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After decades of declining incidence, tuberculosis is re-emerging. Since
1985 there has been a substantial increase in the number of cases nationally.
Of particular concern are multi-drug-resistant tuberculosis strains that
are prevalent in some parts of our country.
To meet this renewed challenge, The University of Iowa Department of Internal
Medicine, Division of Pulmonary Diseases continues to offer a TB Chest Clinic.
Clinic staff focuses on the evaluation and management of TB and other chronic
infectious of the lung. In close cooperation with faculty from the Division
of Infectious Diseases, clinic staff will evaluate TB referrals, along with
referrals of patients suffering from lung infections such as pneumonia,
bronchiectasis and chronic fungal infections.
A major factor in the increasing incidence of multi-drug resistant tuberculosis
has been inadequate initial therapy for active TB. To help guide your initial
therapeutic choices, we have enclosed a summary of American Thoracic Society
and Center for Disease Control recommendations on adult TB therapy and believe
that directly observed therapy (DOT) should be considered for all patients
who require treatment for active TB.
For more information about TB, or other lung infections, please call any
one of the TB Chest Clinic staff listed on the back.
To Refer a patient toUniversity of Iowa Department of Internal Medicine
Chest Clinic, call the internal medicine pulmonary outpatient scheduling
center at (319) 356-8486.
General Consideration for the Adult TB Patient
Individuals for whom TB Screening is Recommended
- Person with conditions known to increase risk of TB
- HIV infections
- HIV seronegative intravenous drug abusers
- Rapid weight loss of > 10% of ideal body weight or chronic poor nutrition
(i.e., malabsorption syndromes, Ca of upper GI or oropharyngeal region,
chronic alcoholism, or jejunoilial bypass)
- Post-gastrectomy without weight loss
- Chronic renal failure
- Diabetes mellitus
- Patients on prolonged corticosteroid or other immunosuppressive therapy
- Previously untreated patients with scars on chest xray consistent with
prior TB
- Hematologic malignancies (leukemia, lymphoma)
- Silicosis
- Household contacts of persons known or suspected to have TB
- Persons from foreign countries with high TB incidence (Latin America,
SE Asia, Pacific Islands, Africa)
- Medically under-served, low income persons and high-risk ethnic minorities
(Hispanics and Native Americans)
- Residents of chronic care facilities and correctional institutions
- Health and child care workers
Individuals in Whom Drug Resistant TB Should be Suspected
- Persons who relapse after previous treatment for TB
- Foreign-born individuals from SE Asia, Africa, Latin America
- Persons with a culture positive sputum after 3 months of therapy
- Contacts of known or suspected drug-resistant cases
- Persons from areas of U.S. where drug resistance is prevalent
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