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Title: Baby Infects Health Care Workers with Tuberculosis: Presented at ICPP

"Baby Infects Health Care Workers with Tuberculosis: Presented at ICPP"

By Adrian Burton Special to DG News NICE, FRANCE -- February 20, 2002 -- Two doctors and four nurses in Belgium were found to have positive tuberculum skin tests after attending to the needs of a newborn with congenital tuberculosis, a physician reported here yesterday at the Fifth International Congress on Pediatric Pulmonology. According to Françoise Mouchet, MD, and associates from St. Pierre University Hospital, in Brussels, the current wisdom states that health care workers are at no risk of contracting tuberculosis (TB) from very young patients. The bacterial load that newborns carry is usually low and they cough infrequently. Dr. Mouchet, a pediatric physician, explained this rare case, which involves a baby born to a woman from the Philippines who had an unknown TB infection of the uterus. "This is not seen very often," Dr. Mouchet said. Active TB was diagnosed in the 29-week preterm baby. By day 30 of life, the child had developed severe broncho-pulmonary disease and sepsis. The gut was also infected, as was the myocardium. Contact tracing showed that none of the 97 babies who had entered the neonatal intensive care unit (ICU) where the child was receiving treatment could have been the source of infection. Screening with tuberculum skin tests (TST) and chest x-rays, done three months apart, showed none of the infants to be TB-positive, meaning none had become infected either. Babies who were still in the ICU underwent gastric aspirate culture testing. Some 148 health care workers and 180 family members were also screened. Six health care workers who came into close contact with the baby were found to have positive TST, while routine checks before the episode had shown them to be TB-negative. All received treatment and none became symptomatic. Upon histological examination of the mother's endometrium, tuberculous granulomas were found which yielded Mycobacterium tuberculosis. Clearly, the child had contracted congenital TB and then passed it on to those who looked after him. "The child was vomiting and producing a lot of sputum. Also, he required tracheal suctioning, which brought him into close contact, especially with the nurses. That's how they all became infected," Dr. Mouchet said. "The message is that congenital TB still exists, and babies who become infected can be contagious," she concluded. "This is quite different to the standard message in most places, and there are clear implications for health workers."

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