Using Epidemiology  in a TB Contact Investigation

EPI Case Study 4: Using Epidemiology

 in a TB Contact Investigation

Estimated Time to Complete Exercise: 1 hour 30 minutes
Suggested citation: New Jersey Medical School Global Tuberculosis Institute. /Incorporating Tuberculosis into Public Health Core Curriculum./ 2009: Epidemiology case Study 4: Using Molecular Epidemiology in a TB Contact Investigation STUDENT Version 1.0.
This exercise is drawn from an article published in Chest, “Mycobacterium tuberculosis Miniepidemic in a Church Gospel Choir” by Mangura and colleagues. 1 Specific aspects of the investigation have been altered, with permission from the authors, to assist in meeting the desired teaching objectives.
Students should be aware that this study describes one particular approach to a TB outbreak investigation. Despite nationally published guidelines and recommendations from the Centers for Disease Control and Prevention for conducting contact investigations, the actual practice implemented during these investigations can vary from program to program.
An epidemiologist investigating a TB outbreak works within the framework of an investigative team that includes persons with expertise in epidemiology, microbiology, TB surveillance, and environmental health. It is through the collaborative efforts of this team, with each member playing a critical role that outbreak investigations can result in a positive outcome.
Suggested Reading can be found on the CDC EXCITE website- How to Investigate an Outbreak:
Note: The Works Cited page is in AMA (American Medical Association) style.
PART I. Identifying a Problem
This morning (June 21) the local health department (large town health department) received a telephone call from the infection control practitioner (ICP) from a nearby hospital reporting that 2 patients were seen in the emergency department (ED) late yesterday with complaints of fatigue, fever, night sweats, and cough. As part of their work-up, the ED physician ordered chest x-rays for both patients. The health department was informed that, in both cases, the radiology report indicated abnormal findings consistent with TB. As a result, both patients were admitted to the hospital with a diagnosis of suspected pulmonary TB. Once admitted, sputum samples collected from both patients were read as positive on microscopic smear with final culture identification pending.
You know that tuberculosis (TB) is an infectious disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually affect the lungs (pulmonary TB) but also can affect any part of the body outside the lungs (extrapulmonary TB) with the most common sites being the lymph nodes, bone, kidney, and pleura. While TB disease was once the leading cause of death in the United States, it can now be treated successfully with appropriate antibiotics. However, if not diagnosed early or not treated appropriately, TB disease can be fatal.