Occupational infection fells two lab workers
CDC case reports of fatal meningitis infections
The Centers for Disease Control and Prevention (CDC) recently issued detailed case reports of two fatal laboratory infections due to Neisseria meningitidis. The case reports are summarized as follows:
Case 1. On July 15, 2000, a 35-year-old Alabama microbiologist presented to a hospital emergency department with acute onset of generalized malaise, fever, and diffuse myalgias. The patient was given a prescription for oral antibiotics and released. On July 16, the patient returned to hospital A, became tachycardic and hypotensive, and died three hours later. Blood cultures were positive for N. meningitidis serogroup C.
Three days before the onset of symptoms, the individual had prepared a Gram’s stain from the blood culture of a patient who was subsequently shown to have meningococcal disease. The microbiologist also had handled and subcultured agar plates containing cerebrospinal fluid (CSF) cultures of N. meningitidis serogroup C from the same patient. Co-workers reported that in the laboratory, aspiration of materials from blood culture bottles was performed at the open laboratory bench. Biosafety cabinets, eye protection, or masks were not used routinely for this procedure. Results of pulsed-field gel electrophoresis (PFGE) and multilocus enzyme electrophoresis testing at the CDC indicated that the two isolates were indistinguishable. The laboratory at hospital A infrequently processed isolates of N. meningitidis and had not processed another meningococcal isolate during the previous four years.
Case 2. On Dec. 24, 2000, a 52-year-old Michigan microbiologist had acute onset of sore throat, vomiting, headache, and fever. By the next day the patient had developed a petechial rash on both legs, which quickly evolved to widespread purpura. The patient presented to a hospital emergency department and died later that day of overwhelming sepsis. Blood cultures were positive for N. meningitidis serogroup C. The patient was a microbiologist in the state public health laboratory and had worked on several N. meningitidis serogroup C isolates during the two weeks before becoming ill. That laboratory had handled a median of four meningococcal isolates per month during the previous four years. Co-workers reported that the worker had performed slide agglutination testing and recorded colonial morphology using typical biosafety level 2 (BSL 2) precautions, which do not entail the use of a biosafety cabinet. PFGE was performed at the state public health laboratory and at CDC on all four specimens handled by the microbiologist. The isolates from the worker and from one of the recently handled laboratory samples were indistinguishable.
Reference
1. Centers for Disease Control and Prevention. Laboratory-Acquired Meningococcal Disease — United States, 2000. MMWR 2002; 51:141-144.
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