Pulmonary tuberculosis in a homeless person

Tuberculosis disproportionately affects certain segments of society, such as the homeless, and can cause extremely serious disease among persons with severely impaired cellular immunity, especially those with HIV infection. Inhalation of droplet nuclei, which are the airborne residual of droplets expelled from an infected host, is the primary means of transmission. Factors associated with transmission in shelters for the homeless include crowding, inadequate ventilation, and poor compliance with drug therapy. One of the greatest challenges to treatment of this infection among the homeless is the provision of adequate follow-up of patients who have begun therapy. Many individuals do not complete their treatment regimen. This creates an environment in which the transmission of tuberculosis, including multi—drug-resistant strains, can occur. Prevention strategies should focus on rapid identification and treatment of persons with active disease and latent tuberculosis infections. Ventilation with good exchange of fresh air or the addition of air cleaning devices may aid in reducing risks of transmission of disease.