Occurrence and clinical characteristics of tuberculosis among home medical care patients

OBJECTIVE: To clarify the occurrence and clinical characteristics of tuberculosis among home medical care patients, we conducted a retrospective study of patients who received home medical care from our hospital. SUBJECTS AND METHODS: We investigated 502 patients (mean age, 79.5 years) who received home medical care from our hospital between January 2003 and December 2012. The newly notified tuberculosis cases aged > or = 70 years in the general population in Miyagi were defined as the control group. Among the patients receiving home medical care, we evaluated the clinical characteristics of the patients with tuberculosis. RESULTS: Four of the 502 patients (0.8%) developed tuberculosis. Using the person-years method, the case rate of tuberculosis was calculated as 298.3 per 100,000 among home medical care patients. Compared with the control group, home medical care patients had a greater incidence of tuberculosis (298.3 vs. 36.06; rate ratio, 8.27; 95% confidence interval, 3.06-22.3; p < 0.001). When home medical care patients visited the hospital or were transported there by ambulance, they were initially often diagnosed with aspiration pneumonia. Moreover, the time interval to the onset of disease from the introduction of home medical care varied among cases (3-192 months). CONCLUSION: Patients receiving home medical care are at high risk of contracting tuberculosis. Therefore, for the medical staff involved in treating home medical care patients, the onset of tuberculosis should be carefully considered in daily medical practice.