AB 19. Contact tracing of a sputum posistive tuberculosis case in a daycare employee
Background: In June 2012 a case of sputum-positive tuberculosis was
detected in an employee of a daycare center and contact tracing was
performed in the children and other employees.
Patients and methods: Among 114 infants examined, 6 (5.3%) had
tuberculin skin test (TST) ≥10 mm and 108 (94.7%) negative TST.
Children with positive TST had normal chest x-ray and no case of active
disease was detected in their family environments. Treatment for latent
tuberculosis (LT) with isoniazid and rifampicin was administered to
those with TST ≥10 mm for 3 months. A new TST after 3 months was
recommended for the children with negative initial TST. In 48 children
(44.4%) with negative TST, who were closer to the index case, treatment
for LT with isoniazid was administered until the second TST. All 94
children (87%) that were reexamined after 3 months had negative TST.
Out of the 48 children who had received isoniazid, 34 were revaluated
(70.8%) and only 22 had actually received treatment.
Results: Among 37 employees examined, all had a normal chest x-ray and
no symptoms. Nine employees had a TST ≥10 mm (24.3%), 1.5-10 mm
(2.7%) and 27 <5 mm (73%). Among those with positive TST, 3 had
a previously known positive result, 4 had converted their TST, 1 had
received full antituberculous treatment in the past and 1 died suddenly.
Treatment for LT with isoniazid for 9 months was administered in the
first 7 people and also to the employee with 5-10 mm (9 mm) due to
recent conversion. In 23 of 27 employees with negative TST, a new
TST was performed 3 months later and conversion was observed
in one person who was given isoniazid. In 4 people who had been
initially considered to have a positive TST, a negative result was found.
Employees did not receive treatment until three months later.
Conclusions: Application of guidelines in the case of sputum-positive
tuberculosis of people working with high-risk groups for preventing
dissemination to susceptible hosts is crucial. The complexity of the
management requires multidisciplinary approach.
