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Nosocomial Transmission of a Drug-Sensitive W-Variant Mycobacterium tuberculosis Strain Among Patients With Acquired Immunodeficiency Syndrome in Tennessee

Published online by Cambridge University Press:  02 January 2015

David W. Haas ,
Scott Milton ,
Barry N. Kreiswirth ,
Vicki L. Brinsko ,
Pablo J. Bifani  and
William Schaffner
David W. Haas*
Affiliation:
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee The Department of Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
Scott Milton
Affiliation:
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Barry N. Kreiswirth
Affiliation:
The Public Health Research Institute, New York City, New York
Vicki L. Brinsko
Affiliation:
The Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Pablo J. Bifani
Affiliation:
The Public Health Research Institute, New York City, New York
William Schaffner
Affiliation:
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee The Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
*
Associate Professor of Medicine, Division of Infectious Diseases, Vanderbilt University School of Medicine, 1211 21st Ave S, Suite 539, Nashville, TN 37212
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Abstract

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 9 , September 1998 , pp. 635 - 639
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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