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Journal of Clinical Microbiology, June 2002, p. 2278-2281, Vol. 40, No. 6
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.6.2278-2281.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Exposure of Laboratory Workers to Francisella tularensis despite a Bioterrorism Procedure

Daniel S. Shapiro1,2,3* and Donald R. Schwartz2

Department of Pathology and Laboratory Medicine, Boston University School of Medicine,1 Clinical Microbiology and Molecular Diagnostics Laboratory, Boston Medical Center,2 Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts3

Received 10 January 2002/ Returned for modification 12 February 2002/ Accepted 28 March 2002

A rapidly fatal case of pulmonary tularemia in a 43-year-old man who was transferred to a tertiary care facility is presented. The microbiology laboratory and autopsy services were not notified of the clinical suspicion of tularemia by the service caring for the patient. Despite having a laboratory bioterrorism procedure in place and adhering to established laboratory protocol, 12 microbiology laboratory employees were exposed to Francisella tularensis and the identification of the organism was delayed due to lack of notification of the laboratory of the clinical suspicion of tularemia. A total of 11 microbiology employees and two persons involved in performing the patient's autopsy received prophylactic doxycycline due to concerns of transmission. None of them developed signs or symptoms of tularemia. One microbiology laboratory employee was pregnant and declined prophylactic antibiotics. As a result of this event, the microbiology laboratory has incorporated flow charts directly into the bench procedures for several highly infectious agents that may be agents of bioterrorism. This should permit more rapid recognition of an isolate for referral to a Level B laboratory for definitive identification and should improve laboratory safety.

* Corresponding author. Mailing address: Clinical Microbiology and Molecular Diagnostics Laboratory, Boston Medical Center H-3600, 88 East Newton St., Boston, MA 02118. Phone: (617) 638-8705. Fax: (617) 638-4556. E-mail: dshapiro{at}bu.edu.

Journal of Clinical Microbiology, June 2002, p. 2278-2281, Vol. 40, No. 6
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.6.2278-2281.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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