Tuberculosis Doctor: Should Parents Worry?

April 14, 2009— -- While the discovery that a doctor at three Chicago-area hospitals has tuberculosis may have worried many parents, early signs indicate that there is little reason for concern.

Since it was first announced Friday that a resident who had rotated through Children's Memorial Hospital, Northwestern Memorial Hospital and Evanston Hospital has TB, testing done on her close friends and family members have returned showing no signs of the illness, reassuring officials that the woman was not highly contagious.

"At this point ... we are encouraged by initial, preliminary results," said Dr. Susan Gerber, speaking on behalf of the Chicago Department of Public Health. "We are encouraged that [friends and family] who the individual was with around that time are, so far, negative."

Gerber noted, however, that the department is continuing to investigate the situation and is considering possible new recommendations for TB testing for hospital personnel.

"I think right now it's possible that this situation could begin a conversation about how often physicians are tested for TB or how they're tested for TB," she said. "As we move forward, I'm sure those conversations would happen."

Additionally, Gerber said, the department has worked with the three hospitals to set up phone lines for concerned parents and others.

Gerber said that while people have called, they have not panicked.

"Although people are concerned, people are not alarmed," she said.

It remains unclear where the resident contracted TB, although some speculation has placed it with her time at an HIV clinic in Africa in 2007, and it simply did not show up on a skin test.

Dr. James McAuley, a pediatrics infectious diseases expert at Rush University Medical Center, noted that in two-thirds of the cases of adult TB, the disease does not immediately become evident through the skin test.

While the test should have been positive for the resident by the time she began her residency, "the skin test is not a perfect test," McAuley said. While she might have had a false negative after picking up TB in Africa, "it's also possible that she picked it up in one of the U.S. hospitals."

In a few weeks, he said, researchers will be able to "fingerprint" the strain of TB the resident has and know more about where she picked it up.

Gerber confirmed the notion that the resident may have picked up TB within the United States.

"I can remind you that we have TB in Chicago," which had 214 new cases last year, Gerber said. "That's an all-time low for Chicago, but I do have to remind people that we do have TB in Chicago."

The announcement of Chicago's record-low TB count came less than a month ago, for World TB Day on March 24.

Close Contacts

"There are certain children who have been patients that are going to be recommended for testing depending on the degree of contact," Gerber said. "I think the most important thing is that the institutions are reaching out to patients and their families."

Spokespeople for all three of the hospitals affected say they have reached out to parents whose children were in the wards when the resident was.

Kathleen Keenan, a spokeswoman for Children's Memorial Hospital said that 122 pediatrics patients were believed to have been in contact with the resident and their parents were contacted; six children and one parent were tested over the weekend and they fielded between 70 and 100 phone calls, which were answered by nurses or, in two cases, deferred to doctors.

"The single most important thing I think that we've all done is establish direct TB hotlines with live people," Keenan said. "We're committed to continuing that as long as there's a concern."

Keenan noted that for urgent concerns, a call could be answered outside of regular hours if patients called the desk and it was an emergency.

She noted that while only a relatively small percentage of the patients have been tested, many were unavailable because of the holiday weekend, but the families were assured that waiting would not be a problem.

McAuley confirmed that assessment.

"On some level, it's actually better when you wait, because the skin test is more reliable," he said.

At Evanston Hospital, the test is being offered to parents midweek this week, according to spokeswoman Amy Ferguson.

The hospital notified 71 parents by phone on Friday and sent mail to nine others for whom they did not have a phone number if the family had a child in their Infant Special Care Unit between February 11 and March 12.

Ferguson said about 35 calls about had come to their hospital over the weekend.

She noted however, that because of the air filter in the infant special care unit ward, precautions the hospital takes against infection and the fact that the resident's close friends and family have not been infected, the hospital sees the risk to the children as "minimal to non-existent."

Watchful Waiting

While infants and small children who come to the hospital can receive a skin test, parents should also be aware of possible symptoms of TB, since a test will not always be accurate.

"It's really all about the maturity of their immune system," said McAuley, since the reading of the immune test simply gauges the body's immune reaction to TB. This problem was once common for HIV patients whose TB would not show up on the test because of their weakened immune systems.

He noted that children may be less likely to inhale airborne TB bacteria than adults, but are more susceptible to the infection itself.

"Adults have a much more mature immune system and are able to handle that infection," he said.

He noted that weak bodily defenses were a particular concern for immunocompromised children who were being treated at the hospital. For them, McAuley said, a chest X-ray would also be prudent.

In many younger children, said Dr. Mark Metersky, a member of the American College of Chest Physicians Chest Infections Network, TB medications might be given right away to head off potential problems. The protocol, he noted, is "treat first and ask questions later."

Metersky noted that in young patients, TB will often show up as fever, weight loss, cough or lethargy, but the symptoms can also be less specific, so parents should be mindful.

"Especially in a [newborn], the infection can manifest itself just about anywhere in the body. The parents of an exposed infant should be looking for any signs of illness," he said.

But while concerns may remain, Gerber, like Metersky and McAuley said that in this case there is little reason to believe any children contracted TB.

"At this point, we have every reason to believe that the risk is minimal," she said.