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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
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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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