title: Nosocomial outbreak of tuberculosis in an outpatient HIV treatment room.
abstract: OBJECTIVE
  To investigate a possible outbreak of tuberculosis in an outpatient HIV treatment facility in Sydney, Australia.
  
  
  METHODS
  Following the diagnosis of pulmonary tuberculosis in an attendee, a prospective screening program was instituted to investigate the potential outbreak.
  
  
  METHODS
  Screening of 89 potentially exposed patients included chest radiographs (n = 89), and sputum examination (n = 37) over a period of 23 weeks.
  
  
  RESULTS
  No cases of tuberculosis were detected by the screening program. However, three (3.4%) of this cohort developed pulmonary tuberculosis between 8 and 10 weeks following diagnosis of the index case. The incidence of active tuberculosis during the following-up period (median, 7.4 months) was 5.3 per 100 person years and represents the lower limit of possible tuberculous infection, as both latent infection, and undiagnosed tuberculosis among those who died could not be excluded. Mycobacterium tuberculosis strains isolated from the index case and three subsequent cases were found to be identical by DNA typing.
  
  
  CONCLUSIONS
  Nosocomial transmission of tuberculosis in an outpatient treatment setting has been demonstrated. The risk of nosocomial transmission of tuberculosis is significant in institutions caring for HIV-infected patients even in countries with a low prevalence of tuberculosis infection, and highlights the importance of adherence to tuberculosis control guidelines.
authors.affiliation: HIV Medicine Unit, St Vincent's Hospital, University of New South Wales, Sydney, Australia.
authors.forename: D L
authors.initials: DL
authors.lastname: Couldwell
authors.forename: G J
authors.initials: GJ
authors.lastname: Dore
authors.forename: J L
authors.initials: JL
authors.lastname: Harkness
authors.forename: D J
authors.initials: DJ
authors.lastname: Marriott
authors.forename: D A
authors.initials: DA
authors.lastname: Cooper
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: J M
authors.initials: JM
authors.lastname: Kaldor
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009517:New South Wales / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital; D012150:Polymorphism, Restriction Fragment Length; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission
chemical_list: D004269:DNA, Bacterial