174916 Nasopharyngeal Tuberculosis: Characterization of Transmissibility in a College Classroom Setting

Wednesday, October 29, 2008

Catherine Moria Kroll, MPH , Bureau of Epidemiology, Florida Department of Health, Tallahassee, FL
Rebecca D'Alessio, BSN , Leon County Health Department, Florida Department of Health, Tallahassee, FL
Janyce Kibler, BSN , Leon County Health Department, Florida Department of Health, Tallahassee, FL
Marjorie Emery Kirsch, MD , Leon County Health Department, Florida Department of Health, Tallahassee, FL
Background:Nasopharyngeal tuberculosis is an unusual presentation of tuberculosis disease that is usually pulmonary. Due to its rare presentation, the transmissibility of nasopharyngeal tuberculosis is not well characterized. This investigation sought to identify contacts of a 28 year old foreign born female college student with a six month history of misdiagnosed nasophayngeal tuberculosis to determine if spread occurred in the months prior to proper diagnosis.

Methods: A contact investigation was initiated. Due to the student's daily routine, a small circle of contacts was unable to be established. The smallest circle identified was 4 classes with a total of 69 students with which the ill student had contact an average of 3-4 hours each week. Contacts were offered tuberculosis education and a single baseline PPD test that was read ~48 hours later. Demographics and a risk factor panel were collected from those tested.

Results: Sixty-nine people were identified at risk. All were offered PPD testing through the county health department, however only 18 people chose to have baseline testing. One contact tested positive. This individual had significant travel history to countries where tuberculosis is endemic.

Conclusions: In this setting, it does not appear that nasopharyngeal tuberculosis was easily transmitted. The one positive contact had potential exposure from travel. The investigation was limited by both the lack of a small circle of close contacts and few students wishing to be tested. Follow up testing three months from the last exposure will be offered to 18 contacts that had baseline testing.

Learning Objectives:
Learning Objectives Participants will be able to: 1. Describe the clinical presentation of nasopharyngeal tuberculosis. 2. Describe the challenges associated with identification of contacts to an individual with tuberculosis in a college setting. 3. Discuss the transmissibility of nasopharyngeal tuberculosis.

Keywords: Tuberculosis, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have completed course work related to content, lead the epidemiologic contact investigation, and did extensive literature review of topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.