Kantor H S, Poblete R, Pusateri S L
Laboratory Service, Veterans Administration Medical Center, North Chicago, Illinois 60064.
Am J Med. 1988 May;84(5):833-8. doi: 10.1016/0002-9343(88)90060-5.
Tuberculosis remains an occupational hazard for hospital employees. A case of acute generalized tuberculosis occurring in a patient with a malignancy who had received corticosteroids was undetected during life and during a gross autopsy examination. Histologic examination of tissue performed one month later was necessary to establish the diagnosis. Of susceptible hospital staff members who were exposed to the index case, infection developed in nine of 56 (16 percent) compared with three of 333 (0.9 percent) unexposed personnel with similar risk but no known exposure (p less than 0.001). This was a 17.8-fold increase in the infection rate for the exposed group. Three employees infected had evidence of active disease: two had pleural effusions and one had cavitary pulmonary infiltrates; six were asymptomatic. The high rate of infection was associated with inadequate air ventilation and exposure to uncontained infectious aerosol. Preventive therapy with isoniazid, high-change-ventilating systems, ultraviolet radiation, and primary barrier systems are recommended methods to reduce the infection risk.
结核病仍然是医院员工面临的职业危害。一名患有恶性肿瘤且接受过皮质类固醇治疗的患者发生了急性全身性结核病，生前及大体尸检时均未被发现。一个月后对组织进行组织学检查才得以确诊。在接触该索引病例的易感医院工作人员中，56人中有9人（16%）发生感染，而333名具有相似风险但无已知接触史的未接触人员中有3人（0.9%）发生感染（p<0.001）。暴露组的感染率增加了17.8倍。三名受感染员工有活动性疾病的证据：两人有胸腔积液，一人有空洞性肺部浸润；六人无症状。高感染率与通风不足以及接触未加控制的感染性气溶胶有关。推荐使用异烟肼进行预防性治疗、更换高效通风系统、紫外线照射和使用一级屏障系统来降低感染风险。
