The risk for transmission of Mycobacterium tuberculosis at the bedside and during autopsy
G L Templeton1, L A Illing, L Young
1John L. McClellan Veterans Administration Hospital, Little Rock, Arkansas, USA.
Objective:
To emphasize the differing infectious potentials of a patient with tuberculosis.
Setting:
Hospital ward and autopsy room.
Design:
An epidemiologic investigation of tuberculin skin test conversions in a clinical setting and during autopsy when results of tuberculin tests done before exposure were available for all participants.
Measurements:
Tuberculin skin test results after the discovery of tuberculosis exposure from a patient with unsuspected tuberculosis for comparison with the test results before exposure; culture of sputum and autopsy material for Mycobacterium tuberculosis; and DNA fingerprinting of organisms.
Intervention:
Preventive therapy for persons with skin test conversion.
Results:
None of the 40 skin test-negative health care workers caring for the patient for 3 weeks on an open medical ward showed a skin test conversion, even though they had not used respiratory precautions. By contrast, among personnel present during the 3-hour autopsy, the test results of all five nonreactors converted from negative to positive (mean reaction, 24 mm). Two of these persons had a positive sputum culture 8 weeks later. The DNA fingerprints of all three isolates were identical.
Conclusions:
A patient who did not transmit tuberculosis before death released a prodigious number of tubercle bacilli during autopsy.
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