YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==TUBERCULOSIS AND ULTRAVIOLET LIGHT== 11 AUTHOR Minor JR TITLE Tuberculosis: re-emergence of an old killer SOURCE ASHP Annual Meeting; VOL 52 ISS Jun 1995, PPI-17, (REF ) ABSTRACT IPA COPYRIGHT: ASHP This session will provide an introductory overview of the re-emergence of Mycobacterium tuberculosis as a major opportunistic infection, its clinical features, and current management guidelines. Public health issues relating to transmission of tuberculosis and emergence of multidrug-resistant tuberculosis will also be discussed. Learning objectives: 1. Describe the clinical, laboratory and immunological features of tuberculosis. 2. Describe factors contributing to the increase in multidrug-resistant tuberculosis. 3. List containment methods for controlling the transmission of tuberculosis in health care institutional settings. Self-assessment questions: 1. HIV is considered a major risk factor for the progression of latent M. tuberculosis infection to active TB. 2. Progressive HIV-induced CD8+ T-lymphocyte depletion leads to a defective immunological response to M. tuberculosis and to an increased risk of active disease. 3. Use of negative pressure isolation rooms, ultraviolet germicidal irradiation, and high efficiency particulate air filtration are selected methods of preventing TB transmission within institutional settings. Answers 1. (T); 2. (F); 3. (T). 12 AUTHOR Hellman SL AUTHOR Gram MC TITLE The Resurgence of Tuberculosis. Risk in Health Care Settings SOURCE AAOHN Journal, Vol. 41, No. 2, pages 66-72, 13 references, 1993 ABSTRACT The risk of tuberculosis in hospitals and other settings that provide care to clients was discussed. Approximately 15 million persons in the United States are infected with Mycobacterium-tuberculosis. New case rates declined until 1984, when annual rates minimally decreased or increased, likely as a result of the influx of persons from Asia, the human immunodeficiency virus epidemic, and the emergence of antibiotic resistant strains of tuberculosis. Transmission of infection from person to person by droplet nuclei occurs indoors, being limited to confined spaces. The risk of transmission is greater if the source case has a positive sputum smear for acidfast bacilli, cavitary disease, the presence of a cough, or laryngeal involvement. The risk is lowered by a large dilution of air, good ventilation, and greater ultraviolet irradiation. Isoniazid preventive therapy is usually recommended for persons with recent infection but no active disease. Hospitalized persons with unrecognized pulmonary tuberculosis pose a definite risk of infection for hospital personnel and other hospitalized persons. The role of the occupational health nurse is vital for educating health care facility employees about the occupational hazards of infection. 1 AUTHOR Boudreau Y AUTHOR Decker JA AUTHOR Burton N TITLE Health Hazard Evaluation Report No. HETA-91-0187-2544, Jackson Memorial Hospital, Miami, Florida SOURCE Hazard Evaluations and Technical Assistance Branch, NIOSH, U.S. Department of Health and Human Services, Cincinnati, Ohio, Report No. HETA-91-0187-2544, 58 pages, 72 references, 1995 ABSTRACT In response to a request from an employee, an investigation was begun into possible hazardous working conditions at the Jackson Memorial Hospital (SIC-8062), Miami, Florida. Concern was expressed regarding exposure to tuberculosis hazards, ventilation systems, exposure to aerosolized pentamidine-isethionate (140647) (AP) and to Mycobacterium-tuberculosis, and potential exposure to ultraviolet (UV) irradiation from UV lamps which had been purchased but not activated. Employees who worked on wards with infectious tuberculosis patients had a higher 4 year rate of conversion on the tuberculin skin test than other workers, 14.5% versus 1.4%. Significantly higher rates of TST conversion were noted for exposed workers for 1989, 1990, and 1991, but not for 1992. Nurses had an 18.2% conversion rate and ward clerks, 15.6%. No greater symptom prevalence was found among workers who administered AP treatments. Similarly, their TST conversion was no different from other workers. The ventilation system in the urgent care clinic was found to be inadequate for the isolation of patients. Ultraviolet radiation from installed UV lamps exceeded the NIOSH recommended levels for 8 hour exposures. The authors recommend specific measures which pertain to each of these potential hazards. 14 AUTHOR Jeevan A AUTHOR Gilliam K AUTHOR Heard H AUTHOR Kripke ML TITLE Effects of ultraviolet radiation on the pathogenesis of Mycobacterium lepraemurium infection in mice. SOURCE Exp Dermatol; VOL 1, ISS 3, 1992, P152-60 ABSTRACT The purpose of this study was to determine whether exposing mice to ultraviolet radiation (UVR) would alter the pathogenesis of infection with Mycobacterium lepraemurium (MLM), which causes a chronic, progressive, lethal disease in susceptible mouse strains. BALB/c mice were irradiated on dorsal skin with various doses of UVR from FS40 sunlamps 3 days before infection with MLM in the hind footpad. The course of disease was followed by assessing the number of acid-fast bacteria in the footpad, regional lymph node and spleen, and measuring the size of the lesion at the site of MLM infection at various times after infection. Mice were also tested periodically for a delayed-type hypersensitivity (DTH) response by injecting MLM antigen into the uninfected footpad and measuring footpad swelling 24 hours later. Mice treated with a single high dose of UVR (45 kJ/m2) had significantly more bacteria in the infected footpad, lymph node and spleen than unirradiated control animals. They also had larger lesions at the site of MLM infection and exhibited significant suppression of the DTH response at 3 and 6 months after infection. Injection of mice s.c. in the footpad with MLM 3d after 45 kJ/m2 UVR reduced the median survival time from 391 to 305 d and after i.v. infection from 171 to 139 d. Dose-response studies indicated that exposing mice to 2.3 kJ/m2 of UVR, which is approximately 1 minimal erythemal dose for this strain, suppressed the DTH response by 50% at 3 months after infection.(ABSTRACT TRUNCATED AT 250 WORDS)