Pulmonary tuberculosis in two employees at a skilled nursing facility: screening and treatment protocols.

In 2004, two employees in a skilled nursing facility developed active pulmonary tuberculosis (TB). Both employees were purified protein derivative (PPD) test positive for more than 10 years before developing the disease. Four employees converted to positive PPD status during the exposure investigation--two at baseline and two at the 12-week follow up. No additional cases of active TB were found. Several changes and additions have been made to the TB screening protocol after these two index cases were discovered.