Tuberculosis Cluster among Health Care Workers in a Hospital, Taiwan, 2005

Su-Hua Huang 1, Min-Nan Hung 1, Chiou-Yueh You 1, Yi-Wen Huang 1, Pei-Chun Chuang 2, Chen-Che Chiu 2 , Chi-Chuan Huang 1, Horng-Ying Chiou 3, Chao-Ching Chang 1, Li-Jen Lin 1

2010 Vol.26 NO.3

Correspondence Author: Su-Hua Huang



About four-fifth of tuberculosis patients decide to receive medical treatment in general hospitals due to changing of medical environment and communicable diseases prevention system in Taiwan. Thus, the risk of exposure to the pathogen for health care workers is increasing. Taiwan CDC received a report of suspected tuberculosis cluster in a hospital from a public health bureau on August 12, 2005. During this investigation, except the index case, 1,194 contacts were screened and 19 health care workers were confirmed as tuberculosis cases. Among the 20 confirmed cases in the cluster (3 males and 17 females), 65% of these cases were nurses in the pulmonary ward. Clinical symptoms were reported in 12 cases and most of which was cough (11 cases). One case showed abnormal with cavitary, 5 pleural effusions and 14 abnormal without cavitary by chest x-ray radiographic examination. However, only 7 cases (35%) were confirmed by laboratory testing. The genotype analysis of the M. tuberculosis isolated from 3 nurses who work in the pulmonary ward showed the same pattern as that of the isolate from the source patient, 11 had epidemiological related linkage but sputum cultures were negative. These 14 cases were considered as a tuberculosis clustering based on the investigative findings. No pathogen was isolated with no epidemiological linkage or different genotypes were found in other 6 cases and, thus, were not listed in the cluster. The infection source was a patient with terminal stage of laryngeal carcinoma. The clinical symptoms of tuberculosis may be concealed by the tumor diseases to delay diagnosis. The exposure risk to tuberculosis in the health care workers is higher than other people and it is important to strengthen the infection control measurements. Any respiratory symptoms should be concerned and the risk of tuberculosis should be evaluated.