Pericardial effusion as the first manifestation of occupational tuberculosis in a health care worker

• Published in: Arhiv za higijenu rada i toksikologiju Vol. 65; no. 4; pp. 417 - 422
• Main Authors: Flego, Veljko, Lender, Dubravka Matanić, Bulat-Kardum, Ljiljana
• Format: Journal Article
• Language: English; Croatian
• Published: Croatia De Gruyter Open 01.12.2014; Institute for Medical Research and Occupational Health
• Subjects: Adult; antituberculotics; antituberkulotici; diseminirana tuberkuloza; disseminated tuberculosis; ekstrapulmonalna tuberkuloza; extrapulmonary tuberculosis; Health Personnel; Humans; Latent Tuberculosis - complications; Latent Tuberculosis - diagnosis; Latent Tuberculosis - drug therapy; Male; Mycobacterium tuberculosis; nosocomial disease; nozokomijalna bolest; occupational disease; Occupational Diseases - diagnosis; Occupational Diseases - drug therapy; Pericardial Effusion - diagnosis; Pericardial Effusion - drug therapy; Pericardial Effusion - etiology; profesionalna bolest; Treatment Outcome; tuberculous pericarditis; tuberkulozni perikarditis
• ISSN: 0004-1254; 1848-6312; 0004-1254
• DOI: 10.2478/10004-1254-65-2014-2548

Tuberculosis (TB) is an infectious disease and, apart from protecting patients, attention must be given to protecting the persons who come in contact with them, especially nurses and medical practitioners. A 43-yearold immunocompetent male nurse developed occupationally disseminated TB after contact with patients affected by active TB (culture positive) while working in a psychiatric hospital. The first manifestation of the disease was exudative pericarditis with Mycobacterium tuberculosis (MT) confirmed two months after pericardiocentesis and evacuation of 1200 mL of pericardial effusion. Many lymph nodes showed histologic findings of granulomatous inflammation with necrosis. Treatment with antituberculosis drugs caused complications, including transient short-term medication-induced toxic hepatitis, prolonged fever, left pleural nonspecific effusion, and mononeuritis of the right peroneus nerve. The treatment lasted 14 months and led to permanent consequences, including fibrothorax with restrictive ventilation disorders and reduced diffusion of the alveolar-capillary membrane. This case highlights the need to improve the protection of health care workers who are in contact with TB patients, as well as the usefulness of the tuberculin skin test and QuantiFERON-TB test, which can be used to identify early latent TB Tuberkuloza (TBC) zarazna je bolest, stoga je prijeko potrebno zaštititi ne samo bolesnike nego i osoblje koje dolazi u kontakt s njima, u prvom redu medicinske sestre i liječnike. Nakon kontakta s bolesnicima oboljelima od TBC-a (u kulturama pozitivne) 43-godišnji imunokompetentni medicinski tehničar, zaposlen u psihijatrijskoj bolnici, obolio je od profesionalnog diseminiranog TBC-a. Prva manifestacija bolesti bio je eksudativni perikarditis s dokazanim Mycobacterium tuberculosis (MT), dva mjeseca nakon perikardiocenteze i evakuacije 1200 mL perikardijalnog izljeva. Histološki nalaz limfnih čvorova na više lokalizacija pokazivao je granulomatoznu upalu s nekrozom. Liječenje antituberkuloticima bilo je praćeno komplikacijama. Došlo je do prolaznog, kratkotrajnog, medikamentozno toksičnog hepatitisa, dugotrajnog febriliteta, nespecifičnog ljevostranog pleuralnog izljeva i mononeuritisa desnog peronealnog živca. Liječenje je trajalo 14 mjeseci. Kao trajna posljedica razvio se fibrotoraks, koji je doveo do restriktivnih smetnji ventilacije i smanjene difuzije alveolarno-kapilarne membrane. Ovaj slučaj upozorava na potrebu poboljšanja zaštite zdravstvenih radnika koji su u kontaktu s oboljelima od tuberkuloze, kao i korisnost tuberkulinskog kožnog testa i QuantiFERON-TB testa, koji mogu rano otkriti latentni TBC