This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (171)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Samuel W. Dooley, MD; Margarita E. Villarino, MD, MPH; Mercedes Lawrence, MPH; Louis Salinas, MPA; Samuel Amil, MD; John V. Rullan, MD, MPH; William R. Jarvis, MD; Alan B. Bloch, MD, MPH; George M. Cauthen, ScD

JAMA. 1992;267(19):2632-2634.

Abstract
Objective.
—To assess nosocomial transmission of tuberculosis (TB). Design.—A historical cohort study of hospitalized patients with the human immunodeficiency virus (HIV) and a purified protein derivative (PPD) tuberculin skin test survey of health care workers (HCWs).

Setting.
—A large public teaching hospital in San Juan, Puerto Rico.

Patients.
—For the cohort study, a case patient was defined as any patient in the HIV unit at the hospital who developed culture-positive TB from 31 days or more after admission through December 31, 1989. For the PPD survey, of 1420 HCWs from the hospital, 908 agreed to participate and had sufficient data for analysis.

Main Outcome Measures.
—For the cohort study, to compare the risk of developing active TB among patients who were exposed to hospital roommates with infectious TB and the risk among nonexposed patients. For the HCW PPD survey, to determine the prevalence of and risk factors for tuberculous infection.

Results.
—Eight of 48 (9.7/10000 person-days) exposed case patients vs four of 192 (0.8/10000 person-days) nonexposed case patients developed active TB (relative risk [RR]=11; 95% confidence interval [CI], 2.3, 50.3). Positive PPDs (10 mm of induration) in HCWs were associated with older age (P=.0001) and with history of community TB exposure (P=.0002). In a multivariable logistic model that adjusted for these variables, HIV unit nurses (nine of 19) and nurses in the internal medicine ward (45 of 90) had a higher proportion of positive PPDs than the reference group (clerical personnel on other floors: 35 of 188, P=.0005).

Conclusions.
—These data suggest that patient-to-patient transmission of TB in HIV units can occur and that HCWs are at risk of acquiring TB infection.

(JAMA. 1992;267:2632-2635)

Author Affiliations
From the Division of Tuberculosis Elimination, National Center for Prevention Services (Drs Dooley, Bloch, and Cauthen and Mr Salinas) and the Hospital Infections Program (Drs Villarino and Jarvis), National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Ga; Puerto Rico Department of Health, San Juan (Ms Lawrence and Dr Rullan); and Hospital Municipal, San Juan, Puerto Rico (Dr Amil).

Footnotes
Presented, in part, at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy, Atlanta, Ga, October 24, 1990, and the Seventh International Conference on AIDS, Florence, Italy, June 20, 1991.

Reprint requests to the Division of Tuberculosis Elimination, Centers for Disease Control, Mailstop E-10, 1600 Clifton Rd NE, Atlanta, GA 30333 (Dr Dooley).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

On methods for studying stochastic disease dynamics
Keeling and Ross
J R Soc Interface 2008;5:171-181.
ABSTRACT | FULL TEXT  

American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Controlling Tuberculosis in the United States
Am. J. Respir. Crit. Care Med. 2005;172:1169-1227.
FULL TEXT  

High Rates of Clustering of Strains Causing Tuberculosis in Harare, Zimbabwe: a Molecular Epidemiological Study
Easterbrook et al.
J. Clin. Microbiol. 2004;42:4536-4544.
ABSTRACT | FULL TEXT  

Evaluation and Utilization as a Public Health Tool of a National Molecular Epidemiological Tuberculosis Outbreak Database within the United Kingdom from 1997 to 2001
Drobniewski et al.
J. Clin. Microbiol. 2003;41:1861-1868.
ABSTRACT | FULL TEXT  

Secondary Typing of Mycobacterium tuberculosis Isolates with Matching IS6110 Fingerprints from Different Geographic Regions of the United States
Yang et al.
J. Clin. Microbiol. 2001;39:1691-1695.
ABSTRACT | FULL TEXT  

Spoligotyping and Polymorphic GC-Rich Repetitive Sequence Fingerprinting of Mycobacterium tuberculosis Strains Having Few Copies of IS6110
Yang et al.
J. Clin. Microbiol. 2000;38:3572-3576.
ABSTRACT | FULL TEXT  

The Validity of Medical History, Classic Symptoms, and Chest Radiographs in Predicting Pulmonary Tuberculosis: Derivation of a Pulmonary Tuberculosis Prediction Model
Tattevin et al.
Chest 1999;115:1248-1253.
ABSTRACT | FULL TEXT  

Transmission of Mycobacterium tuberculosis by a Fiberoptic Bronchoscope: Identification by DNA Fingerprinting
Michele et al.
JAMA 1997;278:1093-1095.
ABSTRACT  

Evaluation of Tuberculosis Control Policies Using Computer Simulation
Brewer et al.
JAMA 1996;276:1898-1903.
ABSTRACT  

Acceptance of Isoniazid Preventive Therapy by Health Care Workers After Tuberculin Skin Test Conversion
Camins et al.
JAMA 1996;275:1013-1015.
ABSTRACT  

The Reemergence of Mycobacterial Infections
Fry
Arch Surg 1996;131:14-17.
ABSTRACT  

National Trends in the Concurrence of Tuberculosis and Acquired Immunodeficiency Syndrome
Burwen et al.
Arch Intern Med 1995;155:1281-1286.
ABSTRACT  

Tuberculosis among Health Care Workers
Menzies et al.
NEJM 1995;332:92-98.
FULL TEXT  

Tuberculosis Susceptibility Patterns, Predictors of Multidrug Resistance, and Implications for Initial Therapeutic Regimens at a New York City Hospital
Weltman and Rose
Arch Intern Med 1994;154:2161-2167.
ABSTRACT  

Preventive Services Guidelines for Primary Care Clinicians Caring for Adults and Adolescents Infected With the Human Immunodeficiency Virus
Gerber et al.
Arch Fam Med 1993;2:969-979.
ABSTRACT  

Drug-Resistant Tuberculosis in New York City
Gensheimer et al.
NEJM 1993;329:134-135.
FULL TEXT  

Trends in Death With Tuberculosis During the AIDS Era
Braun et al.
JAMA 1993;269:2865-2868.
ABSTRACT  

Exogenous Reinfection with Multidrug-Resistant Mycobacterium tuberculosis in Patients with Advanced HIV Infection
Small et al.
NEJM 1993;328:1137-1144.
ABSTRACT | FULL TEXT  

Hospital Outbreak of Multidrug-Resistant Mycobacterium tuberculosis Infections: Factors in Transmission to Staff and HIV-Infected Patients
Beck-Sague et al.
JAMA 1992;268:1280-1286.
ABSTRACT  

Multidrug-resistant Tuberculosis
Dooley et al.
ANN INTERN MED 1992;117:257-259.
ABSTRACT  

Tuberculosis Control: Back to the Future?
Gordin
JAMA 1992;267:2649-2650.
ABSTRACT