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Nosocomial exposure to active pulmonary tuberculosis in a neonatal intensive care unit

  • Jong Gyun Ahn
    Affiliations
    Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea

    Department of Medicine, The Graduate School of Yonsei University, Seoul, Korea
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  • Dong Soo Kim
    Affiliations
    Department of Medicine, The Graduate School of Yonsei University, Seoul, Korea

    Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Ki Hwan Kim
    Correspondence
    Address correspondence to Ki Hwan Kim, MD, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul 120-752, Korea.
    Affiliations
    Department of Medicine, The Graduate School of Yonsei University, Seoul, Korea

    Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
    Search for articles by this author
Published:August 23, 2015DOI:https://doi.org/10.1016/j.ajic.2015.07.020

      Highlights

      • The risk of nosocomial tuberculosis transmission to neonates in a neonatal intensive care unit environment remains.
      • All exposed neonates should receive isoniazid treatment after nosocomial tuberculosis exposure.
      • We handled exposed neonates and health care workers safely with appropriate screening and treatment.

      Background

      Nosocomial transmission of tuberculosis (TB) in a neonatal intensive care unit (NICU) is a recognized risk. We investigated TB transmission to neonates and health care workers (HCWs) exposed to a nurse with active TB in a NICU.

      Methods

      A NICU nurse in a tertiary referral hospital in Seoul, Korea, developed pulmonary TB. The investigation included 108 infants and 75 HCWs. Tuberculin skin test (TST) and chest radiograph were performed at baseline. Isoniazid prophylaxis was started in neonates. After 3 months of prophylaxis, infants underwent repeat TST and chest radiograph. HCWs underwent a second TST after 3 months.

      Results

      Baseline chest radiographs were negative in infants and HCWs. Four (3.7%) of 108 infants screened had a positive TST, including 2 conversions, and received isoniazid for 6-9 months. Among the 59 HCWs screened, 27 (45.8%) had an initial positive TST result, and 6 (10.2%) had a positive TST result at 3 months. Four of the 6 HCWs with TST conversions received isoniazid treatment for 9 months. In the 2-year period after exposure, none of the exposed infants or HCWs developed active TB.

      Conclusion

      In this investigation, 4 (3.7%) of 108 infants exposed to a nurse with active TB developed latent TB infection. They were given isoniazid therapy without any adverse events and did not progress to TB disease in the 2 years after exposure.

      Key Words

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