Published Date: 2005-05-23 23:50:00
Subject: PRO/EDR> Tuberculosis, nursery school - Spain (Catalonia)
Archive Number: 20050523.1416
TUBERCULOSIS, NURSERY SCHOOL - SPAIN (CATALONIA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: 13 May 2005
From: ProMED-mail <email@example.com>
Source: Eurosurveillance Weekly, 12 May 2005 [edited]
Outbreak of tuberculosis in a Catalonian nursery school affects 27 children
On 15 Apr 2005, a female assistant at a private school in a wealthy
area of Barcelona province was diagnosed with pulmonary tuberculosis
at the emergency department of a hospital. She had had a cough for
one month before. A chest x-ray revealed cavitary lesions, and the
sputum smear was positive for _Mycobacterium tuberculosis_.
Tuberculosis contact investigation was initiated 24 hours after
diagnosis of the index case. Of the 150 exposed people, 122 were
asymptomatic children under 5 years of age (62 percent were under 2
years old and 90 percent under 3 years), 19 were assistants from the
nursery school and 9 were close relatives of the index case.
5 days after the index case was diagnosed, an assessment of previous
history of tuberculosis and immune suppression was done, as well as a
tuberculin skin test (TST) and chest x-ray of all exposed people. The
vast majority of children were not vaccinated with the Bacille
Calmette Guerin (BCG) vaccine.
Among the 122 children, 36 (30 percent) had a positive TST (in 92
percent it was greater than 10 mm). Of these 36 children, 12 (10
percent) had an abnormal chest x-ray and were diagnosed as having
primary tuberculosis disease. Many children who had a positive TST
and an unclear or normal chest x-ray underwent a computerized
tomography (CT) scan due to described difficulties associated in
diagnosing tuberculosis among young children. The CT scan yielded
abnormal findings suggestive of primary tuberculosis disease among 15
more children. Blood samples and an early morning gastric washing
were collected from all children with tuberculosis. Testing for
acid-fast bacilli in gastric aspirates has yielded negative results
in all collected samples.
None of the 19 nursery assistants investigated had abnormal chest
x-rays, but the 12 who were TST positive were considered infected and
prescribed chemoprophylactic therapy, determined on individual basis.
Of the 9 close relatives investigated, 5 had a positive TST, but all
had normal chest x-rays.
So far, 27 cases of pulmonary disease among children under 5 years
old have been notified to the Public Health Unit of the Health
Department of Catalonia. All children with a negative TST are
receiving prophylactic therapy and a TST will be repeated in 8 to 10
weeks. Children with TB infection but not disease (latent
tuberculosos - Mod.LL) are also receiving prophylactic therapy for 9
months, and those with pulmonary tuberculosis are receiving a
standard treatment regimen, according to published guidelines .
_M. tuberculosis_ has been cultured in sputum from the index case,
and drug susceptibility testing has shown the strain to be sensitive
to the 4 1st-line anti-tuberculosis drugs.
1. American Thoracic Society/Centers for Disease Control and
Prevention/Infectious Diseases Society of America. Treatment of
Tuberculosis October 2002. Am J Respir Crit Care Med 2003; 167:
[Byline: Pina JM, Rodes A <firstname.lastname@example.org>, Alcaide JM, et al,
Program of Prevention and Control of Tuberculosis, Catalan Health
Department, Barcelona, Spain]
[ProMED does not usually post on tuberculosis, but the size of this
cluster is noteworthy. It generally requires about 6 weeks or more to
convert a tuberculin skin test to positive after exposure. Therefore,
it is likely that the index case was infectious significantly before
the cough was reported to have begun. No information is given
regarding the degree of exposure between the index case and the
infected/non-infected cohorts/children. It would be likely that the
closer the contact, the higher the number of skin test positives.
Since tubercular disease can progress rapidly from skin test
conversion to disseminated infection, such as miliary or meningeal
tuberculosis, young children with exposure but a non-reactive skin
test are begun on chemoprophylaxis until a repeat test is done, as
was done in this outbreak. - Mod.LL]