Een kind met meningo-encephalitis tuberculosa, door DNA-'fingerprinting' in verband gebracht met een micro-epidemie van tuberculose in Zuid-Limburg

UNLABELLED: MICROEPIDEMIC: In a child fatal tuberculous meningoencephalitis was diagnosed and the Regional Public Health Service Geleen, Limburg, the Netherlands, was notified. Source identification and contact tracing (ring investigation) did not reveal a source of the infection. In a person living in the same village pulmonary tuberculosis had been diagnosed, but there was no evident contact between both patients. When the mycobacteria from all patients with tuberculosis were typed by DNA fingerprinting, both patients belonged to the same cluster, thus identifying the infection source of the meningoencephalitis patient. In the management of the outbreak 950 persons were examined in a contact tracing survey. Of them 35 had recently been infected and four of these had recently acquired pulmonary tuberculosis.

DISCUSSION: Highly infectious patients with tuberculosis are able to infect persons who cannot be found by conventional contact tracing survey as the transmission of tuberculosis is more subject to casual encounters than was hitherto believed. DNA fingerprinting is a very useful method in contact investigation of tuberculosis. In the Netherlands, therefore, the early diagnosis and treatment of symptomatic patients with infectious tuberculosis is more important to stop the transmission of Mycobacterium tuberculosis than the identification and screening of risk groups in the population.