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4:00AM Thursday Sep 25, 2008
By Craig Borley Hundreds of hospital staff and up to 20 patients are being tracked down
and tested for an aggressive super form of Tuberculosis, after a highly
contagious patient was left undiagnosed for weeks in Auckland City Hospital.
Testing had only just begun yesterday and results were not yet
available, but the hospital confirmed that none of the other patients
exposed to the highly unusual strain of tuberculosis had died. The female patient at the centre of the scare was initially diagnosed as
having a respiratory illness. She died several weeks ago after a stay of
many weeks in the hospital. But her illness was actually an extremely rare, aggressive and
contagious form of TB, the Auckland District Health Board confirmed
yesterday. That diagnosis was not made until tests were done on the
patient after her death. Her case was so rare none of the appropriate TB screenings - all of
which were performed by hospital staff - indicated she could have the
disease. No further specialised TB tests were done on the patient. That meant that throughout the patient's stay at the hospital she was
treated as any other non-contagious patient would be - in the same
critical care department other patients were being treated in. Patients with contagious TB should be treated in negative-pressure
isolation rooms away from other patients, and staff treating them should
be issued with special masks. But normal treatment protocols include none of that, instead demanding
hand-washing, staff wearing standard masks if patients are coughing and
gloves for dealing with patients' fluids. The infected woman's time at the hospital also included her being moved
to several different departments, bringing her into contact of eight
hours or more with more than 200 staff - who are now being tested. Of those staff, it is thought up to 16 were medical students, exposed to
the patient while training at the hospital. Auckland District Health Board chief medical officer David Sage told the
Herald yesterday it was possible a handful of those exposed to the
patient would have contracted TB. Those people did not need to panic, he said. They were not at immediate
risk of developing symptoms of TB as the disease took a long time to
become established, and those around them were not at risk of infection
because TB was contagious only when it reached an advanced stage. If infected people were found, they would be treated by a course of
several antibiotics taken over several months, he said. Dr Sage yesterday defended the hospital's attempts at diagnosing the
patient. Because none of the screenings had indicated TB as a
possibility, no specialised testing had been deemed necessary. That
decision was not a mistake, he said. "We would do exactly the same next time. We wouldn't change our
procedures at all." Only through a separate testing process for another TB case did the
patient's name come up. By that time she was dead, and laboratory tests
confirmed she had been infected by the disease, he said. Tuberculosis was always "high on your list of suspicions" when a patient
presented with respiratory illness, Dr Sage said. "But this form was so unusual, it wasn't diagnosed." KILLER BACTERIA
* Tuberculosis is caused by bacteria.
* Usually infecting the lungs, it can also infect many other parts of
the body.
* Typical symptoms include a constant blood-tinged cough, and fever.
* It is thought TB kills well over one million people worldwide each year.
* Most of those deaths are in developing countries. NEW ZEALAND CASES
* There were 290 TB cases in New Zealand last year.
* The number of reported cases fluctuates yearly; last year's figure was
the lowest in 20 years. The highest number of cases was 446.
* There were 54 reported TB cases in the Auckland District Health
Board's area last year.
* Between two and eight people die of the disease each year in the
Auckland DHB's catchment.
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