The clinical case of a physician specialized in microbiology is presented, with many years of experience, who when performing a microbiogram by the distal method is accidentally inoculated with a glaze catheter derived from a pure strain of Mycobacterium tuberculosis 960;
At the time of inoculation he immediately treats the wound (washed with water and soap), later complaining to the Occupational Risk Service (SPRL) where the accident is recorded.
The SPRL reviews the medical-laboral history of the injured worker and it is observed as data of interest that has a previous positive Mantoux; requests laboratory tests and serology for HCV, HIV and antituberculosis drugs.
At three weeks, an erythematous papule, slightly painful to pressure, growing up to 1.5-2 cm in size, without axillary lymphadenopathy, or general symptoms, appears at the site of inoculation.
(Imagen 3)
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Image 3.
Biopsy of the lesion
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When observing the worker that the injury does not improve, she informally consults the Plastic Surgery Service, from this Service a biopsy and excision of the lesion is requested.
The pathological results were granulomatous dermatitis with occasional necrosis, highly suggestive of tuberculous dermatitis.
(Imagen 4)
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Image 4.
Pathology: granulomatous dermatitis suggestive of tuberculous dermatitis.
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Microbiological study revealed two acid-alcohol resistant bacilli, and when cultured in BEC MGIT 960, growth of Mycobacterium tuberculosis was confirmed.
Subsequently, both isolates (from source and injured worker) were studied by MIRU (Mycobacterial interspersed repetitive units) confirming the identity of both strains.
(Imagen 5)
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Image 5.
Microbiological Study
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The diagnosis of Cutaneous Tuberculosis was confirmed and the patient was referred to the Internal Medicine Department, where after being evaluated, she started treatment with continuous anti-tamide at 300 mg rifampicin plus isoniazid 600 mg and 1500 mg.
This service also monitors the patient with monthly blood tests in which no changes are detected, good tolerance to medication is observed, and is discharged 7 months after the beginning of treatment.
SPRL communicates occupational disease according to RD 1299/2006 of November 10, which approves the framework of occupational diseases in the Social Security system and establishes criteria for its notification and registration.
