Nosocomial transmission of tuberculosis to a nurse demonstrated by means of spoligotyping of a formalin-fixed bronchial biopsy

• Published in: Netherlands journal of medicine Vol. 59; no. 3; pp. 152 - 157
• Main Authors: van der Zanden, A.G.M., Bosje, T., Heilmann, F.G.C., van Soolingen, D.
• Format: Journal Article
• Language: English
• Published: Alphen aan den Rijn Elsevier B.V 01.09.2001; Van zuiden
• Subjects: Bacterial diseases; Biological and medical sciences; Biopsy - methods; Bronchitis - diagnosis; Bronchitis - drug therapy; Bronchitis - microbiology; Cross Infection - diagnosis; Cross Infection - drug therapy; Cross Infection - microbiology; Cross Infection - transmission; Diagnosis, Differential; DNA Fingerprinting; DNA, Bacterial - analysis; DNA, Bacterial - genetics; Female; Human bacterial diseases; Humans; Infectious Disease Transmission, Patient-to-Professional - methods; Infectious diseases; Medical sciences; Mycobacterium tuberculosis; Mycobacterium tuberculosis - genetics; Nurses; PCR; Polymorphism, Genetic; RFLP; Serotyping - methods; Students, Nursing; Tomography, X-Ray Computed; Tropical medicine; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - microbiology; Tuberculosis, Pulmonary - transmission; Mycobacterium tuberculosis; ZN; Nurses; PCR; RFLP; Human; Surgical biopsy; Nosocomial infection; Radiodiagnosis; Respiratory disease; Transmission; Bronchus; Spoligotyping; Mycobacterial infection; Infection; Case study; Polymerase chain reaction; Tuberculosis; Surgery; Young adult; Bacteriosis; Bronchus disease; Medical imagery; Female; Computerized axial tomography; Diagnosis; Molecular biology; Nurse
• DOI: 10.1016/S0300-2977(01)00153-X
• ISSN: 0300-2977

Background: Tuberculosis was diagnosed in a student nurse. The source of infection was unknown and no positive culture was available. Methods: The diagnosis of tuberculous bronchitis was established on the grounds of a positive Mantoux test, the pathology of a bronchial biopsy and the results of a CT scan of the thorax. Spoligotyping of, for example, formalin-fixed tissue makes it possible to establish the diagnosis in a later phase after all. Results: Cultures for Mycobacterium tuberculosis were not performed for the student nurse and Ziehl-Neelsen staining of the formalin-fixed bronchial biopsy was negative. The final tuberculosis diagnosis was confirmed by a PCR fingerprint technique, i.e., spoligotyping of a formalin-fixed biopsy specimen. By means of contact investigation and identification of the strain via spoligotyping, comparison of the spoligo patterns made it possible to treat both the patient and those infected by this person correctly. Conclusions: When there is a pronounced suspicion of tuberculosis and a microbiological culture is not available, it is recommended that supplementary spoligotyping of clinical specimens be carried out. The purpose is to confirm the diagnosis, trace the presumed source case and indirectly to provide information on the drug susceptibility of the relevant M. tuberculosis strain.