 and p less than 0.001). There was insignificant cross-reactivity with the other atypical mycobacteria at the levels of growth tested. This technique potentially offers a sensitive and specific means for the early identification of TB in BACTEC culture bottles.
Subject(s)
Bacteriological Techniques/instrumentation , Enzyme-Linked Immunosorbent Assay , Tuberculosis/diagnosis , Antigens, Bacterial/analysis , Humans , Mycobacterium tuberculosis/growth & development , Mycobacterium tuberculosis/immunology , Time FactorsABSTRACT
To ascertain the value of screening for tuberculosis in the New York City (NYC) alcoholic and drug abusing welfare population, 2,641 clients were interviewed, and 970 (36.7%) of them met preestablished criteria for alcohol or drug abuse. The prevalence of active tuberculosis was 0.91%, which is 28 times the age-matched NYC rate. Screening only those persons with a positive PPD and a cough substantially increased the yield of active tuberculosis to 7.2%, or 225 times the NYC rate. The prevalence of a positive tuberculin skin test was 32.4%, or 1.5 times greater than the age-matched NYC rate. Treatment or prophylaxis for tuberculosis was required in 128 or 13.2% of the screened population. Seventy thousand NYC welfare clients are routinely evaluated for medical illness each year. This study predicts that in 1 yr this subpopulation could yield 239 clients with active tuberculosis and 3,181 requiring INH prophylaxis. Screening for tuberculosis in the alcoholic and drug abusing welfare clients is therefore urgently recommended.
