By Bruce Japsen and Joshua Boak
The Chicago Tribune
CHICAGO — A Northwestern University doctor-in-training potentially exposed hundreds of patients, including infants, at three Chicago-area hospitals to tuberculosis in what is being called an unusual case of a medical-care provider putting patients’ health at risk.
The 26-year-old female pediatric resident was diagnosed Tuesday with TB at Northwestern Memorial Hospital in Chicago after experiencing symptoms consistent with the infectious disease, hospitals and the Chicago Department of Public Health said. Symptoms of “active” TB include coughing, night sweats, fever, chills and weight loss.
As of Friday evening, no patients or workers related to this case had been diagnosed with TB. The three hospitals — Northwestern, Children’s Memorial and Evanston — said they believe the risk to patients is “minimal” from the resident, whose identity was not released. However, hospitals are continuing to notify patients Friday who may have been exposed to the resident over the past 10 months.
Tuberculosis is a bacterial disease that usually affects the lungs but can also affect the brain, kidneys, spine and other body parts. The disease, which can be fatal if left untreated, remains common in many developing countries and is still found in the United States.
The pediatric resident most recently was at Children’s Memorial Hospital in Chicago, where she came in contact with at least 150 children and infants and more than 300 workers, hospital officials said. Her work rotations also affected more than 100 patients, including 17 newborns, at Northwestern Memorial’s Prentice Women’s Hospital between Nov. 3 and 21.
An additional 80 babies at Evanston Hospital’s infant special care unit, including 20 who were still there Friday, and a “small group of employees” were in close contact with the doctor between Feb. 12 and March 11. All three hospitals are part of Northwestern University’s residency training program.
“She did have some time when she was contagious at those three institutions,” Dr. Susan Gerber, chief medical officer of the Public Health Department, said in an interview with the Tribune. “We are researching the different days and different places that she has been during the time that she would have been contagious.”
Experts said tuberculosis can remain hidden, or latent, without any symptoms for years.
As part of its ongoing investigation into the case, health officials were examining a trip the Northwestern resident had made as a medical student in late 2007 working at an HIV clinic in Botswana, where cases of drug-resistant TB are common, sources said, adding that they were uncertain of the trip’s relevance as of Friday.
Children’s said no evidence suggests the resident has drug-resistant TB. There were 12,898 cases of TB reported in the U.S. in 2008, according to the U.S. Centers for Disease Control and Prevention, and just 214 cases diagnosed in Chicago, though worldwide TB kills about 2 million.
The resident’s infection was “susceptible and sensitive” to treatment, Gerber said at a news conference Friday. The recommended length of drug therapy for most types of TB is from six to nine months.
People most at risk are those who have been exposed for 120 hours or more to someone with TB, making infections more likely to happen among family, friends and co-workers. But children and infants are vulnerable, Gerber said.
“Typically, those who live in the same house are most at risk,” said Dr. James McAuley, director of pediatric infectious diseases at Rush University Medical Center. “You start getting less risk when there is decreasing amounts of exposure. It is worrisome, and they are taking it seriously.”
The resident was admitted to Northwestern Memorial on April 3 after being encouraged by fellow workers at Children’s to seek medical attention, sources close to the investigation said. She was kept in isolation until her diagnosis was confirmed Tuesday and was discharged Wednesday, the sources said.
Northwestern Memorial called the health department Monday after her first set of tests came back, and on Tuesday to confirm the diagnosis. The investigation involves the Centers for Disease Control and Prevention and the Chicago, Cook County and Illinois departments of public health.
Medical professionals stressed the rarity of an infected health-care worker exposing TB to patients, adding that staffers are screened each year for the disease. But that doesn’t preclude a person from contracting TB in between screenings.
“It happens rarely to occasionally,” said Dr. Stanford Shulman, chief of infectious diseases at Children’s. “It’s the reason why hospitals, including ours, annually test hospital employees on a routine basis.”
Shulman confirmed that the resident had been tested in the past. But hospital officials would not say when the last one occurred.
The hospital setting could help protect patients from infection because a good ventilation system would prevent the bacterium from lingering, said Dr. Carlos Perez-Velez, a pediatric and adult infectious disease specialist at National Jewish Hospital in Denver.
The infected doctor’s condition is key, and whether she was coughing in the room with patients, Perez-Velez said. If she wasn’t coughing, “I would suspect there would be a very low risk.”
Tribune reporter Judith Graham contributed to this report.
Copyright 2009 Chicago Tribune Company