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Saxena A, Karim A, Saini H, Alam MS. Follow-up ICD generator explantation in tuberculous myocarditis induced ventricular tachycardia patient. BMJ Case Rep 2023; 16:e256480. [PMID: 37914176 PMCID: PMC10626888 DOI: 10.1136/bcr-2023-256480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
A rare case of ventricular tachycardia caused by extrapulmonary tuberculosis has been followed up. Automatic implantable cardioverter defibrillator implantation was done at the time of presentation. Following this, the patient is clinically well without any episodes of ventricular tachycardia and is considered for an implantable cardioverter defibrillator explantation.
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Affiliation(s)
- Anil Saxena
- Department of Cardiology, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Azmat Karim
- Jawaharlal Nehru Medical College and Hospital, Department of TB & Respiratory Diseases, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
- Pulmonary Medicine, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Himanshu Saini
- Pulmonary Medicine, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
| | - Mohammad Shadab Alam
- Department of Cardiology, Fortis Escorts Heart Institute and Research Centre, New Delhi, Delhi, India
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2
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Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13030432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
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3
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Zora V. Cardiac Arrest in an Extensive Pulmonary Tuberculosis Patient. Cureus 2021; 13:e16057. [PMID: 34336529 PMCID: PMC8321424 DOI: 10.7759/cureus.16057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) disease affects a large population worldwide but is often missed. Early diagnosis can be challenging at times due to failure to include TB in the differential diagnoses. Tuberculosis is a treatable disease but it can lead to undesirable consequences if left untreated. Here we report a case of a young Guatemalan woman presented with respiratory failure and extensive lung opacification on imaging who went into cardiac arrest. Post resuscitation, workup was significant for Mycobacterium tuberculosis (TB) on sputum smear. Despite appropriate treatment, she expired. The aim of this paper is to summarize TB complications that directly contribute to mortality as many clinicians do not consider TB as an immediate cause of death.
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Affiliation(s)
- Vancy Zora
- Internal Medicine, Indiana University (IU) Health Ball Memorial Hospital, Muncie, USA
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4
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Cavitary Pulmonary Lesion and Extensive Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Stephenson L, Byard RW. An atlas overview of characteristic features of tuberculosis that may be encountered at autopsy. Forensic Sci Med Pathol 2019; 16:143-151. [PMID: 31471869 DOI: 10.1007/s12024-019-00161-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2019] [Indexed: 11/29/2022]
Abstract
Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in any organ or tissue. Global population movements and the emergence of resistant strains are contributing to increasing numbers of cases in certain populations. Subtlety of symptoms and signs, chronicity of disease and failure to seek medical assistance may result in the diagnosis only being made at the time of autopsy. For this reason forensic pathologists need to understand the protean manifestations of the disease and the variable mechanisms by which TB may cause death. This atlas overview provides descriptions of the pathological manifestations of TB in a variety of organs with accompanying illustrations. It serves as a summary of conditions that should be checked for at autopsy in suspected or confirmed cases.
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Affiliation(s)
- Lilli Stephenson
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia
| | - Roger W Byard
- Forensic Science South Australia (FSSA) and the School of Medicine, The University of Adelaide, Level 2 Medical School North Building, Frome Road, Adelaide, South Australia, 5000, Australia.
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Chinen K, Ito K. Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis. AUTOPSY AND CASE REPORTS 2019; 9:e2018059. [PMID: 30863732 PMCID: PMC6394360 DOI: 10.4322/acr.2018.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 12/26/2022] Open
Abstract
An 84-year-old Japanese woman with myelodysplastic syndrome was admitted with pyrexia and dyspnea, but died suddenly during diagnostic evaluation. The autopsy revealed miliary tuberculosis in addition to myelodysplastic syndrome in the bone marrow. The immediate cause of the patient’s sudden death was pulmonary fat embolism derived from bone marrow necrosis. This case shows that the infiltration of the myelodysplastic bone marrow by tuberculosis and consequent bone marrow necrosis and fat embolism can be the cause of sudden death. In this article, we report the autopsy results of this unusual cause of sudden death, and discuss tuberculosis-related sudden death with a review of the literature.
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Affiliation(s)
- Katsuya Chinen
- a Nerima General Hospital, Department of Pathology. Tokyo, Japan.,b Tokyo Healthcare Foundation, Institute for Health Care Quality Improvement. Tokyo, Japan.,c Nerima General Hospital, Department of Cardiology. Tokyo, Japan
| | - Kashima Ito
- a Nerima General Hospital, Department of Pathology. Tokyo, Japan.,b Tokyo Healthcare Foundation, Institute for Health Care Quality Improvement. Tokyo, Japan.,c Nerima General Hospital, Department of Cardiology. Tokyo, Japan
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7
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Yaguchi D, Ichikawa M, Inoue N, Kobayashi D, Shizu M, Imai N, Watanabe K. Sudden Death from Cardiopulmonary Arrest on Arrival of a Patient with Pulmonary Tuberculosis: A Case Diagnosed by Postmortem CT and Autopsy. J Forensic Sci 2018; 63:1582-1586. [PMID: 29357402 DOI: 10.1111/1556-4029.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 11/28/2022]
Abstract
Sudden death due to massive hemoptysis during management of tuberculosis occurs in a considerable number of patients. However, when massive airway hemorrhage occurs in a patient in whom tuberculosis has not been confirmed and a blood is not apparent externally on the face/body, it is difficult to immediately identify the cause of death as airway obstruction by tuberculous bleeding in the airway. We encountered an 83-year-old Japanese woman with her medical history included treatment of tuberculosis in her 20s who was in cardiopulmonary arrest on arrival (CPAOA), and the cause of sudden death could not initially be identified. Postmortem CT (PMCT) and autopsy revealed that the cause of sudden death was airway obstruction/asphyxia by tuberculous massive airway hemorrhage. Identification of the cause of death facilitated a subsequent active contact investigation and led to prevention of secondary tuberculosis infection.
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Affiliation(s)
- Daizo Yaguchi
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
| | - Motoshi Ichikawa
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
| | - Noriko Inoue
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
| | - Daisuke Kobayashi
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
| | - Masato Shizu
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
| | - Naoyuki Imai
- Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
| | - Kazuko Watanabe
- Department of Pathology, Gifu Prefectural Tajimi Hospital, 5-161, Maehata-cho, Tajimi, Gifu, 507-8522, Japan
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Liu Y, Wang X, Wang Z, Zhu Y, Zhang L, Li X, Xu R, Ge W. Bacteria endocarditis consolidation with vertebra bone tuberculosis: a case report. BMC Infect Dis 2017; 17:38. [PMID: 28061897 PMCID: PMC5219769 DOI: 10.1186/s12879-016-2168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/23/2016] [Indexed: 11/16/2022] Open
Abstract
Background The clinical features of bacteria endocarditis became atypical when consolidated with other conditions such as tuberculosis (TB). Especially, the symptoms of bacteria endocarditis (BE) which were hidden behind the TB fever often lead to misdiagnosis and missed diagnosis. Case presentation A 56-year-old male with thoracic vertebra bone TB history presented with low-grade fever, shortness of breath and cardiac souffle. After conventional antibiotic therapy and strengthen anti-tuberculosis treatment condition did not be improved. Further inspection, there were bacteria endocarditis with the vegetation across the mitral valve. But the other valves were not involved. He was treated with intravenous penicillin for 4 weeks in all including during surgery, and following with oral antibiotic for another 2 weeks. The patient improved clinically eventually. Conclusion It is the first reported case of isolated thoracic vertebra tuberculosis with valve endocarditis caused by streptococcus viridans and was successfully managed by combination therapy of internal medicine and surgery. It was suggested in tuberculosis patients, the possibility of bacterial endocarditis should be considered when came into fever and unexplained cardiac soufflé (in tuberculosis patients).
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Affiliation(s)
- Yan Liu
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, People's Republic of China
| | - Xiaoming Wang
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, People's Republic of China
| | - Zhibin Wang
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, People's Republic of China
| | - Yongsheng Zhu
- Department of ultrasound diagnosis, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, 710032, People's Republic of China
| | - Liying Zhang
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, Shaanxi Province, China
| | - Xiaoli Li
- Department of Geriatrics, Weinan Central Hospital, Weinan, 714000, Shaanxi Province, China
| | - Rong Xu
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, People's Republic of China
| | - Wei Ge
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Changle West Road #127, Xi'an, Shaanxi Province, 710032, People's Republic of China.
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9
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Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Infection. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7120007 DOI: 10.1007/174_2016_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community-Acquired Pneumonia (CAP) is the first leading cause of death due to infection worldwide.Many gram-positive, gram-negative bacteria, funguses and viruses can cause the infectious pulmonary disease, and the severity of pneumonia depends on the balance between the microorganism charge, the body immunity defenses and the quality of the underlying pulmonary tissue. The microorganisms may reach the lower respiratory tract from inhaled air or from infected oropharyngeal secretions. The same organism may produce several different patterns that depend on the balance between the microorganism charge and the body immunity defenses.CAP is classified into three main groups: lobar pneumonia, bronchopneumonia and interstitial pneumonia.Lobar pneumonia is characterized by the filling of alveolar spaces by edema full of white and inflammatory cells. Necrotizing pneumonia consists of a fulminant process associated with focal areas of necrosis that results in abscesses. Bronchopneumonia or lobular pneumonia, is characterized by a peribronchiolar inflammation with thickening of peripheral bronchial wall, the diffusion of inflammation to the centrilobular alveolar spaces and development of nodules.The interstitial pneumonia represents with the destruction and esfoliation of the respiratory ciliated and mucous cells. The interstitial septa, the bronchial and bronchiolar walls become thickened for the inflammation process and lymphocytes interstitial infiltrates.Chest radiography represents an important initial examination in all patients suspected of having pulmonary infection and for monitoring response to therapy.Its role is to identify the pulmonary opacities, their internal characteristics and distribution, pleural effusion and presence of other complications as abscesses and pneumothorax.High spatial CT resolution allows accurate assessment of air space inflammation.The CT findings include nodules, interlobular septal thickening, intralobular reticular opacities, ground-glass opacities, tree-in-bud pattern, lobar-segmental consolidation, lobular consolidation, abscesses, pneumatocele, pleural effusion, pericardial effusion, mediastinal and hilar lymphoadenopaties, airway dilatation and emphysema.
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Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
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Michira BN, Alkizim FO, Matheka DM. Patterns and clinical manifestations of tuberculous myocarditis: a systematic review of cases. Pan Afr Med J 2015; 21:118. [PMID: 26327955 PMCID: PMC4546727 DOI: 10.11604/pamj.2015.21.118.4282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 02/03/2015] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis is a rare cause of myocarditis. It is however associated with a high mortality when it occurs and is often diagnosed at post-mortem. Tuberculous myocarditis prevalence in males is twice that in females. Most of the reported cases of tuberculous myocarditis are predominantly in immunocompetent patients. Out of the reported fatalities (sudden cardiac deaths), eighty one percent (81%) occur in the ‘young’ patients (below 45years). Antituberculosis drug therapy does not appear to offer mortality benefit against sudden cardiac deaths.
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Affiliation(s)
| | - Faraj Omar Alkizim
- School of Medicine, University of Nairobi, Nairobi 00100, Kenya ; Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
| | - Duncan Mwangangi Matheka
- School of Medicine, University of Nairobi, Nairobi 00100, Kenya ; Department of Medical Physiology, University of Nairobi, Nairobi 00100, Kenya
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11
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Liu A, Nicol E, Hu Y, Coates A. Tuberculous Endocarditis. Int J Cardiol 2013; 167:640-5. [DOI: 10.1016/j.ijcard.2012.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/11/2012] [Accepted: 08/21/2012] [Indexed: 10/27/2022]
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12
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Desai N, Desai S, Chaddha U, Gable B. Tuberculous myopericarditis: a rare presentation in an immunocompetent host. BMJ Case Rep 2013; 2013:bcr-2012-007749. [PMID: 23456155 DOI: 10.1136/bcr-2012-007749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis is a common cause of pericardial disease in India. Myocardial involvement, although well described in the literature, is a rare manifestation of tuberculosis. We report a patient with disseminated tuberculosis and myopericarditis manifesting as cardiogenic shock. The patient gradually improved on antituberculosis drug therapy, steroids and an evidence-based guideline driven therapy for heart failure. Follow-up imaging showed calcification of the pericardium and improvement of his left ventricular systolic function.
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Affiliation(s)
- Nayan Desai
- Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA.
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13
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Liu A, Hu Y, Coates A. Sudden cardiac death and tuberculosis – How much do we know? Tuberculosis (Edinb) 2012; 92:307-13. [DOI: 10.1016/j.tube.2012.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/07/2012] [Indexed: 12/13/2022]
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14
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Brar R, Prasad A, Kumar A, Bagai M, Malhotra M. Myocardial tuberculosis presenting with congestive heart failure and pulmonary venous occlusion. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.ejrex.2010.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Khurana R, Shalhoub J, Verma A, Assomull R, Prasad SK, Kooner JS, Sethi A. Tubercular myocarditis presenting with ventricular tachycardia. ACTA ACUST UNITED AC 2008; 5:169-74. [DOI: 10.1038/ncpcardio1111] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 11/14/2007] [Indexed: 11/09/2022]
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16
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Ischaki E, Vasileiadis I, Koroneos A, Kolias S, Floros I, Roussos C, Vassilakopoulos T. Acute heart failure following decompression of tuberculosis induced pericardial tamponade. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rmedc.2007.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Biedrzycki OJ, Baithun SI. TB-related sudden death (TBRSD) due to myocarditis complicating miliary TB: a case report and review of the literature. Am J Forensic Med Pathol 2007; 27:335-6. [PMID: 17133033 DOI: 10.1097/01.paf.0000233633.16185.32] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
TB-related sudden death (TBRSD) is rarely reported in the literature and in the majority of cases is due to bronchopneumonia and hemoptysis. Cardiac complications of tuberculosis causing sudden death can take many forms and are rarer still, with only a handful of cases reported. We describe a case of a previously fit and healthy 20-year-old Asian female who, after returning from a holiday in India, collapsed while getting off a bus. At postmortem, the only macroscopic finding of note was a localized area of fibrosis on the anterior wall of the left ventricle. Microscopic examination of this area showed Langhans giant cells; noncaseating epithelioid granulomas and acid-fast bacilli were demonstrated on Ziehl Nielsen staining. In addition, the lungs, liver, and kidneys contained multiple noncaseating granulomas. The case serves to highlight the protean nature in the presentation of this disease and the importance of postmortem histology in autopsy work.
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Affiliation(s)
- O J Biedrzycki
- Division of Cellular Pathology, The Royal London Hospital, Stepney Way, Whitechapel, England.
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18
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Gokhale S, Malaviya AK, Basu A, Varghese SJ, Agarwal A. Clinicopathological Quiz. Med J Armed Forces India 2005. [DOI: 10.1016/s0377-1237(05)80067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Grabau JC, Hughes SE, Rodriguez EM, Sommer JN, Troy ET. Investigation of sudden death from Mycobacterium tuberculosis in a foreign-born worker at a resort hotel. Heart Lung 2004; 33:333-7. [PMID: 15454912 PMCID: PMC7124461 DOI: 10.1016/j.hrtlng.2004.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A 60 year-old man born in Central America died suddenly in the hallway of his residence on the grounds of a resort hotel where he worked as a dishwasher. The dishwashing station was in a large, poorly ventilated area where a substantial number of food service workers (cooks, wait staff, bus persons, dishwashers, supervisors, etc.) shared air space with the index patient. Several social contacts of the patient reported that he had been coughing for many months before his death. The County Department Of Health conducted a contact investigation, which identified 171 individuals in need of follow-up. Thirty-six percent of those tested in the first round were tuberculin skin test-positive; a second round of testing yielded a 15% (8 of 52) conversion rate.
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Affiliation(s)
- John C Grabau
- New York State Department of Health, Bureau of Tuberculosis Control, Albany, NY 12237, USA
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20
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Tuberculosis of the Heart and Pericardium. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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