Navigation Links
US soldiers in high-tuberculosis areas face new epidemic: false positives
Date:5/30/2008

U.S. Army service members are increasingly deployed in regions of the world where tuberculosis (TB) is rampant, such as Iraq and Afghanistan, and the military now faces a growing medical problem. But it is not TB itself that is on the riseinstead, the problem lies with the growing number of pseudoepidemics, or clusters of false-positives for TB that are the result of universal testing with a notoriously inaccurate tuberculin skin test (TST) and inconsistent procedures for interpreting those tests in low-risk populations.

These false positives tests have become more than a mere institutional inconvenience or a momentary medical scare for Soldiers being tested. They are a real financial and medical burden because they inappropriately diverting limited funds and resources.

A recent study, published in American Thoracic Societys first issue for June of the American Journal of Respiratory and Critical Care Medicine, describes eight outbreaks of false-positive TB tests between 1983 and 2005. The study was led by U.S. Army Major James Mancuso, M.D., of the Uniformed Services University of the Health Sciences.

Recent deployments to Iraq and Afghanistan, which are reported to have among the highest rates of active TB in the world, have raised concerns about TB exposure. However, many service members do not have sufficient contact with locals to raise their risk of contracting TB. As a consequence, testing after recent deployments to the endemic and hyperendemic areas has occasionally resulted in large numbers of U.S. Army service members with [positive tests] and massive efforts aimed at preventing active TB, wrote Dr. Mancuso.

Because the positive-predictive value of a testthat is, the likelihood of a positive result indicating an actual caseis dependent on the prevalence of disease in a population. The lower the prevalence of a disease, and the higher the variability in the test and testing procedures, the less the positive-predictive value of a test will be. This may dramatically reduce the positive-predictive value of the test to below 50 percent, said Dr. Mancuso.

Dr. Mancuso and his colleagues conducted outbreak investigations in deployed locations such as the Balkans and Afghanistan, where they collected and reviewed medical records of reported active and latent TB cases in deployed U.S. Army service members. They then obtained the medical histories of these soldiers, including prior diagnoses and treatments, determined current symptoms and interviewed the subjects to identify other possible risk factors. Finally, they retested all available skin test converters.

Repeat testing of converters (positives) found that 30 to 100 percent were negative on retesting, wrote Dr. Mancuso. In one case, 95 percent of positive TB tests (38 of 40 tests) from Army National Guard servicemen in Kosovo were subsequently found to be negative, and the pseudoepidemic was primarily attributed to variability with the test administration and reading, as well as to the specific type of test used.

The testing of [a] predominantly low-risk population leads to false-positive results in individuals and pseudoepidemics of false-positive TST conversions in U.S. Army populations, Dr. Mancuso concluded, recommending three actions to reduce the occurrence of false positive skin tests and these apparent outbreaks: test only truly high-risk personnel; standardize testing procedures; and use the more reliable of the TST tests, Tubersol, in lower-risk populations such as the U.S. Army.

As always, an individualized assessment of each patients risk of tuberculosis should be used to target testing and treatment of latent tuberculosis infection. In the absence of other risk factors, clinicians and public health officials should interpret reported skin test conversions after deployment with caution, he added.


'/>"/>

Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

Related medicine news :

1. New Veterans Drug Court Focuses on Rehabilitating Our Soldiers Through Mental Health Treatment
2. Soldiers Receive Free Memorial Day Lasik Surgery Before Going to Iraq
3. UVA Health System part of Armed Forces multi-million dollar effort to help soldiers
4. Healing Wounds and Hearts: Warrior Weekend Helps Soldiers Relax and Recover
5. UBs bioblower closer to protecting soldiers from biological attack
6. How do multiple deployments affect soldiers and their families?
7. Wounded Warrior Project (WWP) Expands Service Offerings for Injured Soldiers with the New Warriors to Work Program
8. Pain treatment in the field: Good for soldiers comfort and better for rebuilding troop strength
9. Champion of blinded soldiers, Congressman Murtha, is Man of Vision
10. Injured Soldiers at Walter Reed Hospital to Benefit From Congressional Fundraiser
11. Life-Saving News for Battlefield Soldiers & Wounded Civilians
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... 13, 2017 , ... Global Healthcare Management’s 4th Annual Kids Fun Run brought ... This free event, sponsored by Global Healthcare Management’s CEO, Jon Letko, is aimed at ... towards children of all ages; it is a non-competitive, non-timed event, which is all ...
(Date:10/13/2017)... ... October 13, 2017 , ... “The Journey: From the Mountains to the ... save lost souls in the Philippines. “The Journey: From the Mountains to the Mission ... of the Bible. She has taught all ages and currently teaches a class of ...
(Date:10/12/2017)... ... October 12, 2017 , ... Planet Fitness, one of the largest ... its plans to open a flagship location in Covington, LA at 401 N. U.S. ... Go store next to Office Depot in the Holiday Square shopping center. Its location ...
(Date:10/12/2017)... ... October 12, 2017 , ... Asante, a nationally ... care, have expanded their existing home health joint venture through an agreement, effective ... operating a joint venture home health company with Asante, delivering clinically integrated care, ...
(Date:10/12/2017)... ... October 12, 2017 , ... Leading pediatric oncology experts at Children’s ... the 49th Congress of the International Society of Paediatric Oncology (SIOP) Oct. ... Center for Cancer and Blood Disorders at Children’s National, and Stephen P. Hunger, ...
Breaking Medicine News(10 mins):
(Date:9/25/2017)... 25, 2017  EpiVax, Inc., a leader in ... immune-engineering today announced the launch of EpiVax Oncology ... personalized therapeutic cancer vaccines. EpiVax has provided $500,000 ... to enabling technologies to the new precision immunotherapy ... EpiVax Oncology as Chief Executive Officer. Gad brings ...
(Date:9/19/2017)... 19, 2017   ZirMed Inc ., a recognized leader ... that it has been ranked #1 by its users for ... Rankings 2017 User Survey. ZirMed was recognized as the top-ranked ... and medical centers over 200 beds and holds one of ... user survey history. ...
(Date:9/12/2017)... Sept. 12, 2017  Consumer reviews on the independent review site ... the number one company for hearing aids, ranking it higher than ... brands. ... #1 by Consumers For Hearing Aids ... Hearing is an online store that provides high performance, state-of-the-art, German-engineered ...
Breaking Medicine Technology: