Nosocomial transmission of tuberculosis associated with a draining abscess

Article Abstract:

Tuberculosis (TB), a serious and potentially fatal infection, is generally known by its expression as a pulmonary disease. However, many other body tissues may also be infected by the TB bacteria. A person infected with TB may pass the disease to others before manifesting its symptoms, and programs designed to detect infectious carriers, such as those in which hospital employees are tested annually, are an important weapon in preventing TB epidemics. It was through such a screening program (which used TB skin tests) that 68 people, who were employees or patients of an Arkansas hospital, were found to have been exposed to TB. The carrier was a patient who had an infected, draining abscess of the hip and thigh but no pulmonary disease. Employees, patients, and hospital visitors were interviewed to determine which factors increased their risk of exposure to TB, and tests were performed to determine which aspects of the type and treatment of the infection increased passage of the bacteria into the air (aerosolization), allowing it to be transmitted to other people. Among the people interviewed, those with the highest risk of developing a positive TB reaction were those who were present in the rooms with or near to the patient during or following surgical cleansing of the abscess. Although people who provided general medical care to the patient were not at higher risk, those who were present during surgical cleaning of the abscess had the highest risk. The increased risk to people who were in rooms near the patient's isolation room was due to improper maintenance of the ventilation system. The room developed positive pressure, which moved air containing TB bacteria into adjoining areas. The nature of the infection contributed to transmission of TB; unlike most nonpulmonary TB infections, it contained high concentrations of bacteria and was exposed to air. Both were major factors in increasing availability of bacteria for airborne transmission, and drainage of the abscess onto bandages increased this as well. Two other factors increased bacterial aerosolization: thrashing by the patient and irrigation of the abscess with a Water Pik dental hygiene appliance. Several conclusions were drawn from the investigation. Draining tubercular abscesses should be treated under strict isolation, and appropriate ventilation must be confirmed. Cleansing of such wounds should be performed so as to minimize airborne transmission, and ultraviolet lamp sterilization of air and facial masks should be used in addition to the other appropriate cautions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Disease transmission, Nosocomial infections, Cross infection

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Tuberculosis and acquired immunodeficiency syndrome - Florida

Article Abstract:

Florida over a five year period between 1981 and 1986 reported 1,858 cases of acquired immunodeficiency syndrome (AIDS) and 8,455 cases of tuberculosis. Of the patients with AIDS, 159 had tuberculosis, and of the patients with tuberculosis, 154 had AIDS. In 50 percent of the patients with both diseases, tuberculosis was diagnosed before AIDS by more than one month; diagnosis of tuberculosis was made one month before or one month after the diagnosis of AIDS in 30 percent; and diagnosis of tuberculosis was made more than one month after the AIDS diagnosis in 20 percent. Patients with both AIDS and tuberculosis were more likely to be Haitian, non-Haitian black or Hispanic when compared with the patients who only had AIDS. Compared with patients with tuberculosis, patients with both diseases were more likely to be younger, male, Haitian, non-Haitian Black or Hispanic, to have tuberculosis in bodily organs other than the lungs, and to have negative tuberculin skin tests and have chest x-rays which do not demonstrate the cavities usually seen with tuberculosis. The data suggest that patients with AIDS may have an increased risk of tuberculosis, and that patients with both diseases differ in important demographic and clinical characteristics from patients who have either AIDS or tuberculosis but not both.

Health aspects, Florida, Diagnosis, Communicable diseases, AIDS (Disease)

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