Human Mycobacterium bovis Infection and Bovine Tuberculosis Outbreak
Although epidemiologic evidence presented for patient 1 is not irrefutable, we conclude that both cases are part of a cluster that is epidemiologically and genotypically confirmed. The initial TST result was negative in both of these cases, likely due to cutaneous anergy (patient 1) and administration too soon after exposure (patient 2). Initial negative skin test results made diagnosis problematic for healthcare providers.
The confirmation of a hunter's acquiring cutaneous M. bovis from an infected deer supports the need for public health precautions. First, hunters should wear heavy latex or rubber gloves while field dressing deer. Second, hunter education was important in the second case because the hunter recognized the deer as infected and specifically mentioned his exposure each time he sought medical treatment. Third, efforts to raise the index of suspicion of the medical community regarding cutaneous and other occupational or recreational exposures to TB continues to be important, so that appropriate diagnoses can be made. Finally, in both cases, the initially negative TST result complicated the diagnostic efforts. It is an ongoing challenge to ensure that providers appropriately apply and interpret the TST.
Although epidemiologic evidence presented for patient 1 is not irrefutable, we conclude that both cases are part of a cluster that is epidemiologically and genotypically confirmed. The initial TST result was negative in both of these cases, likely due to cutaneous anergy (patient 1) and administration too soon after exposure (patient 2). Initial negative skin test results made diagnosis problematic for healthcare providers.
The confirmation of a hunter's acquiring cutaneous M. bovis from an infected deer supports the need for public health precautions. First, hunters should wear heavy latex or rubber gloves while field dressing deer. Second, hunter education was important in the second case because the hunter recognized the deer as infected and specifically mentioned his exposure each time he sought medical treatment. Third, efforts to raise the index of suspicion of the medical community regarding cutaneous and other occupational or recreational exposures to TB continues to be important, so that appropriate diagnoses can be made. Finally, in both cases, the initially negative TST result complicated the diagnostic efforts. It is an ongoing challenge to ensure that providers appropriately apply and interpret the TST.
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