Nosocomial transmission of a drug-sensitive W-variant Mycobacterium tuberculosis strain among patients with acquired immunodeficiency syndrome in Tennessee.

Haas DW, Milton S, Kreiswirth BN, Brinsko VL, Bifani PJ, Schaffner W
Infect Control Hosp Epidemiol. 1998 19 (9): 635-9

PMID: 9778159

OBJECTIVE - To use DNA fingerprinting to characterize nosocomial spread of Mycobacterium tuberculosis following hospitalization of a patient with acquired immunodeficiency syndrome and active pulmonary tuberculosis, for whom respiratory isolation was not initiated promptly.

DESIGN - Epidemiological investigation.

SETTING - A tertiary-care medical center in Tennessee.

PARTICIPANTS - Patients and healthcare workers potentially exposed to the infectious patient in 1992.

RESULTS - Of 172 healthcare workers exposed, 35 (20%) were judged to have acquired tuberculous infection. Risk of acquisition was greatest for nurses and medical receptionists. Active tuberculosis later developed in one healthcare worker and one hospitalized patient. Nosocomial transmission was supported by epidemiological evidence and DNA fingerprinting. The outbreak strain of Mycobacterium tuberculosis differed from other isolates at this hospital, but its DNA hybridization pattern was highly similar to that of the multidrug-resistant outbreak strain W that has been prevalent in New York City, suggesting a common strain ancestry. However, the Tennessee isolates were susceptible to all first-line antituberculous agents.

CONCLUSIONS - This report suggests the possibility that a molecular characteristic(s) shared by these successful outbreak strains is associated with increased transmissibility or pathogenicity and emphasizes the need for continued vigilance for tuberculosis in the nosocomial setting.

MeSH Terms (18)

Academic Medical Centers AIDS-Related Opportunistic Infections Cross Infection Disease Outbreaks DNA, Bacterial DNA Fingerprinting Drug Resistance, Microbial Humans Infection Control Infectious Disease Transmission, Patient-to-Professional Microbial Sensitivity Tests Mycobacterium tuberculosis Occupational Exposure Personnel, Hospital Risk Factors Serotyping Tennessee Tuberculosis, Pulmonary

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