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'NIAY' 1(..f]
ISSN 0382-232X
Rapport hebdomadaire des
maladies au Canada
Canada Diseases
Weekly Report.
of publication:
27 April 1991
Contenu du present numero:
contained In this Issue:
Mycobacteriumshimoidei-Alberta . . . . . . • . . . .
Transmission of Multidrug-Rssistanl Tuberculosis from an HIV-Positive Client
in a Residen~al Substance-Abuse Treatment Faclliiy - United Stales •
Announcement • • • . . • • • • • . • • • • .
Mycobacterium shimofdei -Alberta • • • • . • • • • . • • • • . •
Transmission, par un sujet VIH p<isilif, d'un bacille \lJoorculeux resistant ap!usieurs
medicaments, dans un centre de trailement des toxlcomanies - Etats-unis . •
AniJQ~CB •
The 19 January, J991 issue ofCDWR (1991 ;17:11-12) carried an
article onMycobacterium s/Jimoidei, considered to have been the
first reported isola~? i'! Cam;z.<fa. Sirn;e then, thefoJlowing report was
recewed of an earlier 1solr;lflon ofthe same organism ma<!e ,m the
ProVincial Laboratory ofPublic Health for Northern Alberta.
The patient, an 84~year-old male who was born in Scotland, had
asthma and emphysema and a history of dust exposure. He had
worked as a hard rock miner for 48 years in Wales and in Flin Floll,
Manitoba. He had been a smoker but guit in 1979. The patient had a
history of recurrent infective bronchitis and had been on oral steroids
prior to 19,83. In July 1988 he deyeloped cor pu~OJ?-ale. In January
the followmg year, sputum subnutted to the Provmqal Laboratory
was positive for acid~fast bacilli. His chestX-ray, in addition to
showing hyperll;flation and flattening of the diaphragm, showed
extensive pleural pµlmonary changes, p;rrticularly on the left side,
consistent with previous tuberculosis. Chest computerized
tomography with contrast d.em.onstrated left sµprahilar density,
pleural calcification arid smail caicifications in, the upper portion of
the liver and spleen. From J;muary to April; 1989, M. shimoidei was
isolated from the sputum on 17 separate occasions. The patient died as
a result of his cluonic pulmonary disease.
The organism isolated.was initially thought to be M.
avium-intracellulare, but on ftirther investigation, several discrepant
· biochemical tests and cultural characteristies prompted the laboratory
to do additional studies. The organism grew slowly at 30°, 37° and
42'C; appeared as fairly rough nonpigmented colonie8; consistently
hydrolized Tween 80; was acid phosphatase-positive and
arylsulfatase-negati:ve after 14 days; and was sensitive to ethambufu1.
The National Reference Centre for Tuoerculosis at LCDC in Oitawa
confirmed that the isolate showed biochemical and cultural
characteristics similar to M: shimoldei, type sti;ain ATCC 27962.
M. shimoidei,tHarely isolatedmycobacterh1msp89i~. first
:fili~2~>~~Ith!~;:!~:Si~~~o~~~~ct:,~~l :dar~i~~!::cies
isolation and identification procedures at their disposal, laboiatories
must be increasingly aware of the possibility of isolating rarely seen
but potentially patho genie my cobacterial species.
Health and Welfare
I.I Canada
• •
• • • •
• • • •
• • • •
• • • • • ,
Mel !lo!jrfra!on No. 5670
• • .
Expose de cas
A Case Report
I Secoid Om
Data da publication: 27 avril 199i
Vol. 17·17
Un articleparu dans le numero du 19 janvier 1991 du RHMC
(1991;17:11"12) presentait un rapporfd'isolemeni de
Mycobacterium shimoidei considere comme etant le premier au Canada.
Depuis, le rapport qui suit a etl re~U,' it poite sur un isolement anterieur du
meme microorganisme, rlalise par le Liiboratoire provincial desante
publique du Nord de /'Alberta.
Le patient, un homme de, 84 ans ne en Ecosse, faisait de r asthme et de
l'emP.hys~me et ~v¥t des antecedents d'exposition ~la poussiere. Pendant48
ans, 11 avrut travaille comrne excavateur dans une rrune eri roche dure - d'abord
au pars de Ga,Iles, :puis Flin Flon au Manitqba. Il av(lit e.te un fumeur
jusqu en 1979, avait des antecedents de bronchite infectieuse recurrente et
avrut pris des sreroides par voie orale avant 1983. Enjuillet 1988, il ayait
presente un cm~ur pulmonaire; au mois de janvier sliivant, un echantillon de
crachat ex:pedie au Laboratoire provincial s 'etait revele positif pour des
bacilles ac;:ido-resistants. Outre une distension et un apliltissemen:t du
diapluagme, le clfohe thoracique avaitrriohtre d'importantS changcmients
pleurci-pulmonaires (surtout du cote gauche) compatibles avec une tuberculose
antmeure. Une tomodensitometrie thoracique en contraste avait revere une
densite suprahilaire·gauche, une calcificationpleurale et des petites _
calcifications clans la partie superieure du foie et de Ia rate. :De janvjer avril
1989, M. shimoidei avait ete isole pariir d' e<tpectorations, 17 reprises. Le
malade est mort de bronchopneumopathie chronique.
On a d'abo'rd pense que le micr9organisme isole etait .
M. ·avium-intracellulare, mais une investigation plus paussee a demoritre que
plusi~lirs ~sts biochimiqti.eS et phisie~~ c~acrez:isti~ues de sulture ne
cadi'aient pas. Le laboratorre a done decide de faired ailtres etudes. Le
microorganisme a pousse lentement 30, 37 et 42 °<;:; iI est apparu sous forme
de colonies non pigmentees assez rugueuses; ii a hydrolyse sails exception le
Tween 80; il s'estrevele phosphatase acide positif et ~lsulfatase negatif au
bout de 14 jours; enfin, il a demonire une sensibilire a1 ethambutol. Le Centre
national de reference pour la tuberculose du LLCM, aOttawa, a confirme que
l'isolatpresen~td.es ~aracreristiqUE:\S biochimiques et cuJtutales semblables
celles de M. sh1mmde1, souche .A.TCC 27962.
M. shinwfqei, m_ie espe~e my~obac~~e rarement isolee, ~t apparue
pour la premiere foIS en 197a , mrus n' a ete reconnue comme etant une
e~ece distincte ~u'en 1982 >.Les methodes )raditionnelles etradiometriques
d'1solement et d'1dentification etantplus sensible11, le8 labOratoires doivi;lnt
savoir qu 'il est maintenant possible d'isoler des especes mycobacteriennes que
I' on observe rarement, mais qui peuvent etre pathogenes.
I Courler do la dew!llme clauo - Ermglrfrenent n'
Santa et Bisn~tre social
1. Tsukamura M, Shimoide H, Schaefer WB. A possible pathogen
of group IIhnyi;obacteria. J Gen Microbiol 1975;88:377-80.
2. 'l'sukamuraM.Mycobacterimn shimoidei sp.1wv., nom. rev., a
lung pathogen. Int J Syst Bacteriol 1982;32:67-9.
Source: SA Chomyc, BSc, RT, Provincial Laboratory ofPublic
Health/or Northern Alberta, Ed!nDnton; JH Pearson,
MD, Queen Elizabeth II Hospital, Grande Prairie,
Alberta; D Helbecque, National Reference Centre for
Tuberculosis, LCDC, Ottawa, Ontario.
1. Tsukamura M, Shimoide H, Schaefer WB. A vossiblPjathogen of
fouv WW>'cobacteria. J GenMicrobiol 1975;88:3'7:so.
2.sukamura M. Mvcobacterium shimoidei sv. nay,, nom. rev .. a lung
pa/hagen. Int J Syst Bacteriol 1982;32:67-9.
Source : SA Chomyc, BSc, RT, Laboratoire provincial de sante publique
du Nord de l' Alberta, Edmonton; D' JH Pearson, Qu.wi.
Elizabeth IT Hospital. Grande Prairie (Alberta),· D Helbecque,
Centre national de reference pour la tuberculose, I.LCM, Ottawa
lnternatlonal Notes
Notes lnternatlonales
In November 1989, aman with ahistory of intravenous
(IV)-drug use first presented to the tuberculosis (TB) clinic of the
Muskegon County (Michigan) Health Department (MCHD), The
patient indicated that he had been .treated for pulmonary TB in
another city, and he produced for clinic staff his labeled
medications, which mcluded isoniazid (INH), rifampin (RIF), and
ethambutol (EMB). The patient also stated rbathe was an!V-drug
user (!VDU) and previou~l_hlid tested positive for human
immunodeficiency virus (.HlV) infection. Sputum specimens for
acid-fast bacilli (AFB) were obtained, and the patient was
maintained on his anti-TB medications. His HIV-antibody status
was confirmed.
The patient was living in a residential substance-abuse treatment
facility 111 Michigan after moving from a large northeastern city.
This treatment facility recruits persons from the northeast who have
a history of IV-drug use and offers them a prescribed rehabilitation
program of 1 year's duration; howev.er, the fl!Cility' ~ attrition rate is
high, and Iio health screening program is in place at the facility.
One week after the initiiil visit, one of the sputum specimens
was reported smear-positive for AFB. A follow-up chest radio graph
of the patient revealed a pulmonary infiltrate with a cavitary lesion.
Three weeks later, .culture ofthe sputum specimen yielded
Mycobacterium tuberculosis resistant to JNH, RIF, and EMB.
Subsequently, the patient's prior medical records arrived at the TB
clinic, coJrlirrning his HIV status and his treatment for TB since
March 1988; these records also indicated thatM. tuberculosis
isolated from his sputum previously had been resistant to INH.
Because the patient could not be properly isolated in the residential
facility, he was transferred to a hospital;
Because of concerns regarding the potential for TB transmission
in the residential facility, the MCHD conducted a TB contact
investigation in the facility. Its rehabilitation program involves
close interaction among clients and staff. Clients are housed in a
two-story building .that contains several large, crowded donnitories
for sleeping. Ventilation is provided by opening windows and
doors, rather thlili through a ~ntral system, and heat is provided by
steam radiators.
Of the 160 clients and staff who were identified as contacts to
the index patient, 146 were tuberculin sk:fu tested with 5 tuberculin
units ofpiirified protein <lerivative {PPD) using the Mantoux
technique. Of the 14 persons not tested, 10 had histories of
tuberculin skin-test positivity, and 4 had left the facility. The skin
tt;sts were read at48 h~urs for 140 of the tested persons (6 residents
did not return forreading). Of tl).e 140 persons, 16 (11 %) had
reactions of~ 5 mm and were considered skin-test positive.
In March 1990, MCHD personnel returned for follow-up skin
testing of 70 persons who were previously skin-test negative and
Were still present in the facility. Of these, 15 (21 %) were positive
(i.e., skin-test converters), 54 (77%) remained negative, and one
(1 %) person had left the facility before having his test read.
Fourteen of those with documented skin-test conversions were
residents of the facility, and one was a staff member.
Chest radio graphs were obtained for all persons with a positive
skin test, including those positive by history alone. Although no
additional cases of clinical TB were identified, the investigation
identified a total of 31 skin-test positive persons and a documented
skin-test conversion rate of 22% (15/69 tested).
En novembre 1989, ui1 homme.ayant fait usage de drogues par voie
endoveineuse se presentea la consultation de tuberculose du Service de
sante du comte de Muskegon, au Michigan (MCHD). TI raconte qu 'il a ere
traite pour la tliberculose pulmonaire et montre des flacons de medicaments
dfiment etiquetees; il s'agit d'isoniazide (INH), de rifompicine (RIF) et
d'ethambutol (EMB). TI ajoute qu'il fait usage de drogues ~arvoie
endoveineuse et qu 'il est infecte par le virus de l 'immunodeficience
huniaine (VIH). On fait un J?Ielevement d'expectorations afin de mettre en
evidence le bacille acidoresIStant; on maintient la chimiotherapie
antitubercufouse. Enfin, sa positivite al'egard du VIH est confirmee.
Le malade, qui vient d 'une grande ville du nord-est du pays, vit alors
dans un centre residentiel de traitement des toxicomanies du Michigan. Cet
etablissement re~it des toxicomanes de la re~ion du nord-est et leur offre
un programme de readaptation d'une duree d une annee; toutefois, le taux
d'abandon est eleve et il n'existe pas de programme de depistage des
maladies dans l'etablissement.
L'un des crachats ayant donne un frottis positif, on demande la
radiographie du thorax ~i montre un infiltrat pulmonaire et une caverne.
Trois semaines plus tare!, la cultrire des expectorations a mis en evidence
Mycobacterium tuberculosis resistant a l 'INH, a Ia RIF et al 'EMB. Le
dossier medical anterieur du malade confirme sa positivire al' egard du
VIH et le fait qu 'il est traire pour une tubei'culose depuis mars 1988; le
dossier indique egalement la resistance al 'INH du M. tuberculosis deja
isole de ses crachats. Ne pouvant etre isole de fa~n satisfaisante au centre
OU il vit, le malade est admis a l'hOpital.
Vu la p9ssibilite de transmission de la tuberculose au centre de
le MCHD effectue un depistage chez les sujets ayant ere en
contact avec le malade. Le programme de reeducation du centre comporte
un fort degre d'interaction entre les clients et le personnel. Les clients sont
loges daris un immeuble a etage, qui compte plusieurs grands dortoirs
encombres. II n 'y a pas de systeme central de ventilation, cette derniere
etant assuree par l' ouvertUre des portes et des fenetres. Les pieces sont
chauffees par des radiateurs a vapeur.
Parmi les 160 clients et membres du personnel qui ant ete en c0ntact
avec le malade; 146 ant une cuti-reaction a 5 uni.tes tuberculine de PPD
(derive proteique purifie) selon la technique intradennique deMantoux.
Parmi les 14 personnes a qui on ne fait pas de cuti-reaction, 10 ont des
antecedents d 'intradermo-reaction positive et 4 ont quitte l'etablissement.
Chez les 140 sujets qui on a fait une cuti-reaction, la lecture en est
effectuee au bout de 48 heures (6 clients ne se sont pas preseiires pour la
lecture). Parmi les 140 sujets presents, 16 (11 %) ont une induration de
~ Smm, consideree comme une reaction positive.
En mars 1990, on repete l'epreuve tuberculinique chez 70 des personnes
qui ant eu une reaction negative et qUi habitertt encore le centre de
desintoxication. Parml ces sujets, 15 (21 %) ant une reaction positive
(virages de la cuti-reaction}, 54 (77%) sont restes negatifs, et une personne
(1 %) a quitte le centre avant la lecture. Quatox:ze des personnes chez qui on
constate un virage de la cu ti-reaction sont des pensionnaires du centre;
l' autre est un membre du personnel.
On radiographie taus les sujets ayant montre une reaction positive a la .
tuberculine et ceux qui ont des antecedents de positivite. Bien qu'aucun
autre cas de tuberculOse evolutive n' ait ere detecte, I' enqilete a pennis de
decouvrir 31 cas de reaction positive a. la tuberculine et un faux de virage
de la cuti-reaction de I' ordre de 22% (15 sur 69 sujets examines).
Editorial Note: Even before the HIV epiWmic, ND Us were
reported to be athigh risk for developing TB . In IVDUs who are
coinfected with HIV and M. tuberculosis, however, the risk of
developing clinica1ly active d~2iase is substantially increased and
may be as high as 7% per year . In several areas, HIV infection
.ffi?.P.4J.IVDUs accounts for much of the HIV-associated increase in
In Muskegon County, a patient with multidrug-resistant TB
infected at least 15 and possibly as man¥. as 31 persons. However,
the number of skin-test converters identified in this investi~ation
may underestimate the true number. Although the HIV-antibody
status of residents of the substance-abuse facility was unknown, the
clients were at high risk for HIV infection; HIV ~related delayed
type hypersensitivity (DTH). wergy ma;v have decreased skin~test
reactivity to PPD tubercUlin( . In addition, nearly half of the clients
who we.re initially skin-test negative were not available for repeat
Federal regulations require tuberculin skin t~tin~ of IVDUs
before they are admitted to treatment programs . Given the
substantial risk for TB and the potential for its :prevention,
substance-abuse programs should perform a skin test and record the
diameter of indutation on each new em:ollee, as well as on persons
who are already emolled but have not been tested. Persons with a
tuberculin skin test of<:: 5 mm induration should be further
evaluated for clinical TB and, if disease is present, treated
according to current guidelines. If clinical disease is ruled out and
exposure to dru~-sensitive M. tuberculosis is assumed, known and
suspected HIV-infected persons, regardless of age, with a
tuberculin reaction of<:: 5 mm should receive 12 months of INH
preventive therapy, unless medically contraindicated; all
HIV-seronegative IVDUf7f1th a reaction of;;:: 10 .mm should
receive 6 months ofINH . All consenting IVDUs and their ffiX
partners should receive counseling and HIV~antibody testing .
Becau~e of~P,arent _PPD aner~y among some asymptomatic
persons with HIV infection, HIV-infected persons should be
evaluated for DTH energy in conjunction with PPD tiiberculin
testing. This recommendation is particularly important for persons
at increased risk for tuberculous infection (e.g., recent contacts of a
person with infectiolll! TB). Companion tesfu!g with 2 DTH skin
test antigens is recommended; rnumps, Candida, and tetanus toxoid
antigeris administered by the Mantoux method are preferred.
Guidelines for anergy testing in HIV-infected persons are being
developed. Anergie HIV-seropositive persons who are known ·
contacts of patients with i:Iif~tiou8 TB should be considered for
preventive therapy once active TB has been ruled out.
The usual approach to managin~_persons recently infected with
M. tube[.fjUlosis IS to administer INH preventive therapy for 6-12
months . In Muskegon County, however, the infected contacts
were pre.sumably infected withorganism.s resistant to INH and RIF.
No ?rug r~gimens haye proven '?ffectiv'? in prev~nting progre~sion
to disease ill perso~ ~ected with multidrug-resIStant TB. This
outbreak 1111;d othe!s 1 hi~hlight the need for alternative preventive
therapy regrmens ill such mlitances.
The findirigs from the investigation in this report underscore the
needs to: 1) immediately isolate. and treat inStitutionalized persons
suspected of haying infeetious TB and rapidly initiate a contact
investigation when the diagnosis of TB is fustconsidered (e.g.,
sputum smell! is positiye for AFB), rather thffifhen it is confirmed
by i<len~fication o~ the or~anisms on cu).ture . ; 2) suspect ..
drug-resIStant TB ill a patient who remains sputum smear-positive
de8pite therapy for >3 months; and 3) develop rapid diagnostic
tests to i~F,tify M. tuberculosis and to perform drug-susceptibility
studies< , Finally, medical information about a patient who is
under a health department's care and who reloeates should be
expeditiously communicated to the health department in the
piitient's new jurisdiction.
. Note de Ia redaction: Avantl'epidemie d'infection au VIH, les
personiles faisant usage de drogues par voie endoveine~W etaient deja
considerees comme etant tres exposees a la tuberculose . Mais chez celles
qui sontinfeetes a la fois par le VIH et par M. tuberculosis, lerisque d'etre
atteint d 'une infection tuberculeuse &yolutive est beaucoup plus ~rand; il
peutmeme s'elever a7% par annee . Dans plusieurs regions, 1 infection
par le VIH chez les con8ommateurs de drogues par voie endoveineuse rend
compte d 'une bonne P!l!t &,~'augmentation du nombre de cas de
tuberculose reliee au VIH ' .
Dans le comte de Muskegon, un malade infecte par un bacille resistant a
plusieurs drogues antibacillaires a transmis I'infection aau moins 15
personnes et peut-Stre meme a31. Toutefois, le nombre de virages de
cuti-reaction constates represente peilt-etre une sous-estimation du nombre
veritable de personnes contaminees. Bien qu'on ne connaisse pas le J:].Ombre
de clients du centre de desintoxication qui etaient VIH positifs, on sait que
de telles personnes sont tres exposees aI'infection par le VIH; i1 est :possible
qu'une diminution de leur caP.a:cite de reagir ala tuberculine PP~..s01t due a
une anergie de l'hypersensib1lite retll!dee, d6terminee par le YIH J}. De plus,
pres de lamoitie des clients chez qui le premier test tuberculinique etait
negatifn'ont pas participe au second test.
Seion les reglements du gouvernement federal, toute personne faisant
usage de drogues par voie endoveineuse doit irubir une cuti-reaction a 111»
tuberculine avant d'etre admise dans un programme de_ desintoxication .
Vu le risque eleve de trlir)smission de la tuberculose et la possibilite de
prevenir cette transmission, les responsables de tels progriurunes sont tenus
de faire une epreuve ala tuberculine chez chaque nouveau client et inscrire
le diametre de l'induration ason dossier; ils ferontdememe chezleurs
clients actuels qui n' ont pas deja ere testes. Les sujets chez qui la
cuti-reaction produit une induration de;;:: Smm passeront d'autres examens a ·
la recherche d'une tuberculose evolutive et, le cas echeant, seront traites
selon lei tnethodes actuellement en usage. Dans le. t:~ d'urie personne
inf~ree ;par ~e VIH, .connue OU suspecte, qui·~ eu un,e .re!Wtion posi~i'!'~ ala
tubercuhne (mdurat10n de~ Smm) et chez qm on a elimine la poss1bilite de
tuberclilose evolutive, si on a des raisons de croire qu'elle a pu etre
e:xposees aM. tuberculosis sensible aux medfoaments, il faut administrer,
queJ que soit son ~ge •. un~ c~oprophylaxi~ al 'iso~azide pendant 12
moIS, sauf contre-md1cation medicale. Le SUJet qui_ fru.t usage de dro2~s par
voie endoveineuse, mais qui est VIH negatif, prendra de l'jsoniazide'VI
pendant 6 mois s'il a une cud-reaction de~ lOmm. Entin, il faut c~mseiller
tous Jes usagers de drogues injectables qui le desirent,'ainsi que leuts
partenaires sexuels, et leur offrir le depistage des anticorps contre le VIH(S).
Acause de ce qui semble etre une' anergie tuberculiriique dam cer:tains
cas d'infection asymptomatique par le VIH, on devrait, chez les sujets VIH
positifs, en plus de la cuti-rea:ction ala tuberculine PPD, rechercher
l' anergie del 'hypersensibilire retardee. Cette recommandation est
particulierement importante dans le cas des personnes qui sont exposees a
!'infection tuberculeuse (p. ex. celle qui a eu receminent des contacts avec
une personne atteinte de tuberculose contagieuse). On recommande acette
fin des intradermo-reactions a2 des anti~enes intervenant habituellement
d_ans !'hypersensib~ite retardee (de prefefence o~eillons1 Candi.da, ~atoxine
tetaruque). On procede actuellement lll'elaboration de lignes drrectnces
pour ~e depistag~ ~}' :mergie chez l'?s :personne~ inl;ectees par le VIH. <;::fiez
un SUJet seropos1tif a 1 egard de celut-c1 chez qu1 on demontre une anerg1e,
et qui a ete en contact avec une personne atteinte de tuberculose
contagieuse, il faut penser aentreprendre un traitement preveiitif, une fois
meme qu' on aura elimine la poss1bilite d 'une tUberculose evolutive •
. E!l general, le.slijet :ece~ent infecre par M. tu~er.culosis est mis sous
chimioprophylax1e al '1soml!Zlde pendant 6 a12 mo!Sl~J. Dans le collite de
Muskegon, toutefois, les personnes ayant eu des contactS avec le CaS de
reference orit vraisemblablement ete infectees par des microbes resistants
l'INH et ala RIF. Or il n' a pas 6te demontre qu 'une prophylaxie, quelle
qu' elle soit, empeche I' apparition de la maladie chez les personnes infecrees
par un bacille tuberculeux resistant alQiusieurs drogues arttibacillaires. La
presente epidelJ}ie, COmnl'? d: autres · , ~ontrentqu 'il y a lieu de chercher
de nouvelles methodes chimioprophylactiques dans ce genre de cils.
Les resultats de l' enquete dont il est fajt etat dans ce rapport demontrent
[)~en la necessite: 1) d'isoler et de traiter inunediatement le pensionnaire de
ce genre de centres chez qui I' on soup~onne une tuberculose (:Ontagieuse, et
d 'instituer rapidement le depistage chez les sujets avec qui il est entre en
contact des qu' on envisage un diagnostic cje .tuberculose-(p. ex,. le frottis met
en evi~~ le.bacille acidoresista:nt), sanii attendre la conlirrnation-par
culture j 2) de sou~nner la presence d'un bacille tuberculeux resistant
aux medicaments antibacillaires lorsque l' examen des frottis de crachats
reste positif malgre uii traitement qui <lure depuis >3 mois; 3) de mettre au
point des me tho des de rec6nna!tre rapid~fi)l M. tuberculosis et de
de~erminey ~a ser;sibili~ aUx. ~6?ic~ents
. E~ lorsqu 'un patient
quttte la region, 1 autonte sarutarre dolt commuruquer sans retard son
dossier medical aux services de sante de la region ou il va s'install~r.
1. Reichman LB, Felton CP, Edsall JR. Drug dependence, a ·
possible new risk factor for tuberculosis disease. Arch Intern
Med 1979;139:337-9.
2. Sel~ PA, Hartel D, Lewis VA, et al. A prospective study of
the risk of tuberculosis among intravenous drug users with
human immunodeficiency virus infection. N EnglJ Med·
3. CDC. Tuberculosis and acquired immunodeficiency syndrome
- New York City. MMWR 1987;36:785-90,195.
4. Sunderain G, McDonald RJ, Maniatis T, et al. Tuberculosis as
a ma.nifestation ofthe acquired immunodeficiency syndrome
(AIDS). JAMA 1986;245:362-6.
5. Robert CF, Hirsche! B, RochatT, et al. Tuberculin skin
reactivity in HIV-seropositive intr(IVenous drug addicts.
N Engl J Med 1989;321:1268. Letter.
6. Food and Drug Administ:i:ation/Na.tional Institute on Drug
Abuse. Methadone in maintenance and detoxification; joint
prop,osed revision of conditions for use; proposed rule. Federal
Register 1987;52:~7046-61. (21 CFR Part 291).
7. CDC. Tuberculosis and hu~ immunodeficiency virus
infection: recommendations of the Advisory Committeefor the
Elimination o/Tuberculosis. MMWR 1989;38:236-8,243-50.
8. CDC .. Public Health Service guidelines for counseling and
anlibody testing to prevent HIV infection and AIDS. MMWR
9. American Thoracic Society/CDC. Treatment oftuberculosis
and tuberculosis infection in adults and children. AM Rev
Respir Dis 1986;134:355-63.
10. CDC. Nosocomial transmission ofmultidrug-resistantTB to
health-care workers and HIV-infected patients in an urban
hospital -Florida. MMWR 1990;39:718-22.
11. CDC. Guidelines for preventin~ the transmission of
tuberculosis in health-care settmgs, wiih special focus on
HIV-related issues. MMWR 1990;39(No.RR-17).
12. Brisson~Noel A, Lecossier D, NassifX, et al. Rapid diaqnosis
of tuberculosis by amplification ofmycobacterial DNA m
clinical samples. Lancet 1989;2:1069-71.
Source: Morbidity and Mortality Weekly Report, Vol40,No 8,
1991. .
1. Reichman LB, Felton CP, Edsall JR. Drug dc.Pendence. a oossible new risk
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2. Selwyn PA, Hartel D, Lewis VA, et coll. A Dr08Jlective studv of the risk of
tuberculosis among in/ravenous drug users with human immunodeficiency
virus infection. N Engl J Med 1989;320:545-50.
3. CDC. D1berculosis and acquired immU!IQde,ficiency zyndrome - New York
Cit)!. MMWR 1987;36:785-90,795.
4. Sundera:m G, McDonald RJ, Maniatis T, et coll. Tuberculosis as a
manifestation o/the acquired immunodeficiency eyndrome (AWSI. JAMA
5. Robert CF, Hirsche! B, Rochat T, et coll. Tuberculin skin reactiviet in
HIV-serovositive intravenous drug mldic(S. N Engl J Med 1989;321: 1268.
6. Food and Drug Administration/National Institute on Drug Abuse.
Methadone in maintenance and deto;rification. joint vrQPOSed revision of
conciitionsfor use· proposed rule. Federal Register 198'7;52:37046-61. (21
CFR Part291).
7. CDC. Tuberculosis and hwnan immunodeficiency virus ir(ection,·
recmnmerulfltignsofthe Adyjsor:iCommittee for the Elimination of
Tuberculosis. MMWR 1989;38:236-8,243-50.
8. CDC. Public Health Service guidelinesfou;ounwling andantibocy testi"n.g
to prevent HIV infection. and AWS. MMWR 1987;36:509-15. .
9. American Thoracic Society/CDC. Treatment af.11J.herculosis and
tuberculosis infection. in adult£ and children. AM Rev Respir Dis
10. CDC. Nosocomial transmission q.fmultidrUi-resistant TB to heaftb-care
workers and HW-ir!fected uatients in an urban hospital - Florida. MMWR
11. CDC. Guidelines for Preventing the transmission qftuberculosjs in
health-care settings, with special focus on HIV-related issues. MMWR
12. Brisson-Noel A, Lecossier D, NassifX, et coll. "~pµJ,µu~~J,.Ll~
l .
. "'
Lancet 1989;2: 1069- 1.
Source: Morbidity and Mortality Weekly Report, Vol 40, n° 8, 1991.
An nonce
The 46th International North-Western Conference on Diseases
in Nature Communicable to Man will be held in Ukiah, Caiifomia,
at Mendocino College, from 11-14 August:, 1991. Papers are
solicited on all aspects of zoonoses. For information, contact the
conference secretazy Evelyne T. Lennett, Ph.D., Virolab Inc.,
1204 Tenth Street, :tJerkeley, Co 94710-1509, U.S.A., Tel: (415)
524-6201.QR Chandar Anand, MD, Provincial Laboratory of
Public Health, P.O. Box 2490, Calgary, Alberta, CANADA
T2P 2M7, Tel: (403) 270-1201.
La Afilh International North-Western Conferejlce on Diseases in Nature
Communicable to Man aura lieu aUkiah (Califomie), au MendoQino Co!le~e. du
11 au 14 aofit 1991. On demande des presentation8 sur tousles aspects des
zoonoses. Pour se renseigner, communiquer avec la secretaire de la Conference,
Mme Evelyne T. Lennett, Ph.D., Virolab Inc., 1204 Tenth Street, Berkeley,
Co 94710-1509, U.S.A., tel.: (415) 524-6201 OU ayec Dr Chandar Anand,
Laboratoire provincial de sante publlque, C.P. 2490, Calgary (Alberta), ·
CANADA T2P 2M7, tel. : (403) 270-UOl.
1ho Cuwla Disoue1 Wooldy Rcportpn:som cum:mt informniionminfz:ttiom and other
for 11UIVCillan<:<1 purpose• and ii availBblo fu:c of chargo upon r~quost. Many of articlos
contain pielimlnuy infonDlltlon and further confuinllioa may bo obtained. from
quoted. Tho Dcportmont of Hcaiih and Welfani does not IL'l51UDO i<:sponsibility for accuracy oc
autmnticlty:Coo!rlbutiaru1 lire welcomt:d (in the o!IiciBI language of your choice) fromanyono
worldng in thi:> helllth field and will notJl'Cclude pub!icationclsewb:ae,
SelontifioAdvtiuJ<y Boord:
Dr. A. Carter
Doaldop Publuhlng
Eleanoc Paubon
Bureau of Communicable Disease Epidemiology
LabO£atory Centro for Di>ease Comrol
OITAWA, Ontario Canada KIA OL2
] oazm:: Regnier
GertrudD Tarouf .
(613) 95'7-4243
(613) 957·1339
(613) 95'7·1329
(613) 957-1788
(613) 9j7.7s4s
(613) 95'7·08.42
Lo Rapport hebdcma&tlro &:a maladlo1 •u Canada, qui fournit &:1 domi6e1 pertinon11>1 rur 101 uuladlo1 inlhcOcU>Ot ct
le! autro1 maladies dall.! lo but do facilimr lour sun"aillancc, pelllSIIc oblotm gmtuiklmont aur delllJIIldo, Un grand
oombn> d' articles nc contiemumt. quo do1 donn6c1 IOIIimaireJ mili do1 rorueignemenbl compl6moni.iro1 p:U\..Ut Stro
obtcnua on 1' addiomnt aux 1oun:c1 oit6oJ. Lo mlnUtro do I< Sllll61111i00Jl!o ot du Bion-SIIc iochl no p:ut Stro
r<:sp9t1sablo 0,, I 'oxactitudo, ni do l '•uthcnticit6. do1 articles. Toutc poI10DDO oouvranl dim lo domiino do la Wll5 cit
iovitk). oollabcrer (daru l• l11ngu1fofliciollo dD ion choil<) otla publlc.tlon d'nn article dam lo J<OJOnt llal'!'<><I n'on .
cmp8cho pail a publ!caticn aillourw.
Groupe do corueillers 1elontifique1: .
(613) 95'7-4243
D' A. Carter
(613) 957-1339
(613) 95'7·1329
(613) 95'7-1788
RidJ.ctrlce en chte
.Joonnc Rcgnlor
(613) 95'7-7845
(613) 95'7-0842
Gcrtrudo Tarouf
Buro au d'6pld6mlologlo des IIlllladio1 tr•mmlniblo1
Laburatolro·do]utte CDlltrC la mala<llo
Cana.da KlA OL2
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