Brote epidémico de tuberculosis en un colegio de Granada

Résumé

Objective To describe the diagnosis and early treatment of an epidemic outbreak of tuberculosis and determine the utility of polymerase chain reaction (PCR) compared with routine culture in gastric juice. Material and methods A computer studies teacher, with clinical features suggestive of tuberculosis and caverns on X-ray, was diagnosed with bacilliferous tuberculosis. Primary health carservices carried out a Mantoux test on the school's 387 students as well as on teachers and other staff. The childrenwith a positive Mantoux test underwent laboratory, radio-logical, and microbiological investigations for one weekin the Pediatric Respiratory Unit of Hospital Clínico inGranada.In the teaching and non-teaching staff, active tuberculosis was ruled out through bacilloscopy of sputum samples, Mantoux test, and chest X-ray. Results In the first screening, the Mantoux test was positive in 67 children. Of these, 7 children were diagnosed with tuberculosis and 60 were found to be infected. Of the 7 children with tuberculosis, five presented positive gastricjuice culturein Lowenstein medium while Roche COBASPCR was negative. In the second screening, 9 children became tuberculinpositive. Of these, 8 were diagnosed with tuberculosis and one was infected. Cultures were positivein 3 and PCR was negative. In 77.6 % of the children(59/76), the Mantoux induration was equal to or higher than 18 mm. All of the 15 children with tuberculosis were aged between 9 and 14 years old, except one who was 5 years old. Conclusions The Mantoux test remains a basic screening method indiagnosis and epidemiological research, whereas the results of microbiological investigation remain poor and inour study the results DNA were disappointing. The screening of tuberculosis and of other infectious diseases shouldbe more closely monitored in professional groups, such asteachers, that are in contact with large numbers of children. This would identify infected adults and prevent epidemics such as that described in the present study.