XML/RSS

Subscribe to content updates on this page via RSS feed.

• HNTC Brochure
  PDF ■ 3.02 MB

Vol. 2 # 4 » December 2007

In This Issue

download (PDF ▣ 360 KB) 2318 downloads

Heartland 2008 Training Topics Heartland National TB Center is finalizing dates for our upcoming 2008 training calendar. The following courses are currently planned for regional participation (ABC order by title): Contact Investigation, Multi Drug Resistant TB: A Primer to Patient Care and Treatment, Nurse Case Management, Preventing Tuberculosis on College Campuses, Outbreak Preparedness, TB 101 with Facilitator Training, TB in Correctional Facilities, TB Intensive, TB Program Managers Course and TB Updates. Heartland Customer Survey The Heartland National TB Center is conducting a short customer satisfaction survey to determine the effectiveness of our training courses and products. We are asking those who have attended one or more of our courses and/or used any of our educational training products in the past two years to please fill out an online survey. This survey should take no more than 10 minutes to complete and your answers will be confidential. The Center will use the results to better serve our region in the future and to target our courses and products to more fully meet our partners' needs. Your assistance in completing this questionnaire by no later than December 31, 2007 is most appreciated. If you have any questions or concerns, please do not hesitate to call us at 1-800-TEX-LUNG (839-5864) or contact Mary Long at mary.long@uthct.edu. Click here to take the survey: http://www.zoomerang.com/survey.zgi?p=WEB227A29TBE8K Regional News: HNTC 2007 Recorded Webinars We are pleased to announce the Recorded versions of Heartland National TB Center's 2007 webinars: TB/HIV: Managing the Co-Infected Patient (11/27/2007), TB Medications: Recognizing and Responding to Adverse Drug Reactions (12/10/2007), Nontuberculous Mycobacterial (NTM) Lung Disease (12/13/2007) and Tuberculosis: Un Vistazo General para Trabajadores de la salud (12/17/2007). These recorded presentations can be viewed in Windows Media Player. Continuing Education Credits will be NOT be available for viewing recorded sessions. These webinars were presented in collaboration with the Centers for Disease Control and Prevention. Case Presentation: Tuberculosis in an Adoptee Case History: A 6-year-old girl presented to her pediatrician with decreased hearing acuity found by routine elementary-age screening. She had been adopted from a Korean orphanage at 9 months of age and had a history of poor growth there. She had scarlet fever and pneumonia prior to the age of 4, but no other recent significant illnesses since adoption. Adoption records did not indicate vaccination with BCG and she had no vaccination scar. She had four documented Tine tests (multi-puncture test for TB infection) during the adoption process, all of which were negative. She had a Tine test at a community hospital prior to presenting to her physician, results of which are unknown. Related Links

Vol. 2 # 3 » November 2007

In This Issue

download (PDF ▣ 281 KB) 724 downloads

Reported Tuberculosis in the United States, 2006 The 2006 TB Surveillance Reports contain tabular and graphic information about reported TB cases collected from 59 reporting areas (the 50 states, the District of Columbia, New York City, U.S. dependencies and possessions, and independent nations in free association with the United States). TB surveillance reports from past years are updated and corrected when new data are received and verified. The current 2006 surveillance report contains the updated summary data for all years. Regional News: Heartland National Web Seminar: TB/HIV The recent National Webinar; TB/HIV: Managing the Co-Infected Patient, sponsored by Heartland with Dr. Timothy Sterling, Vanderbilt University Medical Center, was recorded and the archived presentation is now available for viewing. It can be found on the Home page of the Heartland website (www.HeartlandNTBC.org) under the NEWS section. The handouts can also be found there. The recorded presentation is best viewed using Microsoft Media Player and has audio along with the PowerPoint. No continuing education credits will be awarded for viewing the recorded presentation. Tbit: Tuberculosis Facts The CDC Division of Tuberculosis Elimination (DTBE) has revised the "Tuberculosis Facts" fact sheet series (http://www.cdc.gov/tb/pubs/TBfactsheets.htm). These fact sheets provide basic TB Information in an easy-to-read format and are also available in PDF format for printing. Tbit: TB Notes Newsletter TB Notes Newsletter, Issue No. 4 2007 is now available from the CDC Division of Tuberculosis Elimination (DTBE) (http://www.cdc.gov/tb/notes/TBN_4_07/tbn407.pdf). Upcoming Trainings: Nontuberculous Mycobacterial (NTM) Lung Disease Thursday, December 13, 2007 11:00 am — 12:00 pm MT, 12:00 — 1:00 pm CT Presented by: David Griffith, MD Assistant Medical Director, Heartland National TB Center Professor of Medicine, University of Texas Health Center at Tyler This webinar is intended for TB program staff and clinical personnel including physicians, nurses and healthcare workers who treat and manage patients with pulmonary infectious diseases. Priority registration will be given to personnel from the Heartland region. Upcoming Trainings: Tuberculosis: Un Vistazo General para Trabajadores de la salud Lunes Diciembre 17, 2007 11:00 a.m. — 12:00 p.m. MT, 12:00 — 1:00 p.m. CT Presentado por: Catalina Navarro, RN Nurse Consultant, Heartland National TB Center Dirigido principalmente al personal de enfermería así como a otros profesionales del área de la salud comprometidos en la lucha contra la tuberculosis, en donde la tecnología (Video conferencia Web) resulta ser un medio valioso para incrementar la cobertura y difusión del conocimiento sobre esta enfermedad. Introducing: 2007 Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians The Technical Instructions for Tuberculosis Screening and Treatment for Panel Physicians, as part of requirements for immigration to the United States, have been revised. The previous screening algorithms were issued in 1991. To prevent applicants with smear-positive tuberculosis from traveling to the United States, the 1991 system relies on chest radiograph findings and sputum smears among overseas foreign national applicants 15 years of age or older. The 1991 system misses applicants with smear-negative but culture-positive tuberculosis, as well as tuberculosis in applicants <15 years of age. Moreover, the 1991 requirements do not provide guidance specifying the quality of treatment applicants with tuberculosis should receive prior to travel. Related Links Case Presentation: Primary Tuberculosis Following Exposure Case History: A twenty year old woman was evaluated as a contact of a patient who had extensive smear positive pulmonary tuberculosis (drug susceptible isolate). She denied any symptoms of cough, weight loss, fatigue, night sweats or fever. She weighed 86 pounds. A TST was positive with a 20 mm induration. A chest x-ray (CXR) showed opacification of the lower half of the left hemithorax reflective of a moderate size left pleural effusion and/or atelectasis. She had normal laboratory values. She was not able to provide a sputum specimen.

Vol. 2 # 2 » September 2007

In This Issue

download (PDF ▣ 273 KB) 1510 downloads

Heartland Presents a National Web Seminar on TB/HIV On Tuesday, November 27, 2007, Heartland National TB Center will sponsor a web seminar entitled TB/HIV: Managing the Co-Infected Patient. Dr. Timothy Sterling, Associate Professor of Medicine at Vanderbilt University Medical Center (UMC), is the Director of Epidemiology Research, Division of Infectious Disease, Vanderbilt UMC; Director of Epidemiology and Outcomes Unit, Vanderbilt-Meharry Center for AIDS Research; and Director of Tuberculosis Research with the Metro-Davidson Health Department. Dr. Sterling has extensive patient and research experience in the field of TB/HIV co-infection. This webinar is intended for TB program staff and clinical personnel including physicians, nurses and healthcare staff who care for TB/HIV co-infected individuals. Upcoming Trainings: Remaining 2007 Heartland Trainings Date: December 4-7 Course: TB Intensive Location: Tyler, Texas Please go to http://www.heartlandntbc.org/training.asp #regional for contact and registration information for this course. Enrollment is limited and is on a first-come basis for registrants from the Heartland partner states. Additional Heartland Web Seminars On December 10, 2007 Heartland will sponsor a webinar entitled TB Medications: Recognizing and Responding to Adverse Drug Reactions. This webinar is intended for TB program staff and clinical personnel including physicians, nurses and healthcare staff who treat TB patients and seek a better understanding of the possibilities and implications of adverse reactions to the common anti-tuberculosis medications. TBit: Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit is a resource guide and toolkit for strengthening TB elimination strategies through partnerships. The guide and toolkit are available on the CDC Division of Tuberculosis Elimination website at http://www.cdc.gov/tb/pubs/forge/ default.htm. Introducing: Joint Regional Training and Medical Consultation Center (RTMCC) Products Page The Joint RTMCC Products Page lists TB-specific educational materials and resources developed by all four Regional Training and Medical Consultation Centers. The web page is physically located on the Southeastern National TB Center’s web site. It is jointly managed by all Centers and is updated as new products are completed. Related Links Case Presentation: Delayed Culture Conversion, Low Serum Drug Levels Case History: Our patient is a 54 year-old male who presented to his physician for follow up of a right upper lobe carcinoma which was ressected in 1979. He complained of shortness of breath, weight loss, fatigue, chest pain and a productive cough but no hemoptysis. A chest x-ray on June 20, 2006 revealed new bilateral alveolar infiltrates. He was referred to a pulmonologist and admitted to his hometown hospital on June 20, 2006. Smears were positive for acid fast bacilli and a CT scan June 22nd showed cavitation in the left upper lobe, bilateral infiltrates and mediastinal adenopathy. He was placed on anti-tuberculosis therapy—isoniazid (INH) 300 mgs, rifampin (RIF) 600 mgs, pyrazinamide (PZA) 1500 mgs and ethambutol (EMB) 1600 mgs daily with vitamin B6 50 mgs. Directly Observed Therapy (DOT) was started on July 7, 2006; given Monday through Friday with self-administration on the weekends. His culture grew Mycobacterium tuberculosis and was susceptible to INH, RIF and EMB.

Vol. 2 # 1 » March 2007

In This Issue

download (PDF ▣ 323 KB) 1823 downloads

Directly Observed Therapy: A Short History and Overview Tuberculosis is a disease that has been impacting the health of individuals, communities and nations throughout history. Long recognized as an infectious disease, early therapy was isolation and palliative care. With the advent of medications that could cure patients, management of the disease moved to include the goal of successful completion of drug therapy. This required patient cooperation; typically one third of patients on their own fail to follow their physician's advice and do not correctly follow or finish therapy. This has serious implications with TB disease where the well-being of the patient and public health interest overlap — lack of a cure means continued infectiousness and risk of exposure to others. Introducing: Heartland Training Schedule for 2007 Heartland National TB Center has developed its training schedule for 2007. With the publication of the new CDC Contact Investigation guidelines in 2005, many health departments have begun updating their policies based on the new recommendations. Heartland has put together an interactive, skill-building course that highlights the changes and teaches the new recommendations as well as interviewing and cultural competency. There are several trainings scheduled around the Heartland region; public health workers who are directly involved in TB contact investigations or setting policy for such investigations are encouraged to attend one of Heartland's Contact Investigation courses. TBit: Briefs from the CDC's MMWR, March 22, 2007 Trends in Tuberculosis Incidence — United States, 2006 A CDC analysis of national tuberculosis (TB) surveillance data shows slowing progress in the efforts to eliminate TB in the U.S. In 2006, the national TB rate fell to an all-time low of 4.6 cases per 100,000 people, with a total of 13,767 active cases. However, the decline in the TB rate in 2006 (3.2 percent) was one of the smallest in more than a decade. TB continues to disproportionately affect minorities and foreign-born individuals. Extensively Drug-Resistant Tuberculosis — United States, 1993-2003 Analysis finds 49 documented cases of extensively drug-resistant (XDR) tuberculosis (TB) in the United States between 1993 to 2006. While the risk of XDR-TB remains relatively low in the U.S., cases have been widely dispersed geographically and pose a continued risk to efforts to treat and control TB. Upcoming Trainings: Heartland National TB Center: 2007 Dates Case Presentation: Failure to Convert: Non Adherence to Treatment Case History: A 67 year old Hispanic male was diagnosed with drug susceptible pulmonary tuberculosis in September 2005. He presented with a three week history of night sweats, weight loss, nausea, shortness of breath and a productive cough. A chest x-ray (CXR) showed extensive bilateral cavitary disease. He was Hepatitis C positive with elevated baseline liver enzymes; HIV testing was negative. Sputum smears were AFB positive with greater than 10 organisms per high powered field. The patient's weight at diagnosis was 96 lbs. Related Links The Centers for Disease Control and Prevention (CDC) Division of Tuberculosis Elimination (DTBE) will be updating the URLs (webpage addresses) on the DTBE website (http://www.cdc.gov/tb). Specifically, "NCHSTP" will be removed, and long, cumbersome URLs will be shortened. DTBE plans to make the transition on April 18, 2007. Regional News: TB Training and Patient Educational Resources Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit has been posted on the CDC Division of Tuberculosis Elimination website and is available on the homepage (http://www.cdc.gov/tb) or directly at http://www.cdc.gov/tb/pubs/forge/default.htm. The print version should be available within the next few months. TB Notes Newsletter — download at http://www.cdc.gov/tb/ notes/TBN_1_07/tbn107.pdf ~ No. 1, 2007 (PDF - 201K) In the Works Heartland has developed several TB training materials. In addition to the algorithms below, other products have been updated and are now located on the Heartland website in PDF format available for printing or downloading.

Vol. 1 # 4 » December 2006

In This Issue

download (PDF ▣ 515 KB) 1244 downloads

Educational and Training Resources for the TB Professional For today's TB health professional, staying informed and up-to-date with the ever-changing field of tuberculosis diagnosis, treatment and patient management can be a daunting task. There are several TB-specific educational and training resources that can make the job easier. Introducing: 2005 Tuberculosis Surveillance Report and Slide Set The Centers for Disease Control and Prevention (CDC), Division of Tuberculosis Elimination (DTBE) has completed their annual Surveillance Report and accompanying slide sets for "Reported Tuberculosis in the United States, 2005." The TB Surveillance Reports contain tabular and graphic information about reported TB cases collected from 59 reporting areas (the 50 states, the District of Columbia, New York City, US dependencies and possessions and independent nations in free association with the United States). Related Links TBit: Stop TB in the African-American Community Website The Division of Tuberculosis Elimination (DTBE) of CDC has launched the new Stop TB in the African-American Community website (http://www.cdc.gov/nchstp/tb/ TBinAfricanAmericans/default.htm) which provides quick, anytime access to information and resources related to TB prevention, control and elimination in the African-American community. This resource has been developed for people who have an interest in the topic of TB in this community. In the Works The following products (algorithms) have been updated and are located on the Heartland website. They are available for printing or downloading. ▣ Assessing and Managing the Risk of Liver Disease in the Treatment of LTBI (PDF ~ 266 KB) ▣ Evaluation of Pregnant Patient at Risk for TB (PDF ~ 250 KB) ▣ Management of the TB Patient at Risk of Hepatotoxicity (PDF ~ 268 KB) Case Presentation: Missed Opportunities Medical History A 52 year old Hispanic female presented in January 2006 with left upper quadrant (LUQ) pain. An abdominal x-ray series revealed a density in the left upper lung; there was no hilar, mediastinal or axillary adenopathy. She denied cough, fever or night sweats. She had no prior history of tuberculosis. She immigrated to the US from Mexico 20 years ago and occasionally returns there to visit family. She is a diabetic and a non-smoker. She was referred to the local public health department where a tuberculin skin test (TST) was done and had an induration of 25 mm. Three sputums were negative for M. tuberculosis by direct staining and culture. A CT scan revealed a 2.4 cm slightly irregular cavitary mass in the left upper lobe. After the negative cultures, she was started on a 9 month course of isoniazid (INH) and vitamin B6. Upcoming Trainings: Heartland National TB Center - Proposed 2007 Dates Please go to http://www.heartlandntbc.org/training.asp for contact and registration information for each course. Additionally, we have webinars planned on Genotyping; Pediatric TB; HIV/TB; and Adverse Drug Reactions. We will also conduct an on-line training course in the fall of 2007 on Hepatotoxicity. Proposed topics and dates are subject to change; check website for the latest updates. Regional News: Latest issue of TB Notes Latest issue of TB Notes is currently available from the CDC Division of TB Elimination (DTBE). This is a quarterly newsletter that contains news about DTBE activities and high-lights from state and local TB programs across the country. It also contains a calendar of events describing meetings, conferences and other educational activities of potential interest to those working in the field of TB. Please go to the following webpage: http://www.cdc.gov/tb/notes/ TBN_4_06/tbn406.pdf. Regional News: Upcoming Conference Upcoming Conference: International Union Against Tuberculosis & Lung Diseases North America Region (IUATLD NAR) 11th Annual Meeting: Powering Up Political Will for TB Control. Sponsors: British Columbia Lung Association and American Lung Association of Metropolitan Chicago. Dates and Location: February 22 - 24, 2007; Vancouver, BC, Canada. For complete conference information visit: http://www.bc.lung.ca/lungdiseases/tuberculosis_iuatld.html

Vol. 1 # 3 » September 2006

In This Issue

download (PDF ▣ 456 KB) 2244 downloads

Refugee Health and Tuberculosis The United States (US) has a long history of humanitarian assistance to displaced peoples; the most common aid to refugees is admission to live in the US and apply for permanent status as a naturalized citizen. This "reflects our core values and our tradition of being a safe haven for the oppressed." Since 1975, the US has resettled 2.4 million refugees and the Refugee Act of 1980 resulted in annual admissions of 61,000 (1980) to a high of 207,000 (1983) with a yearly average of 98,000. Introducing: Heartland Region TB Focal Points The Regional Training and Medical Consultation Centers (RTMCC) are supported by CDC Cooperative Agreement (COAG) funds awarded to COAG recipients in locations where the RTMCCs are headquartered. The RTMCCs work cooperatively with all states to strengthen the capacity of TB programs and other partners to prevent and control TB through improved training, education, communications, and information dissemination. Each state has designated a TB Focal Point as the go-to-person for TB trainings and communications within their area. The Focal Points are TB professionals who have a wide range of TB experience within their state. They serve as a liaison to CDC and their RTMCC; providing feedback on trainings, products and medical consultation needs. The Focal Points meet annually at the CDC's TB-ETN conference, networking with each other and serving as a sounding board for new ideas. TBit: New Lung Health Image Library Launched The World Lung Foundation and The Union have launched a new Lung Health Image Library (LHIL) that incorporates and builds on the former Stop TB Partnership Image Library, which has now closed. The LHIL is a searchable database of thousands of high- and low-resolution photographs relating to tuberculosis, TB-HIV, asthma, child lung health, tobacco control and air pollution. It also includes a wide variety of images of health workers, patients, community health education and social mobilization for lung health, primarily in low-income countries. Case Presentation: Evaluation and Management of Childhood Contacts to Infectious Pulmonary Tuberculosis (REVISED Nov. 22, 2006) Patient History: A 31 year old male was admitted to the hospital after experiencing gross hemoptysis. He had a 2 month history of productive cough, a 25 pound weight loss, night sweats, and fatigue. A chest x-ray (CXR) revealed bilateral cavitary infiltrates. The initial sputum specimen was 4+ positive for acid fast bacilli (AFB) and a genetic probe assay confirmed Mycobacterium tuberculosis. A culture was positive for M. tuberculosis which was later reported to be resistant to INH and streptomycin. The patient has a history of heavy alcohol and drug use, is HIV negative but Hepatitis B and C positive. He has a long history of cigarette use and a chronic smoker's cough. The patient resides with his wife and 3 children (2 are step-children). [Original case presentation] :: [Original newsletter] Regional News: Heartland National TB Center (HNTC) Advisory Committee In 2006, 33 members were recruited for the HNTC Advisory Committee. Members are a combination of TB Controllers, TB Focal Points, Program Managers, TB Supervisors and Academic and Public Health Physicians. They represent 12 of the 13 states in the HNTC region. The Advisory Committee serves a vital role in the planning and implementation of HNTC training, product development and medical consultation activities. Many have served as faculty, advisors, reviewers and advocates for HNTC services. We thank them all for their tremendous support and contributions! Please check our website for more information. Regional News: TB Training and Patient Educational Resources Many of Heartland's partner states have developed training and patient educational materials for TB workers that they are willing to share. Upcoming Trainings Related Links In the Works: The following products (algorithms) have been updated and are located on the Heartland website. They are available for printing or downloading. ▣ Assessing and Managing the Risk of Liver Disease in the Treatment of LTBI (PDF ~ 266 KB) ▣ Evaluation of Pregnant Patient at Risk for TB (PDF ~ 250 KB) ▣ Management of the TB Patient at Risk of Hepatotoxicity (PDF ~ 269 KB) State Refugee Health Coordinators: Heartland Region (REVISED Nov. 22, 2006) :: [Original version] State TB Focal Point Information: Heartland Region (REVISED Nov. 22, 2006) :: [Original version]

Vol. 1 # 2 » June 2006

In This Issue

download (PDF ▣ 816 KB) 1067 downloads

Medical Consultation at Heartland Tuberculosis infection, whether it is active disease or latent infection, requires a delicate balancing act of diagnosis, treatment and patient care. Even the most experienced TB professional will occasionally encounter a situation that is so unique or unusual that they are unsure of the direction to take. Heartland National TB Center has as one of its goals to "...share expertise in the treatment and prevention of tuberculosis by...delivering expert medical consultation and providing technical assistance..." This medical and nursing consultation is available at NO cost to physicians, nurses and other healthcare professionals in the thirteen states that comprise the Heartland Region. Introducing: Heartland Mini-Fellowships Heartland National TB Center (HNTC) is housed at Texas Center for Infectious Disease (TCID) in San Antonio. This facility has a long history as a tuberculosis hospital — at one time it was one of the largest in the nation with 908 beds devoted to inpatient TB medical care. Today the facility has 72 beds and is organized to provide patient care, scientific investigation and therapeutic and educational services supporting public health needs. Heartland’s location and relationship with TCID allows it to offer unique learning experiences to our regional medical professionals. One such opportunity is a mini-fellowship targeted to physicians and advanced practice clinicians in the HNTC region and tailored to accommodate specific learning needs and time constraints of the individual candidates. State TB Control: Heartland Region TBit: The White Death: A History of Tuberculosis by Thomas Dormandy, New York University Press, 2000 Regional News: The US-Mexico Binational Tuberculosis (TB) Referral & Case Management Project Numerous factors have influenced the prevalence of TB along the US-Mexico border but chief among them has been the lack of access to adequate health care and socio-economic conditions that contribute to disease spread. Historically, many TB patients have abandoned their TB treatment to cross the border and this can and does lead to the development of drug-resistant TB strains. Frequently, binational TB patients are men of productive age and have other illnesses related to TB. Their exact migratory routes are often unknown, and coupled with the emergence of drug-resistance and high prevalence of TB infection along the border, the individual national TB programs have historically had difficulty managing TB disease. Consequently, under the auspices of the USMBHC, the two governments came together in 2003 to combat and control TB through the US-Mexico Binational TB Referral and Case Management Project. Case Presentation: Abdominal Tuberculosis Patient History: A 27-year old Hispanic female presented to hospital on January 27, 2005 with a fever of 104°, a two week history of abdominal swelling, decreased appetite and body aches. She was admitted for diagnostic testing and follow-up. Upcoming Trainings Related Links In the Works The following products (algorithms) have been updated and are located on the Heartland website. They are available for printing or downloading. ▣ Assessing and Managing the Risk of Liver Disease in the Treatment of LTBI (PDF ~ 266 KB) ▣ Evaluation of Pregnant Patient at Risk for TB (PDF ~ 250 KB) ▣ Management of the TB Patient at Risk of Hepatotoxicity (PDF ~ 269 KB)

Vol. 1 # 1 » March 2006

In This Issue

download (PDF ▣ 155 KB) 803 downloads

Heartland National TB Center: New RTMCC In 2005, the CDC's Division of Tuberculosis Elimination funded four TB Regional Training and Medical Consultation Centers (RTMCCs). The RTMCCs are regionally assigned to cover all 50 states and the U.S. territories. Introducing: Heartland TB Focal Point Meeting The RTMCCs are supported by CDC Cooperative Agreement (COAG) funds awarded to COAG recipients in locations where the RTMCCs are headquartered. The RTMCCs work cooperatively with all states to strengthen the capacity of TB programs and other partners to prevent and control TB through improved training, education, communications, and information dissemination. Each state has designated a TB Focal Point as the go-to-person for TB trainings and communications within their area. TBit: Major study involving UTHCT researchers shows new blood test better at diagnosing tuberculosis than current skin test Results from a major study of a new blood test, ELISPOT, for latent tuberculosis infection show it may be more sensitive than the TB skin test, said Dr. Peter Barnes, director of the Center for Pulmonary and Infectious Disease Control and professor of microbiology at The University of Texas Health Center at Tyler. Regional News: Minnesota Department of Health Check their website for multilingual patient brochures and fact sheets. Case Presentation: TB in a Patient Receiving Immunosuppression Including a TNF Alpha Blocker Patient History: A 55-year old female emigrated from El Salvador in the mid 1980s. She had been employed by a poultry processing plant for 15 years (high risk environment associated with TB transmission). Medical history included a diagnosis of rheumatoid arthritis which was treated with prednisone 20 mgs twice daily, methotrexate and Humira (adalimumab-a tumor necrosis factor alpha blocking agent (TNFa)). In the Works TBeat is the quarterly newsletter for Heartland National TB Center. We would like to make this a successful and much-anticipated resource for our partners; to that end you may submit news and noteworthy items for consideration. Upcoming Trainings Related Links