A RETROSPECTIVE ANALYSIS OF MYCOBACTERIUM TUBERCULOSIS(Mtb) CASES IN HIV POSITIVE PERSONS AT THE TORONTO HOSPITAL.

C. Kennedy*, M. Garcia, G. Gillis, H. Simpson, I. Campbell, and J. Conly.

The Toronto Hospital, Toronto, Ontario, Canada

The alarming increase of reported Mycobacterium TB (Mtb) cases and the nosocomial transmission of multidrug resistant TB(MDR-TB) to patients and healthcare providers in the United States has been well documented. Given this background and a perceived increase in the number of Mtb cases at our institution, a retrospective review was conducted of all laboratory confirmed cases from 1987 to 1993. The Toronto Hospital is a two site 1,230 bed tertiary care centre with and average of 38,600 adult admissions a year. There are significant immigrant, homeless and IV drug using populations living within the downtown area which they serve. In 1992, the rate of Mtb in Ontario was 7.9/100,000 however in the downtown core of Toronto it was 53.3/100,00. During the 7 year period reviewed, 360 Mtb cases were documented with only one isolate identified to be MDR-TB. Of these, 243(67%) were pulmonary and 117(33%) extra pulmonary. Further investigation revealed that 26 of these cases were also documented to be HIV positive, 18(69%) of which were pulmonary. These numbers have risen since 1989. Of the 26 HIV positive cases, 9 were noted to be recent immigrants to Canada(< 4 years). No MDR-TB was identified in the HIV positive group. A large HIV positive group is served by our clinic, however there has been no suggestion of nosocomial transmission. To prevent the potential spread occurring within this group, continued active surveillance and judicious use of preventative strategies must be maintained.