Healthcare and Hospital Management

Background: The management of an outbreak of Tuberculosis (TB) poses many challenges, particularly in the immunocompromised setting. The authors outline an outbreak of TB where two transplant recipients with sputum positive pulmonary TB attended a renal outpatients department in an acute hospital,

Methods: Interferon Gamma Release Assay (IGRA) has a higher sensitivity and specifi city (53%, 69%) than the Tuberculin Skin Test (TST) (31%, 63%) in immunocompromised individuals . IGRA was the primary screening test employed for immunocompromised contacts. Immunocompetent contacts were screened using the Mantoux TST. Results: A total of 13 cases of LTBI were identifi ed out of 138 screened contacts. Of  these, 9 cases were identifi ed out of 38 immunocompetent close contacts (detection rate 23.7%) and 4 cases were identifi ed out of 100 immunocompromised hospital contacts (detection rate 4%). No further active cases of TB were identifi ed. Conclusion: It was anticipated that a greater rate of LTBI would be found in immunocompromised individuals. The true LTBI rate may well be higher; however, this could not be accurately assessed owning to the poor sensitivity and specifi city of screening

tests in immunocompromised individuals. Thus, all immunocompromised contacts with negative IGRA require chest x-ray follow up over a two year period.