Delay in diagnosis leading to nosocomial transmission of tuberculosis at a New York City health care facility
Delay in diagnosis leading to nosocomial transmission of tuberculosis at a New York City health care facility
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DOI：
10.1016/j.ajic.2012.02.015
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发表时间：
2013-02-01
影响因子：
4.9
通讯作者：
Proops, Douglas
中科院分区：
文献类型：
--
作者：
Harris, Tiffany G.;Meissner, Jeanne Sullivan;Proops, Douglas
背景资料：人口统计学的变化增加了老年人的数量，对他们来说，年龄相关的免疫衰老可能会增加潜伏性结核病（TB）感染（LTBI）的激活风险。随着结核病发病率的下降，保持对结核病的临床怀疑是具有挑战性的。及时识别、隔离和治疗传染病患者在有弱势个体的环境中尤为重要。方法：在结核菌素皮肤试验（TST）阴性癌症患者长期暴露于与延迟诊断相关的结核病导致继发性结核病病例沿着其他传播证据后，在长期护理机构/医院综合体进行了爆发调查。结果：研究人员确定了64名患者和239名工作人员接触者。在接受TST测试的患者中，7名（23%）患者和5名（8%）长期护理机构的工作人员发生了转换。由于传播的证据，对TST无反应性的担忧，以及大量患有增加TB风险的癌症和糖尿病等疾病的患者，LTBI治疗被推荐用于所有暴露的长期护理机构患者，无论TST结果如何，一旦活动性TB被排除。调查结束后，以前的病人谁测试TST阴性，并没有接受LTBI治疗开发活动性TB。结论：当评估有症状的患者，特别是老年人，临床医生应该“认为结核病”，无论结核病感染的阴性测试。在已知暴露后，当存在传播证据时，临床医生应考虑向患有合并症的老年接触者提供LTBI治疗，无论LTBI检测结果如何。版权所有（C）2013由感染控制和流行病学专业人员协会，Inc.爱思唯尔公司出版All rights reserved.
Background: Demographic changes have increased the number of elderly individuals for whom age-related immunosenescence may increase latent tuberculosis (TB) infection (LTBI) activation risk. As TB rates decline, maintaining clinical suspicion for TB is challenging. Timely identification, isolation, and treatment of infectious patients are especially important in settings with vulnerable individuals.Methods: An outbreak investigation was conducted at a long-term care facility/hospital complex after a prolonged TB exposure associated with delayed diagnosis in a tuberculin skin test (TST)-negative cancer patient resulted in a secondary TB case along with other evidence of transmission.Results: Investigators identified 64 patient and 239 staff contacts. Among those tested with TST, 7 (23%) patients and 5 (8%) staff at the long-term care facility had conversions. Because of evidence of transmission, concerns about TST anergy, and the high number of patients with illnesses such as cancer and diabetes that increase TB risk, LTBI treatment was recommended for all exposed long-term care facility patients regardless of TST results once active TB was ruled out. After the investigation concluded, a former patient who tested TST-negative and did not receive LTBI treatment developed active TB.Conclusion: When evaluating symptomatic patients, especially elderly individuals, clinicians should "think TB" regardless of a negative test for TB infection. After known exposure and when transmission evidence exists, clinicians should consider providing LTBI treatment to elderly contacts with comorbidities regardless of LTBI test results. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.