ICAAC Highlights
Nebulizer implicated in day care outbreak
A nebulizer apparently served as a potent agent for transmitting tuberculosis in a day care facility, says Sarmistha B. Hauger, MD, director of pediatric infectious diseases at the Children’s Hospital of Boston.
The nebulizer had been placed over the face of an infant who later was found to have endobronchial TB, Hauger says. The infant had been misdiagnosed with broncho spasm and was being treated with medication delivered through the nebulizer. "The baby had been coughing even without the treatment; but in general, children [with TB] are less infectious than adults since they don’t have an especially forceful cough, and they tend not to harbor a lot of bacteria," says Hauger.
The nebulizer had the effect of provoking a more robust cough. Just as significant, perhaps, it generated an aerosol of droplets "in just the right width particle to carry the bacteria," she says.
The infant was sick for four to five months before finally being diagnosed with TB. By that time, "he had both TB and pneumonia in his lungs, positive acid-fast bacilli stains, moderate to high amounts of bacteria in his tracheal aspirates, and also meningitis," she says. "This was a very severe case." The day care facility was a relatively confined space, and the infant had not been isolated from the other children.
As a result of the exposure, a cluster of children and adults was infected, and some developed active disease. Hauger was able to obtain an isolate from one of the children who developed disease; RFLP testing showed a match between that child and the index case.
In this instance, no one suspected TB because no risk factors were apparent. The facility served working- and middle-class families. The parents of the index case were middle class people who exhibited none of the stereotypical risk factors for TB. Eventually, she discovered that the infant probably was exposed during a brief encounter with an elderly friend of his grandparent, whose house the infant was visiting.
The take-home message is this: "For anyone with a prolonged respiratory illness, think TB," Hauger says.
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