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October 1, 1997

Transmission of Mycobacterium tuberculosis by a Fiberoptic BronchoscopeIdentification by DNA Fingerprinting

Author Affiliations

From the Departments of Medicine (Drs Michele, Graham, Chaisson, and Bishai) and Pathology (Ms Harrington), Johns Hopkins University School of Medicine; Departments of Molecular Microbiology and Immunology (Dr Bishai) and Epidemiology (Drs Graham and Chaisson), Johns Hopkins University School of Hygiene and Public Health; the Baltimore City Health Department (Drs Michele, Chaisson, and Bishai and Ms Pope); and the Maryland Department of Health and Mental Hygiene (Ms Cronin and Dr Dwyer), Baltimore, Md. Dr Graham is now with Glaxo-Wellcome Research and Development, Research Triangle Park, NC.

JAMA. 1997;278(13):1093-1095. doi:10.1001/jama.1997.03550130067039

Context.  —An ongoing restriction fragment length polymorphism (RFLP) study of Mycobacterium tuberculosis isolates from tuberculosis (TB) cases revealed an identical 10-banded IS6110RFLP pattern unique to 2 patients diagnosed as having TB 6 months apart. Their only identifiable link was care at the same hospital.

Objective.  —To determine if nosocomial transmission had occurred.

Design.  —Traditional and molecular epidemiologic investigation.

Measurements.  —We reviewed medical charts and bronchoscopic records, examined hospital locations visited by both patients, evaluated hospital ventilation systems, and observed cleaning and disinfection of bronchoscopes.

Results.  —A patient with cough, hoarseness, and fever underwent bronchoscopy and was diagnosed as having TB. A second patient with a mediastinal mass underwent bronchoscopy 2 days later and was diagnosed as having small cell carcinoma. Following 6 months of chemotherapy and radiation therapy, the second patient developed fever and an infiltrate of the right upper lobe of the lung. Bronchoscopic washings revealed acid-fast bacilli and were culture positive for M tuberculosis. Both patients had undergone bronchoscopy with the same instrument in the same operating room with no intervening bronchoscopies. Bronchoscope cleaning and disinfection procedures were inconsistent with national guidelines.

Conclusions.  —A contaminated bronchoscope was the most likely source of M tuberculosis transmission between these 2 patients. The RFLP analysis of M tuberculosis isolates was responsible for detecting this nosocomial source of transmission and led to the implementation of public health measures to prevent further spread of infection and disease. This study emphasizes the need for continued vigilance in endoscope cleaning techniques.