Tuberculosis in Healthcare Workers Caring for a Congenitally Infected Infant

Abstract Objective: To assess the extent of nosocomial transmission of tuberculosis among infants, family members, and healthcare workers (HCWs) who were exposed to a 29-week-old premature infant with congenital tuberculosis, diagnosed at 102 days of age. Design: A prospective exposure investigation using tuberculin skin test (TST) conversion was conducted. Contacts underwent two skin tests 10 to 12 weeks apart. Clinical examination and chest radiographs were performed to rule out disease. Isoniazid prophylaxis was administered to exposed infants at higher risk. Setting: A neonatal intensive care unit in an urban hospital in Brussels, Belgium. Participants: Ninety-seven infants, 139 HCWs, and 180 visitors. Results: Newly positive TST results occurred in HCWs who had been in close contact with the infant. Six (19%) of 32 primary care nurses and physicians had TST conversions and received treatment. Among the 97 exposed infants, 85 were screened and 34 were identified as at higher risk of infection. Of these, 27 received preventive isoniazid. None of the infants and none of the 93 other infants' family members evaluated were infected. Conclusions: Congenital tuberculosis in an infant poses a risk for nosocomial transmission to HCWs. Delayed diagnosis of this rare disease and close proximity are the most important factors related to transmission.

[1]  陈克正.  Congenital tuberculosis , 2003 .

[2]  D. Holt,et al.  Congenital Tuberculosis and Management of Exposures in a Neonatal Intensive Care Unit , 2002, Infection Control & Hospital Epidemiology.

[3]  L. Saiman,et al.  Observational study of the use of infection control interventions for Mycobacterium tuberculosis in pediatric facilities , 2001, The Pediatric infectious disease journal.

[4]  J. Starke,et al.  Congenital tuberculosis presenting as sepsis syndrome: case report and review of the literature. , 2001, The Pediatric infectious disease journal.

[5]  H. Shintaku,et al.  Connatal tuberculosis in an extremely low birth weight infant: case report and management of exposure to tuberculosis in a neonatal intensive care unit , 2001, European Journal of Pediatrics.

[6]  P. Roach,et al.  Nosocomial Transmission of Tuberculosis (TB) Associated With Care of an Infant With Peritoneal TB , 2000, Infection Control & Hospital Epidemiology.

[7]  R. Wilkinson,et al.  Tuberculosis diagnosed during pregnancy: a prospective study from London , 2000, Thorax.

[8]  S. Y. Kim,et al.  Pulmonary tuberculosis in five young infants with nursery exposure: clinical, radiographic and CT findings , 1998, Pediatric Radiology.

[9]  C. LeVea,et al.  Congenital tuberculosis in a neonatal intensive care unit: case report, epidemiological investigation, and management of exposures. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  J. Thole,et al.  Low Risk for Tuberculosis in a Regional Pediatric Hospital: Nine-Year Study of Community Rates and the Mandatory Employee Tuberculin Skin-Test Program , 1998, Infection Control & Hospital Epidemiology.

[11]  T. Frieden,et al.  A continuing outbreak of multidrug-resistant tuberculosis, with transmission in a hospital nursery. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  M. Adhikari,et al.  Tuberculosis in the newborn: an emerging disease. , 1997, The Pediatric infectious disease journal.

[13]  David Satcher,et al.  Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities, 1994--CDC. Notice of final revisions to the "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in health-care facilities, 1994". , 1994, Federal register.

[14]  K. Sepkowitz.  Tuberculosis and the Health Care Worker: A Historical Perspective , 1994, Annals of Internal Medicine.

[15]  G. Adams,et al.  PPD skin test conversion in health-care workers after exposure to Mycobacterium tuberculosis infection in infants , 1991, The Lancet.

[16]  R. Feigin,et al.  Textbook of Pediatric Infectious Diseases , 1986 .

[17]  W. Bailey,et al.  Nursery Exposure of 528 Newborns to a Nurse With Pulmonary Tuberculosis , 1978, Southern medical journal.

[18]  E. I. Semenova,et al.  [Congenital tuberculosis]. , 1978, Pediatriia.

[19]  P. Steiner,et al.  Miliary tuberculosis in two infants after nursery exposure: epidemiologic, clinical, and laboratory findings. , 1976, The American review of respiratory disease.

[20]  I. Light,et al.  Management of newborns after nursery exposure to tuberculosis. , 1974, The American review of respiratory disease.

[21]  N. J. Ehrenkranz,et al.  Tuberculosis outbreak in a general hospital: evidence for airborne spread of infection. , 1972, Annals of internal medicine.