The risk for transmission of Mycobacterium tuberculosis at the bedside and during autopsy

Ann Intern Med. 1995 Jun 15;122(12):922-5. doi: 10.7326/0003-4819-122-12-199506150-00005.


Objective: To emphasize the differing infectious potentials of a patient with tuberculosis.

Setting: Hospital ward and autopsy room.

Design: An epidemiologic investigation of tuberculin skin test conversions in a clinical setting and during autopsy when results of tuberculin tests done before exposure were available for all participants.

Measurements: Tuberculin skin test results after the discovery of tuberculosis exposure from a patient with unsuspected tuberculosis for comparison with the test results before exposure; culture of sputum and autopsy material for Mycobacterium tuberculosis; and DNA fingerprinting of organisms.

Intervention: Preventive therapy for persons with skin test conversion.

Results: None of the 40 skin test-negative health care workers caring for the patient for 3 weeks on an open medical ward showed a skin test conversion, even though they had not used respiratory precautions. By contrast, among personnel present during the 3-hour autopsy, the test results of all five nonreactors converted from negative to positive (mean reaction, 24 mm). Two of these persons had a positive sputum culture 8 weeks later. The DNA fingerprints of all three isolates were identical.

Conclusions: A patient who did not transmit tuberculosis before death released a prodigious number of tubercle bacilli during autopsy.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Air Microbiology
  • Autopsy*
  • Humans
  • Infectious Disease Transmission, Patient-to-Professional*
  • Mycobacterium tuberculosis / isolation & purification
  • Personnel, Hospital*
  • Risk Factors
  • Tuberculin Test
  • Tuberculosis / transmission*
  • Ventilation