Abstract Introduction Tuberculosis prevalently affects vulnerable populations, such as incarcerated individuals in overcrowded conditions. Comprehensive prevention and therapeutic strategies should be implemented in these settings to decrease tuberculosis transmission. We present one case that highlights the importance of this. Case presentation A 23-year-old inmate with no chronic illnesses presented with a 1-month history of productive cough, hemoptysis, constitutional symptoms, and left chest pain after being in contact with multiple inmates who had similar symptoms. The Mantoux and HIV tests were negative. He was undernourished and severely anemic. He had decreased air entry to the left chest and pleural rub. A chest CT done revealed multiple air-filled cavities in the left lung. The AFB smear was positive. Sputum PCR revealed Mycobacterium tuberculosis. Sputum culture isolated pseudomonas and other unspecified gram-negative bacilli, all sensitive to imipenem, which he commenced. The patient completed 2 months of RIPE therapy in the hospital and was to continue rifampicin and isoniazid as an outpatient. He was lost to follow-up while incarcerated and presented d four months later with persistent symptoms. Five other inmates who were in close contact with him were also admitted for confirmed pulmonary tuberculosis. Discussion Tuberculosis transmission is increased in correctional facilities due to factors like poor ventilation, overcrowding, and limited access to healthcare. To combat this, it’s crucial to implement comprehensive prevention strategies within correctional facilities, focusing on early detection with routine screening. In this case, the patient had persistently worsened symptoms for a month before receiving medical attention. Early screening for tuberculosis should be done routinely in these facilities, with the IGRA being the preferred, especially for those with prior BCG vaccination. The tuberculin skin test is also used for screening; however, it may produce false positives and requires two visits for confirmation, which might not be ideal. Contact investigation should be done to curb the spread of the disease. For inmates that are symptomatic, early testing with Xpert MTB/RIF or Xpert MTB/RIF Ultra, should be performed on sputum or other relevant specimens. Early treatment improves the outcomes and lowers the risk of morbidity from tuberculosis. Tuberculosis is commonly treated with two months of RIPE therapy followed by at least four months of rifampicin and isoniazid. Robust adherence should be ensured during incarceration by ensuring that the medications are made available along with routine medical follow-up visits. Conclusion TB control measures including routine screening, early detection and uninterrupted treatment prevent transmission and ensure public health. This abstract is funded by: None
Leach et al. (Fri,) studied this question.