NOSOCOMIAL OUTBREAK OF TUBERCULOSIS IN A RENAL-TRANSPLANT UNIT - APPLICATION OF A NEW TECHNIQUE FOR RESTRICTION-FRAGMENT-LENGTH-POLYMORPHISM ANALYSIS OF MYCOBACTERIUM-TUBERCULOSIS ISOLATES

From January 1990 through February 1991, tuberculosis (TB) developed in 10 renal transplant (RT) patients at one hospital; 5 patients died. Possible nosocomial transmission was investigated. Mycobacterium tuberculosis isolates were compared by restriction fragment length polymorphism (RFLP) by a polymerase chain reaction method. The source case occurred in an RT patient (source) who had posttransplant exposure to TB at another hospital. The source patient was rehospitalized on the RT unit; diagnosis of TB and thus isolation precautions were delayed. Epidemiologic and RFLP analysis showed transmission from the source to 5 RT patients and 1 human immunodeficiency virus-infected patient. M. tuberculosis isolates from 4 RT patients had other RFLP patterns. The median incubation period for TB in RT patients was 7.5 weeks (range, 5-11). Bronchoscopy and intubation of the source patient and inadequate ventilation on the RT unit possibly increased transmission. Early detection of TB and effective isolation are essential to prevent nosocomial transmission.