Tuberculosis Exposures

Potential exists for slips and falls in the radiology area. Ensure floors don t contain slip hazards such as water, blood, vomit, or excreta. Keep aisles and passageways clear and in good repair with no obstruction across or in the aisles. Provide floor plugs for equipment to prevent the need for placing cords across pathways. Report and clean all spills immediately. Correctly maintain floors by using nonskid waxes. 

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A thorough history and examination is important to determine the cause of phlyctenulosis. Inspect the lid margins for signs of staphylococcal blepharitis and question the patient regarding recent infections or tuberculosis exposure. If there is reason to suspect tuberculosis or if no other cause can be found, a tuberculin skin test may be indicated. If diarrhea or gastrointestinal distress is present, consider a stool examination for nematodes. 

Pulmonary History. Is there a prior history of chest trauma, hay fever, asthma, pneumonia, tuberculosis, exposure to tuberculosis, recurrent bronchitis, chronic cough or sputum production, or shortness of breath on exertion ... 

During the medical history checkup, the clinicians usually ask the patient about any previous tuberculosis exposure, infection, or disease (CDC, 2014). The clinicians have to take into consideration the demographic factors, such as ethnicity or racial group, age, country of origin, and occupation (Yetman et al., 2010). These factors could determine the possible risk and severity of the disease (CDC, 2014). Furthermore, clinicians have to define the current medical condition of the patient as that could increase the risk of tuberculosis infection, especially if the patient has a weak immune system due to HIV infection or diabetes (Yetman et al. 2010). 

OSHA can issue citations to employers as a result of exposure or potential exposnre to the exhaled air of a suspected or confirmed case of tuberculosis. Exposure can occnr during a high-hazard procedure performed on an individual with suspected or confirmed tnberculosis. OSHA can issne citations under the respirator standard (29 CFR 1910.134) when anployers fail to provide respirators and fit testing to potentially exposed employees. 

This Tuberculosis Exposure Control Plan applies to aU areas of this practice where exposure to pulmonary or laryngeal TB may occur. It is intended to prevent transmission of pulmonary Mycobacterium tuberculosis (TB) from infected individuals to susceptible hosts. All employees must comply with this plan. TB precautions are not necessary if the patient is on anti-TB medications (and compliant) and has no symptoms such as coughing, night sweats, weight loss, and fever. Person(s) responsible for this plan are listed as follows ... 

Long exposure to Si02 dust can result in fibrosis of the lung or silicosis which may eventuate in pulmonary hypertension and cor pulmonale. Susceptibility to tuberculosis is enhanced. The tolerance level for cryst forms of Si02 is calculated from the formula 250/(%SiO2 +5), and for amorph forms the tolerance level is 20 millions of particles/cu ft of air... 

Compare the risk for active tuberculosis disease among patients based on their age, immune status, place of birth, and time since exposure to an active case. 

Purified protein derivative (PPD) Material used in the tuberculin skin test, the most common test for exposure to Mycobacterium tuberculosis. 

In rural regions with maximal pesticide exposure, children more often suffer the following illnesses before the age of 14 [A109] iron-deficit anemias (10 times more often in Turkmenia, 4 times in Armenia, 2.5 times in Azerbaijan, 2 times in Uzbekistan, and 1.4 times in Moldavia) active tuberculosis (2 times in Moldavia, 2.3 times in Kirgizia, 1.6 times in Armenia and Azerbaijan) viral hepatitis (23.7 times in Turkmenia, 2.4 times in Armenia, 2 times in Azerbaijan, 1.2 times in Kirgizia) and acute upper respiratory tract infections (21 times in Turkmenia, 1.4 times in Kirgizia). 

Same as isoniazid sensitive high probability of exposure to isoniazid-resistant tuberculosis... 

Cigarette smoking is responsible for about 80% of lung cancer cases. Other risk factors include exposure to respiratory carcinogens (e.g., asbestos, benzene), genetic risk factors, and history of other lung diseases (e.g., tuberculosis, pulmonary fibrosis). 

A second form of delayed-type hypersensitivity response is similar to that of contact dermatitis in that macrophages are the primary effector cells responsible for stimulating CD4+ T cells however, this response is not necessarily localized to the epidermis. A classical example of this type of response is demonstrated by the tuberculin diagnostic tests. To determine if an individual has been exposed to tuberculosis, a small amount of fluid from tubercle bacilli cultures is injected subcutaneously. The development of induration after 48 h at the site of injection is diagnostic of prior exposure. 

Some studies of survivors of massive chlorine exposures have shown either persistent obstructive or restrictive deficits, but pre-exposure data on these patients were not available. Persistent respiratory symptoms, bronchial obstruction, and bronchial hyperresponsiveness were observed in 82%, 23%, and 41 % of chronically exposed pulp mill workers, respectively, 18-24 months after cessation of exposure." In most cases it is not known whether prolonged symptoms after chlorine exposure are due to aggravation of preexisting conditions such as tuberculosis, asthma, chronic obstructive pulmonary disease, or heart disease." "... 

The progression of symptoms may continue after dust exposure ceases. Although there may be a factor of individual susceptibility to a given exposure to silica dust, the risk of onset and the rate of progression of the pulmonary lesion are clearly related to the character of the exposure (dust concentration and duration). The disease tends to occur after an exposure measured in years rather than in months. It is generally accepted that silicosis predisposes to active tuberculosis and that the combined disease tends to be more rapidly progressive than uncomplicated silicosis. 

The emergence of microbial antibiotic drug resistance was speeded by the indiscriminate use of antibiotics in humans and livestock. Exposure to very low concentrations of antibiotic in meat or milk may have provided a path whereby human pathogens could eventually evolve high-level antibiotic drug resistance. Recently some strains of enterococcus and tuberculosis have developed resistance to all known antibiotic drugs. Inappropriate use of antibiotics is very common, and it accelerates the development of resistance in pathogens. 

Nakamura,53 in a 1956 paper, reported working conditions in a Japanese mustard-gas factory operated secretly in Hiroshima from 1930 to 1945. Workers alternately worked 1 h in gas production and 2 h in a gas-free environment over a 10-h workday. They wore gasmasks and complete protective clothing, including rubber boots, and were often rotated. Nevertheless, many workers showed a darkening of skin some developed ulcers, diarrhea, and jaundice and later coughed blood and developed tuberculosis. The concentration of mustard gas may have reached 50-70 mg/m, as determined by bioassay. The bioassay involved exposure of unprotected birds in the work areas that resul-... 

Beebe, in a later study mainly on cancer, included some data on tuberculosis. These data (Table 4-5), although suggestive of a residual effect from mustard-gas exposures, were not statistically significant. 

Single exposures, even if severe, as in military service, are not associated with statistically verifiable increases in mortality from tuberculosis and cancer but repeated small exposures, such as occur in industrial operations, do increase cancer deaths significantly. 

The committee examined other diseases that might have been Increased by exposure to CS. Most remarkable were the data on new tuberculosis cases for the year after the riots the rate had Increased for all Londonderry districts except the Bogslde, where the riots had occurred. 

Little Is known about possible long-term effects of CS Inhalation. This is due In part to the fact that short-term experiments with experimental animals, carried out for from several days to a month and using much higher (In some cases, nearly lethal) concentrations of CS, showed that ocular, respiratory, and cutaneous alte-. rations were mild and readily reversible, whereas necropsy findings failed to reveal any evidence of systemic alterations. Retrospective studies performed by the Hlmsworth committee at the request of the British Parliament after the extensive use of CS in Northern Ireland showed that no adverse effects of CS use were observed, with respect to eye burns, residual respiratory tract injury, Increased death rate in the elderly, exacerbations of mental Illness, increased Incidence of strokes or heart attacks, or incidence of tuberculosis. At exposure concentrations reported by the Hlmsworth committee (about 90 mg-min/m ), no persistent or notably adverse health effects were observed. 

Firefighters, in the normal course of their duties, may find themselves exposed to infectious/communicable diseases including hepatitis, meningitis, HIV, and tuberculosis. Potentially infectious persons may have no specific signs, symptoms, or complaints, and they may have no awareness of their potential to transmit their disease to others. Therefore, firefighters must take preventative and protective measures with each and every person to whom they respond to prevent or reduce the risk of direct exposure to communicable diseases. 

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