The risk for transmission of Mycobacterium tuberculosis at the bedside and during autopsy.
OBJECTIVE
To emphasize the differing infectious potentials of a patient with tuberculosis.


METHODS
Hospital ward and autopsy room.


METHODS
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.


METHODS
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.


METHODS
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.
Templeton
G L
GL
John L. McClellan Veterans Administration Hospital, Little Rock, Arkansas, USA.
Illing
L A
LA
Young
L
L
Cave
D
D
Stead
W W
WW
Bates
J H
JH
D000391:Air Microbiology; D001344:Autopsy; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010564:Personnel, Hospital; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000635:transmission*; D014691:Ventilation