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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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References

1. Coronado, VG, Beck-Sague, CM, Hutton, MD, Davis, BJ, Nicholas, P, Villareal, C, et al. Transmission of multidrug-resistant Mycobacterium tuberculosis among persons with human immunodeficiency virus infection in an urban hospital: epidemiologic and restriction fragment length polymorphism analysis. J Infect Dis 1993;168:1052–1055.CrossRefGoogle Scholar
2. Tabet, SR, Goldbaum, GM, Hooton, TM, Eisenach, KD, Cave, MD, Nolan, CM. Restriction fragment length polymorphism analysis detecting a community-base tuberculosis outbreak among persons with human immunodeficiency virus. J Infect Dis 1994;169:189–192.CrossRefGoogle Scholar
3. Edlin, BR, Tokars, JI, Grieco, MH, Crawford, JT, Williams, J, Sordillo, EM, et al. An outbreak of multi-drug resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.CrossRefGoogle ScholarPubMed
4. Mathur, P, Sacks, L, Auten, G, Sall, R, Levy, C, Gordin, F. Delayed diagnosis of pulmonary tuberculosis in city hospitals. Arch Intern Med 1994;154:306–310.CrossRefGoogle ScholarPubMed
5. Daley, CL, Small, PM, Schecter, GF, Schoolnik, GK, McAdam, RA, Jacobs, WR Jr, et al. An outbreak of tuberculosis with accelerated progression among persons infected with the human immunodeficiency virus: an analysis using restriction length polymorphism. N Engl J Med 1992;326:231–235.CrossRefGoogle Scholar
6. Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:92–98.CrossRefGoogle ScholarPubMed
7. Centers for Disease Control. Guidelines for preventing the transmission of tuberculosis in health care settings with special focus on HIV-related issues. MMWR 1990;39(RR-17):1–29.Google Scholar
8. Maloney, SA, Pearson, ML, Gordon, MT, Del Castillo, R, Boyle, JF, Jarvis, WR. Efficacy of control measures in preventing nosocomial transmission of multi-drug resistant tuberculosis to patients and health care workers. Ann Intern Med 1995;122:90–95.CrossRefGoogle ScholarPubMed
9. Centers for Disease Control and Prevention. Tuberculosis morbidity—United States, 1996. MMWR 1997;46:695–700.Google Scholar
10. Van Embden, JDA, Cave, MD, Crawford, JT, Dale, JW, Eisenach, KD, Gicquel, B, et al. Strain identification of Mycobacterium tuberculosis by DNA fingerprinting: recommendations for a standardized methodology. J Clin Microbiol 1993;31:406–409.CrossRefGoogle ScholarPubMed
11. Genewein, A, Telenti, A, Bernasconi, C, Mordasini, C, Weiss, S, Maurer, A, et al. Molecular approach to identifying route of transmission of tuberculosis in the community. Lancet 1993;342:841–844.CrossRefGoogle Scholar
12. Frieden, TR, Sherman, LF, Maw, KL, Fujiwara, PI, Crawford, JT, Nivin, B, et al. A multi-institutional outbreak of highly drug-resistant tuberculosis: epidemiology and clinical outcomes. JAMA 1996;276:1229–1235.CrossRefGoogle ScholarPubMed
13. Bifani, PJ, Plikaytis, BB, Kapur, V, Stockbauer, K, Pan, X, Lutfey, ML, et al. Origin and interstate spread of a New York City multidrug-resistant Mycobacterium tuberculosis clone family. JAMA 1996;275:452–457.CrossRefGoogle ScholarPubMed
14. Plikaytis, BB, Marden, JL, Crawford, JT, Woodley, CL, Butler, WR, Shinnick, TM. Multiplex PCR assay specific for the multidrug-resistant strain W of Mycobacterium tuberculosis . J Clin Microbiol 1994;32:1542–1546.CrossRefGoogle Scholar
15. Sreevatsan, S, Pan, X, Stockbauer, KE, Connell, ND, Kreiswirth, BN, Wittam, S, et al. Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionarily recent global dissemination. Proc Nat Acad Sci USA 1997;94:9869–9874.CrossRefGoogle ScholarPubMed
16. van Soolingen, D, Qian, L, de Haas, PEW, Douglas, JT, Traore, H, Portaels, F, et al. Predominance of a single genotype of Mycobacterium tuberculosis in countries in East Asia. J Clin Microbiol 1995;33:3234–3238.CrossRefGoogle ScholarPubMed
17. Ordway, DJ, Sonnenberg, MG, Donahue, SA, Belisle, JT, Orme, IM. Drug-resistant strains of Mycobacterium tuberculosis exhibit a range of virulence for mice. Infect Immun 1995;63:741–743.CrossRefGoogle ScholarPubMed
18. Valway, S, Sanchez, M, Shinnick, T, Orme, I, Agerton, T, Onorato, I. Extensive transmission of Mycobacterium tuberculosis due to increased virulence. In: Program and Abstracts of the Infectious Diseases Society of America, 35th Annual Meeting; San Francisco, CA; 09 1997:77.Google Scholar
19. Alland, D, Kalkut, GE, Moss, AR, McAdam, RA, Hahn, JA, Bosworth, W, et al. Transmission of tuberculosis in New York City. An analysis by DNA fingerprinting and conventional epidemiologic methods. N Engl J Med 1994;330:1710–1716.CrossRefGoogle ScholarPubMed
20. Ramirez, JA, Anderson, P, Merp, S, Raff, MJ. Increased rate of tuberculin skin test conversion among workers at a university hospital. Infect Control Hosp Epidemiol 1992;13:579–581.CrossRefGoogle ScholarPubMed
21. Tennessee Department of Health. Annual Report of the Division of Tuberculosis Control for the Year 1992. Nashville, TN: Tennessee Department of Health; 1994.Google Scholar