![[ Visit the Fifth Decennial online ]](images/banner.gif)
Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: The possibility of transmission of tuberculosis (TB) in the neonatal population is a rare and isolated occurrence, leading to significantly high mortality of infected neonates.
Objective: To describe the experience of a community hospital dealing with neonates and adults exposed to a patient with active pulmonary TB, while he visited his daughter in the Neonatal Intensive Care Unit (NICU).
Methods: A contact investigation was initiated after a 19 year-old male was admitted to the same community hospital where his infant daughter was receiving care in the NICU. The index case reported 3 weeks of cough, right-sided chest pain, malaise, and did not report being in contact with populations at risk for TB. A diagnosis of active pulmonary TB was made, based on radiologic imaging showing a pulmonary cavitary lesion and an induced-sputum sample demonstrating acid-fast bacilli that was confirmed by culture as M. tuberculosis. It was quickly realized that the index case was in the NICU between 6 to 12 hours a day over a 17 day period with his wife and infant daughter. The goal of the investigation was to identify and contact both the parents of infants and adults who were exposed to the index case, offer diagnostic testing by tuberculin skin testing (TST) and chest roentgenogram (CXR), and to provide isoniazid prophylaxis after discussing the risks and benefits of such therapy. A person was considered exposed if they were in the NICU, emergency department, and the labor and delivery floor, during the time the index case was present in these areas over the 17 day period.
Results: 26 infants in the NICU (median length of stay, 5 days, range 1-16 days) and 71 adults (NICU visitors, respiratory staff, nurses, ancillary staff, and physicians) were exposed. Parents of all 26 exposed infants were contacted and a letter describing the exposure, diagnostic options, and treatment recommendations were sent to all of the pediatricians of record. 24 infants were reported as being followed in clinic while 2 infants were lost to follow-up. A second reminder letter was sent 3 months post-exposure to the pediatricians of the 24 exposed infants. 3 responded with TST-negative reactions. Parents of 13 infants consented to a CXR, with all results reported as normal. Only one parent of an exposed infant agreed to isoniazid prophylaxis. After contacting the 71 adults identified as exposed, 10 reported for TST, with none testing positive for TB. Five months after the date of last exposure, the county DPH reported no cases of active disease in the 24 exposed infants.
Conclusions: Contact investigation of a community hospital where adults and neonates of a NICU were exposed to a parent with active pulmonary TB reveals low numbers of people choosing to follow-up for diagnostic TB testing such as TST or a CXR. Despite these low numbers, none of the locatable neonates that were in the same room as the index case developed active TB.
Objective: To describe the experience of a community hospital dealing with neonates and adults exposed to a patient with active pulmonary TB, while he visited his daughter in the Neonatal Intensive Care Unit (NICU).
Methods: A contact investigation was initiated after a 19 year-old male was admitted to the same community hospital where his infant daughter was receiving care in the NICU. The index case reported 3 weeks of cough, right-sided chest pain, malaise, and did not report being in contact with populations at risk for TB. A diagnosis of active pulmonary TB was made, based on radiologic imaging showing a pulmonary cavitary lesion and an induced-sputum sample demonstrating acid-fast bacilli that was confirmed by culture as M. tuberculosis. It was quickly realized that the index case was in the NICU between 6 to 12 hours a day over a 17 day period with his wife and infant daughter. The goal of the investigation was to identify and contact both the parents of infants and adults who were exposed to the index case, offer diagnostic testing by tuberculin skin testing (TST) and chest roentgenogram (CXR), and to provide isoniazid prophylaxis after discussing the risks and benefits of such therapy. A person was considered exposed if they were in the NICU, emergency department, and the labor and delivery floor, during the time the index case was present in these areas over the 17 day period.
Results: 26 infants in the NICU (median length of stay, 5 days, range 1-16 days) and 71 adults (NICU visitors, respiratory staff, nurses, ancillary staff, and physicians) were exposed. Parents of all 26 exposed infants were contacted and a letter describing the exposure, diagnostic options, and treatment recommendations were sent to all of the pediatricians of record. 24 infants were reported as being followed in clinic while 2 infants were lost to follow-up. A second reminder letter was sent 3 months post-exposure to the pediatricians of the 24 exposed infants. 3 responded with TST-negative reactions. Parents of 13 infants consented to a CXR, with all results reported as normal. Only one parent of an exposed infant agreed to isoniazid prophylaxis. After contacting the 71 adults identified as exposed, 10 reported for TST, with none testing positive for TB. Five months after the date of last exposure, the county DPH reported no cases of active disease in the 24 exposed infants.
Conclusions: Contact investigation of a community hospital where adults and neonates of a NICU were exposed to a parent with active pulmonary TB reveals low numbers of people choosing to follow-up for diagnostic TB testing such as TST or a CXR. Despite these low numbers, none of the locatable neonates that were in the same room as the index case developed active TB.