Tuberculosis in chronic care homes.

Caucasian Canadians are in the tertiary phase of a 300-year tuberculosis epidemic. In this phase, the pattern of disease over the age spectrum is low in the young and middle-aged groups and rises to four times this rate in the elderly. The concentration of the elderly in chronic care homes (CCHs) magnifies the tuberculosis problem by increasing case rates another four times above the rate of elderly persons living separately, and 20 times above the overall Canadian rate. In spite of effective drugs with cure rates of over 95%, tuberculosis in the institutionalized elderly continues at an alarming rate. The difficulty lies in case finding. The prevailing attitude is that tuberculosis is no longer a problem. Surveillance programs are rudimentary. Between 35% and 40% of active cases in CCHs are the result of primary infection, mimicking bacterial pneumonia clinically and radiographically. In this target group of high-incidence tuberculosis, surveillance of residents is necessary, and the diagnosis needs to be considered in antibiotic-unresponsive pneumonia and in fever of unknown origin.