Investigation of tuberculosis in an adolescent. The Outbreak Control Team

In February 1996, sputum smear positive tuberculosis was diagnosed in an adolescent white girl born in the United Kingdom. The investigation was complex because the index case had attended two schools and had a large extended family. The extent of transmission was consistent with "adult" pulmonary disease; eight previously unvaccinated contacts showed evidence of infection: one had proven tuberculosis, four had pulmonary radiological changes and positive Heaf test results, and three had positive Heaf test results. Seven of the eight were family/ household contacts, the eighth was a school contact. Current guidelines for the management of tuberculosis in schools were followed in this investigation and it was concluded that they remain appropriate. The source of infection for the index case was not definitely established. It may have been an adult who presented with active tuberculosis in 1994. The index case had erythema nodosum with a normal chest radiograph in 1993.