Peds Resident with TB

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BigNavyPedsGuy

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  1. Attending Physician
http://abcnews.go.com/Health/story?id=7315396&page=1


Doctor Possibly Exposed Hundreds to TB
Babies, Children May Be Among Those Exposed; No Other Confirmed Cases Yet
By DIANA ALVEAR
April 11, 2009

Barely days old, hundreds of babies in Chicago may already have been exposed to tuberculosis.

A Chicago-area doctor-in-training may have exposed hundreds of patients, including infants, to tuberculosis.
"We are investigating a situation in which a physician may have unknowingly exposed patients and hospital co-workers," Dr. Terry Mason of the Chicago Public Health Department said Friday.

"The one thing that makes this investigation stand out is its size and its scope," Mason added.

Officials said the 26-year-old resident, whose name has not been released, was on rotation at three different Chicago-area hospitals for the last 10 months, working with at least 150 children and infants at Children's Memorial Hospital; 100 patients, including 17 newborns at Northwestern Memorial Hospital; and an additional 80 babies at Evanston Hospital's Infant Special Care Unit.

So far, officials said, not a single patient has tested positive for tuberculosis -- although some of the most vulnerable of those exposed may receive preventive antibiotics.


Kids Not Necessarily More at Risk

Dr. James McAuley, a pediatrics infectious diseases expert at Rush University Medical Center, said young children are not necessarily more at risk for tuberculosis, but the danger lies in what happens once they're infected.

"Often they will go right from infection to TB throughout the body, including meningitis, which can be very dangerous," McAuley said.


However, tuberculosis is not easy to catch, McAuley said. The disease, mostly spread through coughing and sneezing, requires extended exposure to result in infection.

Once the resident was diagnosed, officials at the affected hospitals immediately took action.

"We are taking this very seriously," said J.P. Gallagher, president of Evanston Hospital.

Staff from all the hospitals involved have identified and notified all patients, families and staff members that might have been exposed.

In addition, Dr. Stanford Schulman, chief at the Division of Infectious Diseases at Children's Memorial Hospital, told ABC News tuberculosis screenings are available.

"We've offered skin testing and several parents have come today for skin testing," he said.
 
While the resident did nothing wrong here it seems, she did apparently have a "negative" PPD 10 months ago. She also did international work in 2007 in Africa, I believe, with hiv+ patients, a good percentage who likely also had concurrent TB, and we could reasonably assume this was when she had the primary infection with TB.

The question might be why was her TB skin test "negative"? While there is a false negative rate, it might be useful to look at who adminstered the PPD, as it needs to be done intradermally and not done too deep, i.e. in the SubQ tissue or too shallow . . . maybe she even had a borderline or equivocal result which might have been interpreted differently if her travel history was known. Maybe if this was known, i.e. recent exposure to a new TB convert (or assumed to be likely working on an hiv ward in africa), then if she had > 5mm on the PPD they might have wanted to do a CXR, etc . . . PPD testing can be done by untrained personel at many hospitals . . .
 
This is so unfortunate-- I sincerely hope this resident is treated and recovers. It is too bad that she is being blamed as the villain when in reality it is her job to take care of patients (whether the patient is TB infected or not).

Seriously, can you imagine what this resident is going through now? I would feel so guilty that I had taken care of newborns while I was infected (and I didn't know about it). I hope she isn't villainized by the media any more.
 
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This is so unfortunate-- I sincerely hope this resident is treated and recovers. It is too bad that she is being blamed as the villain when in reality it is her job to take care of patients (whether the patient is TB infected or not).

Seriously, can you imagine what this resident is going through now? I would feel so guilty that I had taken care of newborns while I was infected (and I didn't know about it). I hope she isn't villainized by the media any more.

That was my first thought when I saw the article and its headline "Doctor Possibly Exposed Hundreds to TB" 🙄
 
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