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	va1-sg19016.securesites.net

	version=3.1.8





TUBERCULOSIS, HOSPITAL EXPOSURE - USA (WISCONSIN) (02)

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I found an additional source of information

"She was then tested and found on 20 Aug 2007 to have peritoneal TB, 

a relatively uncommon form of the disease that is better known in 

Africa and Asia."



The same article also noted, "Fortunately, due to effective screening 

methods and treatment, there has not been a single case of TB 

exposure that resulted in active disease to patients or employees in 

35 years at UW Hospital." The rest of the information was redundant.



In WA State where I practice, state law dictates a two step PPD for 

new hires in licensed inpatient health care facilities. I checked WI 

law and unfortunately it did not require 2 step testing.



[Wisconsin law ref.] HFS 124.07(2)(c)

"(c) A Mantoux tuberculin skin test consisting of 5 tuberculin units 

(TU) of purified protein derivative (PPD) and, if necessary, a chest 

roentgenogram to determine whether disease is present, unless 

medically contraindicated. Persons with positive findings shall be 

referred to a physician for evaluation."



The employee was noted to work at both the UW hospital and the VA 

hospital. The VA hospitals in the US follow OSHA regulations and not 

state regulations. OHSA requires current CDC guidelines be followed, 

and issued this interpretation letter in 1997 which I believe is 



"Your second question pertains to tuberculosis skin testing and which 

employees are required to be tested. OSHA's position is that 

employers, in covered workplaces, shall offer Mantoux TB skin tests 

(at no cost to employees) to all current potentially exposed 

employees and to all new employees prior to exposure. A two-step 

baseline shall be used for new employees who have an initially 

negative TB skin test result and who have not had a documented 

negative TB skin test result during the preceding 12 months"

This of course does not confirm that the particular rule was followed.



employee in the above news release from latent infection acquired 

less than 6-8 weeks before, or at some time after, her negative skin 

test in November 2006." While the report said the woman had been ill 

only a few weeks, with TB's insidious onset and patient histories 

being unreliable, this may not represent rapid progression. Also, 

from 6 Nov 2006 to 7 Jul 2007, (assuming onset was at least a month 

before diagnosis) is 8 months not 8 weeks. So I am confused about 

this Mod comment. Could you please clarify it, thank you.



--

Ginger Switzer, ARNP, COHN-S

EHPEC Employee Health Practitioners, Educators, and Consultants





[I thank Ginger Switzer for her comments. The U.S. Centers for 

Disease Control and Prevention "Guidelines for Preventing the 

Transmission of Mycobacterium tuberculosis in Health-Care Facilities, 

guidelines say that healthcare workers (HCWs) who potentially are 

exposured to _M. tuberculosis_, including those with a history of BCG 

vaccination, should have baseline tuberculin skin testing performed 

during the pre-employment physical or when applying for hospital 

privileges. Tuberculin skin test-negative HCWs should undergo repeat 

tuberculin skin testing at regular intervals; the frequency of 

testing is determined by the risk for transmission of _M. 

tuberculosis_ in the particular work area of the healthcare facility.



These guidelines address the issue of "2-step testing" to detect the 

boosting phenomenon that might be misinterpreted as a skin-test 

result during the preceding 12 months, the baseline PPD testing 

should employ the 2-step method; this will detect boosting phenomena 

that might be misinterpreted as a skin-test conversion. Decisions 

concerning the use of the 2-step procedure for baseline testing in a 

particular facility should be based on the frequency of boosting in 

that facility."  Thus the CDC guidelines leave the decision to employ 

2-step testing to the discretion of the healthcare facilities, the 

decision likely dependent to some degree on the prevalence of latent 

tuberculosis in the local population and on local regulations.



The postulated mechanisms by which tubercle bacilli reach the 

peritoneum from a primary lung focus or (ii) spread from an 

intra-abdominal site of tubercular disease, such as the intestine, 

ovaries, or lymph nodes, whose source is also a primary lung focus. A 

review of published single cases and case series of abdominal 

tuberculosis, including peritoneal tuberculosis, reveals that the 

majority of patients do not have evidence of concomitant active 

pulmonary tuberculosis, the abdominal site having reactivated at some 

interval of time after the primary pulmonary site healed. The 

healthcare worker in the news release had concomitant active 

pulmonary and peritoneal tuberculosis, which suggests uncontrolled 

progression without a period of immune suppression of the tubercular 

process. - Mod.ML]



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Tuberculosis, MDR, airplane exposure - multicountry (02)  20070728.2430

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Tuberculosis, XDR, airplane exposure - multicountry (02)  20070530.1752

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2005

----

Tuberculosis, hospital exposures - USA (MA)  20050616.1702

Tuberculosis - Iraq (Missan)  20050613.1652

Tuberculosis, nursery school - Spain (Catalonia)  20050523.1416

Tuberculosis, supermarket exposure - Netherlands (Zeist) (03)  20050225.0602

Tuberculosis, supermarket exposure - Netherlands (Zeist)  20050207.0411]

....................ml/ejp/jw