Reynolds D L, Gillis F, Kitai I, Deamond S L, Silverman M, King S M, Matlow A G, Crockett M
Durham Region Health Department, Whitby, Ontario, Canada.
Int J Tuberc Lung Dis. 2006 Sep;10(9):1051-6.
This report investigates the unusual transmission of Mycobacterium tuberculosis from a 12-week-old infant with nosocomially acquired tuberculosis (TB). Compliance with recommendations on the post-exposure management of young children is described.
Contacts of an infant case of TB were identified and recommended to undergo baseline and post-exposure tuberculin skin tests (TST) as per Canadian TB standards. TST conversion was measured at least 8 weeks post exposure. Children aged <6 years were recommended to initiate preventive treatment with isoniazid (INH) until their post-exposure TST. Information on TST results and adherence to therapy were analysed from existing medical records.
Overall, 17 TST conversions were documented among 732 contacts: both parents, two health care workers (HCWs) who provided close care, and several patients, visitors and one staff member without obvious close contact. Of 65 eligible children, 46% completed post-exposure therapy as recommended. The most common reasons for treatment failure were concern about side effects, perception of low risk and lack of physician support.
This investigation suggests that all children, including infants, with cough and numerous bacilli or extensive pulmonary disease should be considered infectious. Health care provider education is necessary to resolve the observed low compliance with current post-exposure management guidelines.
本报告调查了一名 12 周大的医院获得性肺结核婴儿中结核分枝杆菌的异常传播情况。描述了对幼儿暴露后管理建议的依从性。
根据加拿大结核病标准，识别了一名婴儿结核病病例的接触者，并建议他们接受基线和暴露后结核菌素皮肤试验（TST）。在暴露后至少 8 周测量 TST 转换情况。建议 6 岁以下儿童开始使用异烟肼（INH）进行预防性治疗，直至其暴露后 TST。从现有医疗记录中分析 TST 结果和治疗依从性的信息。
总体而言，在 732 名接触者中记录到 17 例 TST 转换：包括父母双方、两名提供密切护理的医护人员（HCW），以及几名患者、访客和一名无明显密切接触的工作人员。在 65 名符合条件的儿童中，46%按照建议完成了暴露后治疗。治疗失败的最常见原因是担心副作用、认为风险低以及缺乏医生支持。
这项调查表明，所有咳嗽且有大量杆菌或患有广泛肺部疾病的儿童，包括婴儿，都应被视为具有传染性。有必要对医护人员进行教育，以解决观察到的对当前暴露后管理指南依从性低的问题。
