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Tuesday, April 14, 2009

Dr. Spreads TB at Childrens Hospital

A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 11 Apr 2009
Source: Chicago Tribune [edited]

A Northwestern University doctor-in-training [resident physician]
potentially exposed hundreds of patients including infants at 3
Chicago-area hospitals to tuberculosis in what is being called an
unusual case of a medical-care provider putting patients' health at

The 26-year-old female pediatric resident was diagnosed Tuesday [7
Apr 2009] with TB at Northwestern Memorial Hospital in Chicago after
experiencing symptoms consistent with the infectious disease,
hospitals and the Chicago Department of Public Health said. Symptoms
of "active" TB include coughing, night sweats, fever, chills and
weight loss.

As of Friday evening [10 Apr 2009], no patients or workers related to
this case had been diagnosed with TB. The 3 hospitals --
Northwestern, Children's Memorial and Evanston -- said they believe
the risk to patients is "minimal" from the resident, whose identity
was not released. However, hospitals are continuing to notify
patients Friday who may have been exposed to the resident over the
past 10 months.

The pediatric resident most recently was at Children's Memorial
Hospital in Chicago, where she came in contact with at least 150
children and infants and more than 300 workers, hospital officials
said. Her work rotations also affected more than 100 patients,
including 17 newborns, at Northwestern Memorial's Prentice Women's
Hospital between 3-21 Nov 2008 [An update issued by Northwestern
Memorial Hospital changed the dates when the pediatric resident was
working to between 3-19 Nov 2008, 2 days earlier than previously

An additional 80 babies at Evanston Hospital's infant special care
unit, including 20 who were still there Friday [10 Apr 2009], and a
"small group of employees" were in close contact with the doctor
between 12 Feb and 11 Mar 2009. All 3 hospitals are part of
Northwestern University's residency training program.

"She did have some time when she was contagious at those 3
institutions," Dr. Susan Gerber, chief medical officer of the Public
Health Department, said in an interview with the Tribune. "We are
researching the different days and different places that she has been
during the time that she would have been contagious."

As part of its ongoing investigation into the case, health officials
were examining a trip the Northwestern resident had made as a medical
student in late 2007 working at an HIV clinic in Botswana, where
cases of drug-resistant TB are common, sources said, adding that they
were uncertain of the trip's relevance as of Friday [10 Apr 2009].

Children's [Memorial Hospital] said no evidence suggests the resident
has drug-resistant TB. There were 12 898 cases of TB reported in the
USA in 2008, according to the U.S. Centers for Disease Control and
Prevention, and just 214 cases diagnosed in Chicago, though worldwide
TB kills about 2 million.

The resident's infection was "susceptible and sensitive" to
treatment, Gerber said at a news conference Friday [10 Apr 2009]. The
recommended length of drug therapy for most types of TB is from 6-9

People most at risk are those who have been exposed for 120 hours or
more to someone with TB, making infections more likely to happen
among family, friends and co-workers. But children and infants are
vulnerable, Gerber said. "Typically, those who live in the same house
are most at risk," said Dr. James McAuley, director of pediatric
infectious diseases at Rush University Medical Center. "You start
getting less risk when there is decreasing amounts of exposure. It is
worrisome, and they are taking it seriously."

The resident was admitted to Northwestern Memorial on 3 Apr [2009]
after being encouraged by fellow workers at Children's [Memorial
Hospital] to seek medical attention, sources close to the
investigation said. She was kept in isolation until her diagnosis was
confirmed Tuesday [7 Apr 2009] and was discharged Wednesday [8 Apr
2009], the sources said.

Northwestern Memorial called the health department Monday [6 Apr
2009] after her 1st set of tests came back and on Tuesday to confirm
the diagnosis. The investigation involves the Centers for Disease
Control and Prevention and the Chicago, Cook County and Illinois
departments of public health.

Medical professionals stressed the rarity of an infected health-care
worker exposing patients to TB, adding that staffers are screened
each year for the disease. But that doesn't preclude a person from
contracting TB in between screenings. "It happens rarely to
occasionally," said Dr. Stanford Shulman, chief of infectious
diseases at Children's. "It's the reason why hospitals, including
ours, annually test hospital employees on a routine basis." Shulman
confirmed that the resident had been tested in the past. But hospital
officials would not say when the last one occurred.

The hospital setting could help protect patients from infection
because a good ventilation system would prevent the bacterium from
lingering, said Dr. Carlos Perez-Velez, a pediatric and adult
infectious disease specialist at National Jewish Hospital in Denver.
The infected doctor's condition is key and whether she was coughing
in the room with patients, Perez-Velez said. If she wasn't coughing,
"I would suspect there would be a very low risk."

[Byline: Bruce Japsen, Joshua Boak, and Judith Graham]

Communicated by:
HealthMap via ProMED-mail

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