Delay in diagnosis leading to nosocomial transmission of tuberculosis at a New York City health care facility

Harris, Tiffany G.; Meissner, Jeanne Sullivan; Proops, Douglas

doi:10.1016/j.ajic.2012.02.015

Cited by 40 publications

(31 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Health care delay, defined as the time from the first consultation with an health provider to the initiation of treatment represents the leading cause of HCW’s unprotected exposure, and is mainly due to difficulties in the diagnosis of pulmonary TB [3,13]. Nosocomial transmission of TB infection has been described in HCWs exposed to patients with delayed diagnosis without respiratory [14,15]. …”

Section: Introductionmentioning

confidence: 99%

Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital

et al. 2014

View full text Add to dashboard Cite

BackgroundThis study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented.MethodsAll HCWs exposed to a patient with cultural confirmed pulmonary TB and respiratory protection measures were not implemented were included. Data on TST results performed in the past (defined as T0) were recorded. TST was performed twice: first, immediately after exposure to an index patient (T1) and three months later (T2). The period of time between T0 and T1 was used to calculate he annual rate of tuberculosis infection (ARTI), while le period of time between T1 and T2 was used to calculate the post exposure annual rate of tuberculosis infection (PEARTI).ResultsFourteen index patients were admitted; sputum smear was positive in 7 (58.3%), 4 (28.6%) were non-Italian born patients. 388 HCWs were exposed to index patients, a median of 27 (12-39) HCW per each index patient. One hundred eighty (46.4%) HCWs received BCG in the past. One hundred twenty two HCWs (31%) were TST positive at a previous routine screening and not evaluated in this subset. Among the remaining 255 HCWs with negative TST test in the past, TST at T1 was positive in 11 (4.3%). ARTI was 1.6 (95% CI 0.9-2.9) per 100 PY. TST at T2 was positive in 9 (3.7%) HCWs, that were TST negative at T1. PEARTI was 26 (95% CI 13.6-50) per 100 PY. At univariate analysis, older age was associated with post exposure latent tuberculosis infection (HR 1.12; 95% CI 1.03-1.22, p=0.01).ConclusionsPEARTI was considerably higher among HCWs exposed to index patients than ARTI. These data underscore the overwhelming importance of performing a rapid diagnosis, as well as implementing adequate respiratory protection measures when TB is suspected.

show abstract

Section: Introductionmentioning

confidence: 99%

Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital

et al. 2014

View full text Add to dashboard Cite

show abstract

“…In developed countries, measures to prevent hospital infections have reduced the number of cases, yet TB outbreaks continue among both patients and staff (29). In our setting, where hospitalization in the last 6 months was the second most important risk factor for active TB after IBD patients started anti-TNF therapy, both the number and duration of hospitalizations were greater among cases than controls.…”

Section: Discussionmentioning

confidence: 75%

Risk factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization

et al. 2016

View full text Add to dashboard Cite

Aims: To determine risk factors for active tuberculosis in patients with inflammatory bowel diseases.Methods: Retrospective, case-control study at 4 referral hospitals in Spain. Cases developed tuberculosis after a diagnosis of inflammatory bowel disease. Controls were inflammatory bowel disease patients who did not develop tuberculosis. For each case, we randomly selected 3 controls matched for sex, age (within 5 years) and time of inflammatory bowel disease diagnosis (within 3 years). Inflammatory bowel disease characteristics, candidate risk factors for tuberculosis and information about the tuberculosis episode were recorded. Multivariate analysis and a Chi-squared automatic interaction detector were used.Results: Thirty-four cases and 102 controls were included. Nine of the 34 cases developed active tuberculosis between 1989 and 1999, and 25 became ill between 2000 and 2012. Multivariate regression showed an association between active tuberculosis and anti-TNF (tumor necrosis factor) therapy in the previous 12 months (OR 7.45; 95% CI, 2.39-23.12; p = 0.001); hospitalization in the previous 6 months (OR 4.38; 95% CI, 1.18-16.20; p = 0.027); and albumin levels (OR 0.88; 95% CI, 0.81-0.95; p = 0.001). The median time between the start of biologic therapy and the onset of active tuberculosis was 13 (interquartile range, 1-58) months. Tuberculosis developed after a year of anti-TNF therapy in 53%, and late reactivation occurred in at least 3 of 8 patients.Conclusions: The main risks factors for developing tuberculosis were anti-TNF therapy and hospitalization. Over half the cases related to anti-TNF treatment occurred after a year.

show abstract

“…In contrast, this may be a problem in regions with low TB incidence in which ED physicians may have limited clinical experience with TB. 6 The time that elapsed from a patient entering the ED to a diagnosis of TB was significantly shorter in our non-delayed group than in our delayed group [median (IQR): 6 (1, 20) days vs. 23 (8,48) days; P < 0.001]. Wu et al reported that there was a shorter mean delay in diagnosis for an ED suspicion group than for an ED nonsuspicion group (6.05 days vs. 25.53 days).…”

Section: Delay In Recognition and Initiation Of Tb Treatmentmentioning

confidence: 91%

“…7 In addition, rapidly aging populations with increased numbers of elderly people pose another unique problem in that, due to age-related immunosenescence, there may be an increased incidence of latent TB infection activation. 8 An emergency department (ED) is often the main entry point to a health care system for hospitalized patients and ED physicians provide a first line of defense against nosocomial transmission of infectious diseases, including TB, SARS, and other aerosolized diseases. 9 Patients with undiagnosed active pulmonary TB with variable clinical features contribute to the difficulties for early suspicion in the ED.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

Yen

Chen

et al. 2015

Heart & Lung

View full text Add to dashboard Cite

Delay in diagnosis leading to nosocomial transmission of tuberculosis at a New York City health care facility

Cited by 40 publications

References 5 publications

Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital

Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital

Risk factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization

Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

Contact Info

Product

Resources

About