Prevalence of tuberculin reactivity and prevalence of risk factors for the development of active tuberculosis in a nursing home in Puerto Rico.

A total of 91 nursing home patients were evaluated to determine the prevalence of tuberculous infection and the prevalence of risk factors for active TB in those with positive tuberculin reactions. Overall prevalence rate for positive PPD was 42.9%. No association was found between prevalence of positive PPD and time since admission to the nursing home. The most prevalent risk factors for active TB among PPD positive patients were diabetes mellitus (38.5%), being 10% below ideal body weight (25.6%), chest X ray with fibrotic changes (13.2%), and carcinoma of oropharynx (5.1%). Twenty-one patients (53.8% of patients with positive test) met criteria for prophylactic treatment with isoniazid. This study detected a high prevalence of positive PPD reactions in this nursing home population and a high prevalence of risk factors for the development of active TB in the group with positive reaction to PPD. Due to the high risk for the development of active tuberculosis in this population, aggressive screening and preventive therapy are mandatory.