Templeton G L, Illing L A, Young L, Cave D, Stead W W, Bates J H
John L. McClellan Veterans Administration Hospital, Little Rock, Arkansas, USA.
Ann Intern Med. 1995 Jun 15;122(12):922-5. doi: 10.7326/0003-4819-122-12-199506150-00005.
To emphasize the differing infectious potentials of a patient with tuberculosis.
Hospital ward and autopsy room.
An epidemiologic investigation of tuberculin skin test conversions in a clinical setting and during autopsy when results of tuberculin tests done before exposure were available for all participants.
Tuberculin skin test results after the discovery of tuberculosis exposure from a patient with unsuspected tuberculosis for comparison with the test results before exposure; culture of sputum and autopsy material for Mycobacterium tuberculosis; and DNA fingerprinting of organisms.
Preventive therapy for persons with skin test conversion.
None of the 40 skin test-negative health care workers caring for the patient for 3 weeks on an open medical ward showed a skin test conversion, even though they had not used respiratory precautions. By contrast, among personnel present during the 3-hour autopsy, the test results of all five nonreactors converted from negative to positive (mean reaction, 24 mm). Two of these persons had a positive sputum culture 8 weeks later. The DNA fingerprints of all three isolates were identical.
A patient who did not transmit tuberculosis before death released a prodigious number of tubercle bacilli during autopsy.
强调肺结核患者不同的传染潜力。
医院病房和尸检室。
在临床环境以及尸检期间对结核菌素皮肤试验结果转变情况进行一项流行病学调查，所有参与者在暴露前均已进行结核菌素试验。
发现一名未被怀疑患有结核病的患者的结核暴露情况后，其结核菌素皮肤试验结果，用于与暴露前的试验结果进行比较；对痰液和尸检材料进行结核分枝杆菌培养；以及对微生物进行DNA指纹分析。
对皮肤试验结果转变者进行预防性治疗。
在开放病房护理该患者3周的40名结核菌素皮肤试验阴性的医护人员中，无人出现皮肤试验结果转变，即便他们未采取呼吸道防护措施。相比之下，在3小时尸检过程中的人员里，所有5名无反应者的试验结果均从阴性转变为阳性（平均反应为24毫米）。其中两人在8周后痰液培养呈阳性。所有三个分离株的DNA指纹相同。
一名生前未传播结核病的患者在尸检期间释放了大量结核杆菌。
