title: [Occupationally acquired tuberculosis in an administrative assistant: aspects of an expert report].
abstract: METHODS
  Since the age of 48 years an administrative assistant had been treated with immunosuppressive drugs for a mixed connective tissue disease. She was in direct personal contact with newly arrived Africans while working at an admittance centre for refugees. At the age of 53 years the symptoms changed with increasing joint pains and loss of weight. The immunosuppressive therapy with corticoids was increased. A total hip arthroplasty followed. An infection of the wound occurred and many revisions of the scar tissue followed. After a total knee arthroplasty an epileptic seizure occurred. A tuberculous meningoencephalitis was diagnosed. Mycobacterium tuberculosis was detected in urine, sputum and in secretions of different joints. A detailed analysis revealed Mycobacterium tuberculosis var. africanum. At the age of 59 years the patient died during a period of rehabilitation, the clinical signs indicating pulmonary embolism.
  
  
  CONCLUSIONS
  The haematogenous spread of Mycobacterium tuberculosis was undoubtedly exacerbated by the immunosuppressive therapy. As a preventive measure a competent occupational consultation could have stopped the occupational exposure to Mycobacteria by transferring the patient during immunosuppressive therapy. The change of symptoms had been misclassified as worsening of the mixed connective tissue disease. Considering legal aspects of the German social insurance system the criteria of an occupational disease would have been fulfilled.
authors.affiliation: Institut mit Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Universität Erlangen-Nürnberg, Erlangen. klaus.schmid@rzmail.uni-erlangen.de
authors.forename: K
authors.initials: K
authors.lastname: Schmid
authors.forename: C
authors.initials: C
authors.lastname: Schoerner
authors.forename: H
authors.initials: H
authors.lastname: Drexler
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D008947:Mixed Connective Tissue Disease / Q000188:drug therapy*; D009784:Occupational Diseases / Q000175:diagnosis* / Q000473:pathology; D016273:Occupational Exposure / Q000009:adverse effects; D012036:Refugees; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000473:pathology / Q000635:transmission; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000473:pathology
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents