Tuberculosis (Active and LTBI)
A large percentage of the elderly on the Delta have had active TB in the past. You’ll see a lot of abnormal x-rays and find a lot of +PPD’s recorded in charts. If a patient doesn’t know if or how they were treated for TB, you can often find a report under the “x-ray” section of the chart on old “TB screening” x-ray reports. The public health nurses may also have a record of the patient’s treatment. The RPMS health summary of ten indicates TB status as well.
The most important thing to remember about TB is to remember TB. You may see new “converters”, new disease in a previous converter, reactivation. Having suspicion is the key to diagnosis of tuberculosis. CXR’s should be done on all converters (to determine skin test + vs. disease) and any person with a +PPD and symptoms suspicious for disease. Sputum’s can be sent to the State labs in “cans” x 3 for AFB and culture and sensitivity.
Public Health Nursing does most of the screening, follow up, and other investigation. They provide skin testing, and school screening. MWF 1-3 is a good time for them. (907-543-2110)
PPDs can also be placed in villages, or on outpatient units.
The hospital has several physicians designated at TB Control Officer (Drs Roll, Bowerman, Chyi and Mondesir) by virtue of their interest and special training - they do all of the prescribing of anti-tuberculosis meds. Please notify this resource.
A TB isolation designation should be used for any patient admitted to the hospital for ‘rule-out TB”. Questions about this can be directed to infection control nurse or physician.
Resources/References
- The Promise of Rapid Detection of Active Pulmonary Tuberculosis in Rural Alaska by Dr. Ron Bowerman.
- Isonaiazid Prophylaxis in an Undeveloped Area -- George w. Comstock, 1962
- Isoniazid Prophylaxis among Alaskan Eskimos: A Final Report of the Bethel Isoniazid Studies --1979
- Rapid (Active) TB Testing in YK Delta 2019 (PowerPoint Presentation)
- High Tech TB (Powerpoint Presentation by Ron Bowerman, MD, MPH)
- Latent Tuberculosis (Powerpoint Presentation by Robert Tyree, MD)
- Ronald J. Bowerman (2020) Rapid detection of tuberculosis in remote Alaska, International Journal of Circumpolar Health, 79:1, 1827786, DOI: 10.1080/22423982.2020.1827786
- Loeffler, Ann. Pediatric drug dosing for tablets, capsules, granules. Drug Resistant Tuberculosis: A Survival Guide for Clinics: 3rd Edition. Ch. 6. released April 2016, updated October 2019.
- Latent Tuberculosis Bacterial Infection (LTBI) YKHC Clinical Guideline
- Active Tuberculosis (>14 years) YKHC Clinical Guideline
- Tuberculosis (Pediatrics) YKHC Clinical Guideline
