The history of tuberculosis is woven through the passing of many great men and women. In the 1820's, poet John Keats wrote poetry about tuberculosis, a disease from which he suffered greatly, describing coughing up blood as a ‘death warrant.' Famous pianist and composer Frederic Chopin suffered from TB as well, eventually dying from it in his Paris flat in 1849. Edgar Allen Poe was inspired to write “The Red Death” after both his mother and his lover died of the disease.

Back then, tuberculosis was a certainly a ‘death warrant'. Physicians struggled to offer cures and remedies to those who suffered from tenacious coughing, excessive weight loss, night sweats, fevers and tremors.

As science and medicine have progressed, TB is not nearly as prominent as it once was. TB sanitarium hospitals have shut down, and researchers report a decline in TB cases with the advent of better diagnostic testing. However, the disease remains an issue, especially in jails and prisons.

“People that are in prison are primarily from low socioeconomic groups, living in very close quarters,” says New Jersey Department of Health and Senior Services Commissioner Fred M. Jacobs. “Certainly, this causes TB to be more prevalent in that environment. You're also dealing with people who are HIV positive in some cases, which makes them much more susceptible to the disease.”

With the recent release of the Center for Disease Control's  Mortality and Morbidity Weekly Report on the Prevention and Control of Tuberculosis in Correctional and Detention Facilities, many experts hope to draw more attention to TB in corrections.

“We continue to see outbreaks of TB in both prisons and jails,” says Mark Lobato, medical officer with the Division of Tuberculosis Elimination for the Center for Disease Control. “Even though we've made good success so far at reducing the rates of TB, it's not a problem that has gone away. Right now, we're focusing on pockets where TB is still a residual problem. One of those pockets is corrections.”

Tuberculosis, an infection caused by Mycobacterium tuberculosis bacteria (pictured above), is a pulmonary disease which typically attacks the lungs. It is a slowly growing disease, which offers modern doctors plenty of opportunity to catch and treat it.

“There are three ways to test for TB,” explains Jacobs. “One option is not preferred over another; however it is crucial that some form of testing take place.”

The first TB test is a skin test, in which a doctor injects a protein into the top layers of skin. If a reaction appears within two days, follow-up testing is necessary. The second test method involves a chest X-ray, which also must be done in conjunction with a symptom screening. The third test, QuantiFERON Gold, is similar to the skin test, but it does not require a two day follow-up.

In corrections, TB screening and treatment usually start at the front door. With the CDC's newest recommendations, Mississippi has decided to change TB tactics and opt for quicker results.

Initially, the Mississippi DOC tested every inmate at its Reception and Classification Center using chest X-rays. When the CDC brought to light that TB skin tests were just as accurate as X-rays and less time-consuming, the MSDOC made a well-planned quick switch to a new method.

“We've always done the skin testing in addition to the X-rays,” explains MSDOC Dr. Kentrell Liddell. “But it was really important to follow the guidelines set by the CDC. We wanted to make sure we were clearly defining the role of the correctional facility in terms of controlling TB. Now, we only perform chest X-rays if the inmate tests positive in the skin test. Mississippi has tried to stay at the forefront of keeping this disease at bay, and we're going to remain vigilant.”

By partnering with the Mississippi Department of Health, the MSDOC was able to phase skin testing into the intake facility. Eliminating mandatory X-ray tests for each incoming inmate saves time for officials and ensures the good health of offenders at a more efficient pace. Liddell maintains that this change was not done to save money.

“There's a common misconception that we did this because of the cost,” she says. “From a DOC standpoint, we save nothing. For myself, and the DOC I'm speaking on behalf of, this is a quality of healthcare issue and not a cost saving issue. That's simply the bottom line.”

Liddell adds that most non-incarcerated patients do not receive X-ray tests, so it makes sense for the DOC to eliminate the procedure from initial TB protocol.

“Every person that comes in with a symptom of TB doesn't have an X-ray. Instead, we treat the patient in a holistic fashion. That is a bedrock of family medicine. Many of us have become accustomed to relying on tests alone, but we really need to listen to the patient and their symptoms. We just want to make sure we aren't susceptible to TB outbreaks,” explains Liddell.

Now, the MSDOC will perform skin tests on all inmates entering the facility and provide annual testing for offenders and DOC employees. Doctors are also quick to point out that staff cannot be overlooked during TB testing.

As facilities across the country adjust their TB testing standards and methods to meet CDC's best practice guidelines, doctors agree that regardless of the test facilities choose, they must ensure that testing is comprehensive and thorough.

“TB is still an important problem and we have to remain vigilant,” says Lobato.
 
Jacobs agrees entirely.

“The thing about TB is that you can never quite forget about it. No matter what you do, it's likely to come back at you,” he says. “It's important to keep it in mind, particularly in corrections.”

Bottom Line: As long as corrections practitioners continue to screen and test, corrections should be able to keep TB rates down and continue returning healthy offenders to their communities.