title: Extensive nosocomial transmission of tuberculosis in a low-incidence country.
abstract: BACKGROUND
  This paper describes a nosocomial outbreak of tuberculosis in a hospital ward where the number of cases with active tuberculosis among contacts was unexpectedly high. The outbreak was not revealed until the Mycobacterium tuberculosis genotyping results from the first two secondary tuberculosis cases were available.
  
  
  OBJECTIVE
  To highlight the importance of correct infection control measures when tuberculosis is suspected.
  
  
  METHODS
  A retrospective review of the contact investigations following the diagnosis of the index case admitted to the ward.
  
  
  RESULTS
  Seven contacts including three healthcare workers (HCWs) developed tuberculosis within 10 months after the death of a HIV positive patient from pulmonary tuberculosis. Six out of seven cases were verified by culture and all six M. tuberculosis isolates were confirmed by restriction fragment length polymorphism to cluster with the M. tuberculosis isolate from the index case. For the HCWs there was a correlation between number of working hours and risk of acquiring tuberculosis infection and disease.
  
  
  CONCLUSIONS
  It is essential that infection control guidelines regarding tuberculosis are followed, and that HCWs should continuously be informed about current tuberculosis control measures. All staff members at clinics treating tuberculosis cases should be screened for latent tuberculosis infection in order to have a reference, in case of future contact-tracing after accidental exposure to tuberculosis.
authors: Infectious Diseases Unit, Department of Medicine, Karolinska Institutet, Solna, Karolinska University Hospital, Stockholm, Sweden. Jerker.jonsson@smi.se
authors: J
authors: J
authors: Jonsson
authors: B
authors: B
authors: Kan
authors: I
authors: I
authors: Berggren
authors: J
authors: J
authors: Bruchfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission*; D005260:Female; D005838:Genotype; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission*