Abstract
A nosocomial infection of pulmonary tuberculosis in a 320-bed general hospital was reported. In March 1997 when a 28 year-old physician developed pulmonary tuberculosis, 20 nurses under the age of 30 years were skin tested with PPD. Their chest x-rays were within normal limits. The skin test was repeated on 16 of the 20 in late May and 11 showed a subcutaneous induration of over 20 mm in diameter with redness. An ad hoc anti-tuberculosis committee was organized in the hospital and recommended a prophylactic administration of INH to the 11 strong reactors if they consented. Eight of them agreed but 3 refused. A 26 year-old nurse, one of the 3 not taking INH against advice developed pulmonary tuberculosis in a month. An emergency mass survey was performed on all hospital employees with chest x-rays and PPD skin tests in late July, 1997. Pulmonary tuberculosis was found in 4 nurses working in the same ward with the 26 year-old nurse and a laboratory technician. Two other nurses who refused to take INH for prophylaxis also developed pulmonary tuberculosis. Pulmonary tuberculosis developed in 9 hospital employees after all. The 7 of the 9 (6 nurses and the physician) worked in the same ward and 4 of the 7 were culture positive for mycobacterium tuberculosis. The DNA patterns of the tubercle bacilli of the 4 by RFPL's or finger-printing method were identical to that of a smear-positive patient who was hospitalized in the same ward for 8 days in late November 1996. This was the index case of the present episode of nosocomial infection of pulmonary tuberculosis of this hospital. The following are the lessons to have been learned; no patients with chest diseases should be directly admitted to a general ward before the smear-negativity of tuberculous bacilli is guaranteed and the PPD skin test should be performed at the time of employment.
