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The Risk for Transmission of Mycobacterium tuberculosis at the Bedside and during Autopsy

Gary L. Templeton, MD; Lee Ann Illing, RN, CIC; Lanne Young, MD; Donald Cave, PhD; William W. Stead, MD, MACP; and Joseph H. Bates, MD, MACP
[+] Article and Author Information

From the John L. McClellan Veterans Administration Hospital, the University of Arkansas College of Medicine, and the Arkansas Department of Health, Little Rock, Arkansas. Request for Reprints: Joseph Bates, MD, John L. McClellan Memorial Veterans Administration Hospital, 4300 West 7th Street, Little Rock, AR 72205.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1995;122(12):922-925. doi:10.7326/0003-4819-122-12-199506150-00005
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Objective: To emphasize the differing infectious potentials of a patient with tuberculosis.

Setting: Hospital ward and autopsy room.

Design: An epidemiologic investigation of tuberculin skin test conversions in a clinical setting and during autopsy when results of tuberculin tests done before exposure were available for all participants.

Measurements: Tuberculin skin test results after the discovery of tuberculosis exposure from a patient with unsuspected tuberculosis for comparison with the test results before exposure; culture of sputum and autopsy material for Mycobacterium tuberculosis; and DNA fingerprinting of organisms.

Intervention: Preventive therapy for persons with skin test conversion.

Results: None of the 40 skin test-negative health care workers caring for the patient for 3 weeks on an open medical ward showed a skin test conversion, even though they had not used respiratory precautions. By contrast, among personnel present during the 3-hour autopsy, the test results of all five nonreactors converted from negative to positive (mean reaction, 24 mm). Two of these persons had a positive sputum culture 8 weeks later. The DNA fingerprints of all three isolates were identical.

Conclusions: A patient who did not transmit tuberculosis before death released a prodigious number of tubercle bacilli during autopsy.

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