3 The cases of tuberculo- sis in all these ethnic minority groups have a very diVerent age distribution from those of UK origin, with a median age usually under 30 years compared with over 50 years in the white population. The increase in the number of patients with tuberculosis who become preg- nant is therefore due to the increasing pro- portion of women of child bearing age. Similar trends have been reported in the USA 45 and in most developed countries in Europe. In devel- oping countries the rise in tuberculosis is also predominantly aVecting the young, mainly the 15-44 age group, fuelled in sub-Saharan Africa by HIV co-infection. 6 This review considers aspects of tuberculosis in pregnancy and does not cover reduced fertility from genital tuber- culosis, although this is an important cause of infertility, especially in developing countries. 7

https://thorax.bmj.com/content/thoraxjnl/56/6/494.full.pdf

Tuberculosis in pregnancy and the puerperium

Molecular epidemiology indicates significant transmission of Mycobacterium tuberculosis after casual contact with infectious tuberculosis cases. We investigated M. tuberculosis transmission after brief exposure using a T cell-based assay, the enzyme-linked-immunospot (ELISPOT) for IFN-gamma. After childbirth, a mother was diagnosed with sputum smear-positive multidrug-resistant tuberculosis. Forty-one neonates and 47 adults were present during her admission on the maternity unit; 11 weeks later, all underwent tuberculin skin testing (TST) and ELISPOT. We correlated test results with markers of exposure to the index case. The participants, who were asymptomatic and predominantly had no prior tuberculosis exposure, had 6.05 hours mean exposure (range: 0-65 hours) to the index case. Seventeen individuals, including two newborns, were ELISPOT-positive, and ELISPOT results correlated significantly with three of four predefined measures of tuberculosis exposure. For each hour sharing room air with the index case, the odds of a positive ELISPOT result increased by 1.05 (95% CI: 1.02-1.09, p = 0.003). Only four adults were TST-positive and TST results did not correlate with exposure. Thus, ELISPOT, but not TST, suggested quite extensive nosocomial transmission of multidrug-resistant M. tuberculosis after brief exposure. These results help to explain the apparent importance of casual contact for tuberculosis transmission, and may have implications for prevention.

https://www.atsjournals.org/doi/pdf/10.1164/rccm.200403-307OC

T cell-based tracking of multidrug resistant tuberculosis infection after brief exposure.

As a result of the recent resurgence in tuberculosis (TB) and the increasing incidence of multidrug-resistant TB, there has been renewed interest in engineering controls to reduce the spread of TB and other airborne infectious diseases in high-risk settings. Techniques such as the use of lamps that produce ultraviolet germicidal radiation may reduce exposure to infectious agents by inactivating or killing microorganisms while they are airborne. We designed and evaluated a test method to quantitatively estimate the efficacy of germicidal lamps, in conjunction with dilution ventilation, for reducing the concentration of viable airborne bacteria. Bacterial particles were generated in a 36m3 room and collected with midget impingers at 5-7 locations. The effectiveness of the control technique was determined by comparing concentrations of culturable airborne bacteria with and without the control in operation. Results for a single, 15 W germicidal lamp showed reductions of 50% for Bacillus subtilis (B. subtilis)...

Evaluation of a Methodology for Quantifying the Effect of Room Air Ultraviolet Germicidal Irradiation on Airborne Bacteria

We investigated an increase in cases of multidrug-resistant tuberculosis (MDRTB) at a large urban facility where a prior nosocomial outbreak of MDRTB had occurred. Nosocomial transmission appeared to account for this outbreak as well, including a cluster of cases in a newborn nursery. Seven of 24 patients (29%) described in this investigation may have been exposed in the hospital nursery during an approximately 2-week period. We believe this to be the first documented outbreak of MDRTB in a hospital nursery. The transmission in the nursery demonstrates that the possibility of exposure to unrecognized active tuberculosis in nursery and hospital personnel is always present. Infection and active disease in the infants developed after a relatively short period of exposure. These findings underscore the need for adherence to published infection control guidelines in health care settings.

A Continuing Outbreak of Multidrug-Resistant Tuberculosis, with Transmission in a Hospital Nursery

Tuberculosis and pregnancy.

Newborn infants are thought to be particularly susceptible to infection with Mycobacterium tuberculosis, and the possibility of exposure to unrecognized clinical tuberculosis in nursery and hospital personnel is ever present. To reduce this possibility, periodic skin testing of hospital personnel is often carried out, and tuberculin-positive personnel are given preventive treatment with isoniazid (INH). Also, environmental controls, such as ultraviolet light and periodic air exchange, are used. The efficacy of these measures has not been fully established. A nursery supervisor with smear- and culture-positive pulmonary tuberculosis and a productive cough exposed 528 newborns over a three-month period before her disease was diagnosed. All 514 infants available for skin testing at approximately 3 months of age had negative skin tests. None received isoniazid preventive treatment. The nursery rooms all had ultraviolet lighting mounted above eye level. Calculated air changes per hour with positive pressure ventilation of fresh air ranged from 12 to 18. The hospital did not regularly test employees for tuberculosis. Periodic tuberculin testing of hospital personnel with preventive treatment of reactors presumably would have prevented this exposure.

Joe Greene

Papers

Nursery exposure of 528 newborns to a nurse with pulmonary tuberculosis.