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Mycobacterium tuberculosis transmission from a pediatrician to patients
G L Askew1, L Finelli, M Hutton
1Boston University School of Medicine, Boston Medical Center, Division of General Pediatrics, Boston, Massachusetts 02118, USA.
Insights
A pediatrician with active tuberculosis (TB) exposed numerous patients and staff. Contact investigations revealed TB infections in 1.7% of children and 13% of adults, highlighting the need for vigilant healthcare worker screening.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Occupational Health
Background:
- A pediatrician diagnosed with active tuberculosis (TB) prompted a large-scale contact investigation.
- The pediatrician presented with symptoms including cough and positive sputum smears for Mycobacterium tuberculosis.
Observation:
- The investigation involved contact tracing among patients, families, and staff at the pediatrician's office, hospitals, and a day care center.
- Mass tuberculin skin testing (TST) was conducted multiple times for individuals with potential exposure.
- Screening identified 1.7% of exposed children and 13% of exposed adults with positive TST results.
Findings:
- Childhood TB infection served as a sentinel event, indicating potential adult disease.
- A significant proportion of infected adults were foreign-born.
- The study underscored the challenges in determining the scope of contact investigations for healthcare workers with TB.
Implications:
- Regular and appropriate TB screening for healthcare workers is crucial.
- Healthcare workers must be aware of their own TB risk and recognize symptoms of potential disease.
- Early identification of TB in children can signal adult disease, necessitating prompt public health interventions.
Unlabelled:
The following report describes the contact investigation of a pediatrician with tuberculosis (TB). The pediatrician's disease was discovered in late February 1993 after tuberculin skin testing (TST) of his 15-month-old son was positive (13-mm induration). Further investigation to identify the source of the child's infection revealed a positive (15-mm induration) TST in the pediatrician. The pediatrician had been symptomatic with a cough since September 1992. The pediatrician had a chest radiograph that revealed numerous cavitary lesions and a sputum smear that was positive for acid-fast bacilli. An investigation was initiated to assess whether the transmission of Mycobacterium tuberculosis had occurred in the pediatrician's office to patients, families, or other visitors. The investigation was later extended to include the hospitals and the day care center where the pediatrician worked.
Methods:
A letter was mailed to parents of children served by the practice, explaining the potential exposure to TB and requesting that all persons who visited the office after September 1, 1992 complete an interview and Mantoux TST. Mass interviewing, testing, and test interpretation within the practice took place seven times during March and April 1993.
Results:
At the completion of screening, 181 (87%) of 208 children who had close contact with the index case were reliably skin-tested and returned for interpretation. Three (1.7%) of the 181 children were TST-positive (>/=5 mm). Thirty-seven (13%) of the 286 adults tested and returning for interpretations were TST-positive (>/=10 mm). Thirty-two (86%) of the 37 adults who tested positive were foreign-born.
Conclusion:
This investigation highlighted the need for identifying childhood TB infection as a sentinel event for adult disease. It also demonstrated the difficulty associated with deciding the extent of contact investigation of a health care worker with TB. Finally, the investigation emphasized the importance of maintaining regularly scheduled and appropriate testing for TB infection in health care workers and the need for health care workers to be cognizant of their own risk and be able to identify, especially in themselves, signs and symptoms of potential TB disease.
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