Nosocomial transmission of tuberculous otitis media in an ear, nose and throat outpatient unit: A clinical and hygienical investigation

Abstract

Primary tuberculous otitis media (TOM) is a rare disease accompanied by chronic otorrhea and hearing loss without additional organ manifestation. 1 Bhalla R.K. Jones T.M. Rothburn M.M. Swift A.C. Tuberculosis otitis media – a diagnostic dilemma. Auris Nasus Larynx. 2001; 28: 241-243 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar , 2 Cho Y.S. Lee H.S. Kim S.W. Chung K.H. Lee D.K. Koh W.J. et al. Tuberculosis otitis media: a clinical and radiologic analysis of 52 patients. Laryngoscope. 2006; 116: 921-927 Crossref PubMed Scopus (65) Google Scholar , 3 Chmielik L.P. Ziolkowski J. Koziolek R. Kulus M. Chmielik M. Ear tuberculosis: clinical and surgical treatment. Int J Pediatr Otorhinolaryngol. 2008; 72: 271-274 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar In November 2005, 2 consecutive cases of primary TOM in the Ear, Nose and Throat (ENT) Clinic of the Charité-University Hospital of Berlin prompted an epidemiological investigation. An overlapping stay at the ENT outpatient clinic was identified as the likely link between the two cases. Possible contact persons during that stay were traced in order to detect additional cases. 14 contacts including 3 medical staff members were identified and examined clinically and by laboratory examination: 20 ml of heparin blood were collected in order to detect T cells reactive to Mycobacterium tuberculosis (M. tuberculosis) antigens by Elispot (T-Spot®, Oxford Immunotec, Oxford UK) and by flow cytometric analysis. 4 Thiel A. Wu P. Lauster R. Braun J. Radbruch A. Sieper J. Analysis of the antigen-specific T cell response in reactive arthritis by flow cytometry. Arthritis Rheum. 2000; 43: 2834-2842 Crossref PubMed Scopus (70) Google Scholar Additionally, tuberculin skin testing was performed. In the case patients, molecular fingerprinting of mycobacterial isolates was performed by spoligotyping in order to reveal a possible genetic linkage. 5 Brudey K. Driscoll J.R. Rigouts L. Prodinger W.M. Gori A. Al-Hajoj S.A. et al. Mycobacterium tuberculosis complex genetic diversity: mining the fourth international spoligotyping database (SpolDB4) for classification, population genetics and epidemiology. BMC Microbiol. 2006; 6: 23 Crossref PubMed Scopus (859) Google Scholar