Occupational hazard

Today, we had a mortality discussion on a very sad incidence of a young staff nurse who recently died of tuberculosis.

She was a 23 years old nurse, who presented with one week history of generalized headache. A CT brain initially done was reported as normal.

On further questioning, she gave history of on and off cough for the last two years, started when she was still a student nurse. She also had history of neck swelling with abscess formation. Non of her family members had TB before. She was previously investigated for tuberculosis, but all investigations were apparently normal or non-conclusive.

On the recent admission, her CXR showed some patchy opacities over the left lower zone, with some small cavitations on 'closer' look.

However, her condition deteriorated and the CT brain repeated one week later showed an obstructive hydrocephalus with some hypodense lesion over the left thalamus region.

This was when her sputum later found to be positive for AFB (Acid fast bacilli).

She was thus referred here for emergency EVD.

MRI done few days later clearly showed a well-defined tuberculoma.

Unfortunately, she died ten days later post-op.

It really saddened us that she died in the course of her duty, as the doctors failed to diagnose her as having TB for the past two years, even though she was symptomatic.

Part of the reason, probably because of her atypical CXR and failure to demonstrate a positive sputum.

This come to question on, how save is our working environment nowadays. Just wonder how many percent of us are affected by occupational hazard?