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Tuberculosis and the Health Care Worker
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Dr. Sepkowitz [1] has misconstrued the attitudes of health workers 60 years ago regarding the hazard of acquiring tuberculosis. Those of us [2, 3] who documented the incredibly high rate of infection among student nurses and young physicians knew that fatal tuberculosis was rare (Sepkowitz's Figure 1). Most physicians and nurses in tuberculosis hospitals had entered this field because they had acquired and recovered from this disease.
At that time, the causes of the high tuberculosis morbidity and mortality were overcrowded tenements, alcoholism, and malnutrition because of poverty. The causes of the high morbidity and mortality in some metropolitan centers today include overcrowded prisons, drug addiction, alcoholism, homelessness, and the acquired immunodeficiency syndrome (AIDS).
The major change from the 1930s to the 1990s has been in the dread with which physicians now regard tuberculous infection, despite the fact that no effective treatment was available then and rapidly effective treatment not requiring hospitalization is available now. The risk for developing disease resistant to both isoniazid and rifampin is extremely small in persons not immunocompromised by AIDS, addiction, or malnutrition. Of 466 patients of culture-positive tuberculosis in New York City in April 1991, only 7 were classified as having acquired isoniazid or rifampin-resistant infection, and the authors failed to specify how many of the 7 had AIDS or had refused tests for the human immunodeficiency virus [4].
Health workers of the 1990s should have less fear of tuberculosis than did their predecessors. Their risk is a fraction of what it was 60 years ago; aside from metropolitan areas plagued by AIDS and homelessness, reported cases of tuberculosis in the United States continued to decrease in 1992 [5].
Harold L. Israel, MD, MPH
Jefferson Medical College; Philadelphia, PA 19107
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
