Nosocomial transmission of tuberculosis to a nurse demonstrated by means of spoligotyping of a formalin-fixed bronchial biopsy

Background: Tuberculosis was diagnosed in a student nurse. The source of in fection was unknown and no positive culture was available. Methods: The diagnosis of tuberculous bronchitis was established on the gro unds of a positive Mantoux test, the pathology of a bronchial biopsy and th e results of a CT scan of the thorax. Spoligotyping of, for example, formal in-fixed tissue makes it possible to establish the diagnosis in a later pha se after all. Results: Cultures for Mycobacterium tuberculosis were not performed for the student nurse and Ziehl-Neelsen staining of the formalin-fixed bronchial b iopsy was negative. The final tuberculosis diagnosis was confirmed by a PCR fingerprint technique, i.e., spoligotyping of a formalin-fixed biopsy spec imen. By means of contact investigation and identification of the strain vi a spoligotyping. comparison of the spoligo patterns made it possible to tre at both the patient and those infected by this person correctly. Conclusions: When there is a pronounced suspicion of tuberculosis and a mic robiological culture is not available, it is recommended that supplementary spoligotyping of clinical specimens be carried out. The purpose is to conf irm the diagnosis. trace the presumed source case and indirectly to provide information on the drug susceptibility of the relevant M. tuberculosis str ain. (C) 2001 Elsevier Science B.V. All rights reserved.