Extensive transmission of Mycobacterium tuberculosis from 9 year old child with pulmonary tuberculosis and negative sputum smear

doi:10.1136/bmj.a1184

Published 28 August 2008, doi:10.1136/bmj.a1184
Cite this as: BMJ 2008;337:a1184

Practice

Lesson of the Week

Extensive transmission of Mycobacterium tuberculosis from 9 year old child with pulmonary tuberculosis and negative sputum smear

S Paranjothy, Walport clinical lecturer in public health medicine¹, M Eisenhut, consultant paediatrician², M Lilley, consultant in health protection³, S Bracebridge, regional epidemiologist⁴, I Abubakar, consultant epidemiologist, head of tuberculosis section⁵^,6, R Mulla, consultant microbiologist², K Lack, senior health protection nurse (TB)³, D Chalkley, lead TB nurse⁷, J Howard, specialist registrar⁴, S Thomas, specialist registrar⁴, M McEvoy, unit director³

¹ Department of Primary Care and Public Health, Clinical Epidemiology Interdisciplinary Research Group, School of Medicine, Cardiff University, Cardiff CF14 4YS, ² Luton and Dunstable Hospitals NHS Foundation Trust, Luton LU4 0DZ, ³ Bedfordshire and Hertfordshire Health Protection Unit, Letchworth, Hertfordshire SG6 1BE, ⁴ Health Protection Agency (East of England) Regional Epidemiology Unit, Institute of Public Health, University Forvie Site, Cambridge CB2 2SR, ⁵ Respiratory Diseases Department, Centre for Infections, Health Protection Agency, London NW9 5EQ, ⁶ School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, ⁷ Luton Training PCT, Liverpool Chest Clinic, Luton LU1 1HH

Correspondence to: S Paranjothy paranjothys@cf.ac.uk

A negative sputum smear does not exclude substantial risk ofinfection from patients with pulmonary tuberculosis

The first 150 words of the full text of this article appear below.

Patients with pulmonary tuberculosis and either a positive sputumsmear or cavitating pulmonary lesions have been considered tobe infectious¹ as these indicate higher bacterial load accumulatingwith longer duration of infection. The source of infection inoutbreaks among children is usually an adult with these features.²Children have been considered less likely to transmit infectionbecause they were unlikely to expectorate infective dropletnuclei. In the absence of a positive sputum smear, guidelinesdo not recommend screening of wider contacts in addition tohousehold contacts,³ although in the United States, contactscreening is recommended if resources are sufficient.⁴ Here,we report extensive transmission of tuberculosis in a juniorschool in Luton, England, from a child with pulmonary tuberculosisin whom a sputum smear was negative.

The index case was a 9 year old boy of Black African ethnicityborn in the United Kingdom. He was investigated by his family. . . [Full text of this article]

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