A Review of Extrapulmonary Tuberculosis.

Mycobacterium tuberculosis is an aerobic, non-spore-forming, non-motile bacillus that causes tuberculosis of both pulmonary and extrapulmonary sites. Though nationwide 66 percent of reported tuberculosis cases occur in foreign-born individuals, these individuals only contributed to 29 percent of the cases in South Dakota in 2015, whereas most of our cases were found in citizens born in the U.S.1 The South Dakota Department of Health also reported 317 cases of latent tuberculosis in South Dakota in 20151, making reactivation tuberculosis a major concern for U.S.-born residents. During the five years spanning 2011-2015, we have seen varying presentations of tuberculosis in South Dakota, many of which included extrapulmonary sites. We report a recent case involving of a 62-year-old Native American female with extrapulmonary tuberculosis cystitis.

Vaccination and the health care worker.

Historically, health care worker vaccination has been a strategy to protect the health care worker from infectious work related risk. This article will discuss the transition to health care worker vaccination as a key patient safety initiative for hospitals and health care systems. As the case is evolving toward mandatory influenza vaccination of health care workers, we have outlined key success factors for a voluntary program in a rural frontier referral hospital. Additionally, pertussis vaccination for health care workers is discussed as to the patient safety aspects of a progressive approach further making the case for value creation on behalf of our patients we have the privilege of providing care.

H1N1 influenza in elderly nursing home residents.

We offer this brief report to inform other nursing home medical directors and attending physicians of a possible change in the profile of persons susceptible to H1N1 influenza. If a significant number of cases appear in older persons, the recommendations for H1N1 vaccination may need to be changed to include the elderly.