Tuberculosis in the limelight
While it is only two months past World TB Day 2014 celebrating when the late Dr. Robert Koch discovered Mycobacterium tuberculosis on March 24, 1882, I thought it would be important to transmit a couple of TB-related ‘events.’ First, I wanted to highlight David Scales et al. research letter to the May Edition of AJPM, pointing out the importance of having county-level TB data (http://www.ajpmonline.org/article/S0749-3797(14)00082-8/fulltext). Many of us may not know that such data, i.e. the CDC’s Online Tuberculosis Information System (OTIS), only provides state-level public surveillance data because of an agreement between the CDC and the states. However, county-level information would enable those in the field to identify sub-state TB clusters, which would assist public health efforts to halt the spread of TB across counties and states.
Yesterday, at the Detroit Medical Center, Dr. David Kissner, Medical Director of TB Clinical Services at the Institute of Population Health gave a wonderful talk and webinar on TB identification geared towards primary care physicians (PCPs). It was very informative and clinically profound, providing attendees with many case examples, with chest x-ray images to train the eyes of us working in primary care. Far too often, we physicians, as PCPs, miss these cases. Would it not be warranted that clinicians be alerted to TB clusters in their county or in relevant counties, rather than only non-specific state-wide alerts? Again, we realize the importance of county-level data.
We should know when and how to test for TB. Those at risk of exposure to or infection with TB initially need simply a TB skin test, but it is important to note that the induration of 5 or more millimeters is what is concerning, not an erythema of even 10 mm. The redness means nothing!
The radiological skill to detect TB, i.e. the mediastinal/hilar lymphadenopathy and the infiltrates with the classic lucent cavitations, are classic, easy to read, but easy to miss for the untrained and unprepared! I encourage all PMRs to attend Dr. Kissner’s webinar as well as to support efforts to make county-level data more accessible so that we can be prepared! You can register for Dr. Kissner’s webinar at http://miphtcdev.web.itd.umich.edu/trainings/tb-primary-care-find-it-recognize-it-and-know-what-do-webcast#.