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The objective of this study was to determine the prevalence of positive skin tests amongst the staff of a 200 bed geriatric hospital in Haifa, Israel. By comparing the findings with those of a study performed five years previously, we hoped to ascertain the number of conversions which had occurred in the period studied. This was undertaken in order to assess a new policy from the Israel Ministry of Health regarding skin testing for health care workers. We also hoped to decide upon the frequency of skin testing required and to compare data from recent immigrants from countries with a high prevalence of TB. In 1997, we performed two-step skin testing (TSST) on 318 health care workers. We ascertained the number of positive reactions on the first and second testing and calculated the number of subjects who showed significant boosting. We also compared the results to those obtained in a study in 1992 and calculated the rate of conversion. We used multivariate analysis to examine the effects of age, gender, country of origin, years in Israel, previous BCG vaccination, previous exposure to contagious TB, work site and area of residence in the city, on the response to TSST. Between 1990 and 1996, 655 000 immigrants from the former USSR arrived; ‘recent immigration’ was defined from that date onward. The final number of positive reactions out of 282 subjects, who were either positive or negative on step 1 and presented for step 2, was 171 (60%).

A 60-year-old temporary Israeli resident travelled to Arizona, developed an influenzalike infection, and returned with a space-occupying lesion in the lung. Since the patient was a heavy smoker, lung cancer was suspected and he was operated on. A granuloma was reported on frozen sections, and Coccidioides immitis was revealed on stained preparations and by microbiological investigation. Coccidioidomycosis is unusual in Israel; therefore, it is important to be aware of this mycosis in patients who have a history of recent visits to areas of endemicity in North America, Central America, and South America.