To the Editor:

Following the death of a Virginia hospital nurse from tuberculosis, an article in The Virginian-Pilot (Simpson E, Hardy K. Aug. 1, 2004) raised questions regarding the nurse’s case.

Specifically, how could her illness have gone undetected in a hospital, and should anything be changed to keep such cases from occurring again?

As stated in the article, the Centers for Disease Control and Prevention established guidelines in 1994 to ensure the safety and health of workers and stem the spread of TB in hospitals.

A key safeguard is annual employee tests for TB. But until the widely used tuberculin skin test (TST or Mantoux) is laid to rest, the Virginia hospital nurse will not be an isolated case.

The TST was developed in 1890 — the decade that saw the invention of the gas-powered automobile — and suffers from a high rate of false-positive, as well as false-negative, results. In addition, interpretation of the TST is highly subjective, not reproducible, and requires two patient visits. On average, more than 30% of patients do not return to have their TST results read.

The U.S. Institute of Medicine has regarded the failings of the TST for TB infection as the single largest problem for TB control in the United States, as discussed in its seminal report Ending Neglect. It is time to begin using accurate TB tests such as QuantiFERON-TB GOLD, a simple blood test currently under review with the Food and Drug Administration that is more accurate and reliable for detecting TB.

In addition to its integral role in the control and spread of TB, a simple, one-step blood test should yield dramatic cost savings in terms of medical staff time and the elimination of common false-positive results, the latter involving costly follow-up testing and unnecessary TB therapy.

For hospitals, such a test would relieve the huge administrative and cost burden associated with maintaining testing compliance.

Old habits may die hard, but knowing an alternative TB test exists that could have prevented this tragedy is even harder. The time has come to relinquish the TST to history.

Lee B. Reichman, MD, MPH
Professor of Medicine
Preventative Medicine and Community Health Executive Director
New Jersey Medical School
National Tuberculosis Center