The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

A Nosocomial Outbreak of Multidrug-Resistant Tuberculosis

Thomas A. Kenyon, MD, MPH; Renee Ridzon, MD; Roberta Luskin-Hawk, MD; Carol Schultz, RN; William S. Paul, MD, MPH; Sarah E. Valway, DMD, MPH; Ida M. Onorato, MD; and Kenneth Castro, MD
[+] Article, Author, and Disclosure Information

From the Centers for Disease Control and Prevention, Atianta, Georgia; and St. Joseph Hospital and the Chicago Department of Public Health, Chicago, Illinois. Acknowledgments: The authors thank the staff of the Chicago Tuberculosis Control Program, particularly Ms. Carla Lee, and the physicians of the exposed patients for their assistance and support. They also thank Mr. Tony Thompson of the Illinois Department of Public Health and Ms. Laura Mosher and Mr. Stephen Dietrich of the Michigan Department of Public Health for assistance with laboratory aspects of the investigation and Dr. Jennifer Lightdale for assistance with data collection. Grant Support: In part by the Centers for Disease Control and Prevention, St. Joseph Hospital, and the Chicago Department of Public Health. Requests for Reprints: Dr. Renee Ridzon, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-10, Atlanta, GA 30333. Current Author Addresses: Dr. Kenyon: American Embassy, Gaborone, Department of State, Washington, DC 20521-2170.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(1):32-36. doi:10.7326/0003-4819-127-1-199707010-00006
Text Size: A A A

Background: An outbreak of seven cases (in six patients and one health care worker, all of whom had AIDS) of multidrug-resistant tuberculosis occurred in a hospital in Chicago. The hospital had a respirator-fit testing program but no acid-fast bacilli isolation rooms.

Objective: To identify risk factors for transmission of Mycobacterium tuberculosis.

Design: Retrospective cohort study.

Setting: Private hospital.

Participants: Patients and health care workers exposed to M. tuberculosis.

Measurements: Analysis of M. tuberculosis isolates, tuberculin skin testing, assessment of exposure, and assessment of participant characteristics.

Results: All seven M. tuberculosis isolates had matching DNA fingerprints. Of patients exposed to M. tuberculosis, those who developed tuberculosis had lower CD4+ T-lymphocyte counts (P = 0.02) and were more likely to be ambulatory (P = 0.03) than those who did not. Of 74 exposed health care workers, the 11 (15%) who had conversion on tuberculin skin testing were no more likely than those who did not have conversion to report that they always wore a respirator with a high-efficiency particulate air filter.

Conclusions: Transmission of M. tuberculosis occurred in a hospital that did not have recommended isolation rooms. A respirator-fit testing program did not protect health care workers in this setting.


Grahic Jump Location
Figure 1.
Timeline demonstrating two chains of nosocomial transmission of tuberculous organisms between August 1994 and September 1995 in a hospital in Chicago.
Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.