TUBERCULOSIS

Tuberculosis trends over a five-year period at a tertiary care university-affiliated hospital in Singapore

INTRODUCTION

Tuberculosis (TB), a potentially fatal infectious disease, poses significant health problems. The objective of this study was to analyse trends among newly diagnosed TB patients seen at the Singapore General Hospital (SGH).

METHODS

This study was a retrospective case record review of notified TB patients at SGH between 2006 and 2010 (inclusive).

RESULTS

A total of 1,979 cases of TB were notified over the five years. The number increased from 368 in 2006 to 407 in 2010 (p = 0.51), in tandem with the increasing number of patients seen at the hospital and the rising population in Singapore. Singaporean residents accounted for 82.8% of the cases, while non-Singaporean residents and non-residents made up the remainder. The year-to-year percentage of non-Singaporean residents and non-residents notified remained stable throughout the five years (p = 0.783). The number of male Singaporean residents (70.7%) notified was more than twice that of female Singaporean residents (29.3%). The majority of patients infected with TB (31.9%) were elderly patients aged > 65 years. Although testing for the human immunodeficiency virus increased from 43.8% (2006) to 64.2% (2010), the number detected with coinfection remained stable (14 and 12 patients in 2006 and 2010, respectively). Mortality rates also remained stable at 12.0%.

CONCLUSION

We cannot afford complacency, as there was no downward trend in the number of notified TB cases at SGH from 2006 to 2010. As the elderly contribute significantly to the TB burden, increased efforts are required to manage this vulnerable population.

Tuberculosis and the elderly. A community health perspective

Tuberculosis is an ancient disease which has had a resurgence in the United States. Many elderly clients were exposed to tuberculosis as children and young adults and are still carrying the infection today. This article describes tuberculosis as it affects the elderly client in community and nursing home settings. The history, etiology, clinical manifestations, treatment, and prevention of tuberculosis infection and disease are presented. Because nurses can be very instrumental in controlling tuberculosis in the elderly, gerontological nursing implications are discussed.

Host defenses against respiratory infection

The respiratory tract is protected from infection by its formidable mechanical and cellular defenses, supplemented when necessary by inflammatory and immune responses. Impairments in these defenses develop as a result of underlying disease and therapeutic interventions. Specific defects in host defenses often predispose to infection with particular etiologic agents. New opportunities for the therapeutic augmentation of defenses are emerging that may be particularly helpful in the care of immunocompromised patients.