In New York, a nurse with tuberculosis prompts a search for patients

Marc Santora:

A New York City maternity-ward nurse who had infectious tuberculosis exposed as many as 1,500 patients to the disease over two months in 2003, and most likely infected at least four infants, according to a joint investigation by the city's health department and the Centers for Disease Control and Prevention.

More than 1,000 of the patients the nurse came in contact with could not be found, the C.D.C said.

It is not clear whether any of them contracted the disease, but city health officials say they have all the patients' names and are watching TB registries to see if they appear. The C.D.C. says it believes that transmission was limited.

So far, the only patients known to have been infected are the four infants, who were treated and are now healthy, city health officials said. So is the nurse, whose identity was not revealed.

While the agency declined to name the hospital, health officials confirmed that it was the Bronx-Lebanon Hospital Center.

Dr. Kenneth G. Castro, director of the Division of Tuberculosis Elimination at the C.D.C., said New York was fortunate to have a health department with an active tuberculosis-control program, because if the infection of the four infants had not been detected, the number of those who caught the disease could have grown exponentially.

Still, the case underscores the difficulty of providing appropriate follow-up care for patients exposed to TB in hospitals and other health-care settings.

Infectious tuberculosis can be treated with an aggressive and extensive drug treatment regimen, but it is essential that the regimen be followed precisely and the disease diagnosed early.

The case also highlights a challenge that increasingly worries public-health officials: screening and treating foreign-born health-care workers for tuberculosis.

The New York nurse was aware she had had latent tuberculosis for 11 years, yet declined treatment. Latent TB is not infectious, but the C.D.C. recommends that treatment be seriously considered to ensure that the illness does not progress.

The reason the nurse gave for refusing treatment, according to the C.D.C., was that many adults in the Philippines - where she had lived and received training and where tuberculosis is rampant - test positive for latent TB and do not get treatment.

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