KEY POINTS:
Hundreds of hospital staff and up to 20 patients are being tracked down and tested for a rare and aggressive disease, after a highly contagious patient was left undiagnosed for weeks in Auckland City Hospital.
Testing had only just begun yesterday and results were not yet available, but
the hospital confirmed that none of the other patients exposed to the highly unusual strain of tuberculosis had died.
The female patient at the centre of the scare was initially diagnosed as having a respiratory illness. She died several weeks ago after a stay of many weeks in the hospital.
But her illness was actually an extremely rare, aggressive and contagious form of TB, the Auckland District Health Board confirmed yesterday. That diagnosis was not made until tests were done on the patient after her death.
Her case was so rare none of the appropriate TB screenings - all of which were performed by hospital staff - indicated she could have the disease. No further specialised TB tests were done on the patient.
That meant that throughout the patient's stay at the hospital she was treated as any other non-contagious patient would be - in the same critical care department other patients were being treated in.
Patients with contagious TB should be treated in negative-pressure isolation rooms away from other patients, and staff treating them should be issued with special masks.
But normal treatment protocols include none of that, instead demanding hand-washing, staff wearing standard masks if patients are coughing and gloves for dealing with patients' fluids.
The infected woman's time at the hospital also included her being moved to several different departments, bringing her into contact of eight hours or more with more than 200 staff - who are now being tested.
Of those staff, it is thought up to 16 were medical students, exposed to the patient while training at the hospital.
Auckland District Health Board chief medical officer David Sage told the Herald yesterday it was possible a handful of those exposed to the patient would have contracted TB.
Those people did not need to panic, he said. They were not at immediate risk of developing symptoms of TB as the disease took a long time to become established, and those around them were not at risk of infection because TB was contagious only when it reached an advanced stage.
If infected people were found, they would be treated by a course of several antibiotics taken over several months, he said.
Dr Sage yesterday defended the hospital's attempts at diagnosing the patient. Because none of the screenings had indicated TB as a possibility, no specialised testing had been deemed necessary. That decision was not a mistake, he said.
"We would do exactly the same next time. We wouldn't change our procedures at all."
Only through a separate testing process for another TB case did the patient's name come up. By that time she was dead, and laboratory tests confirmed she had been infected by the disease, he said.
Tuberculosis was always "high on your list of suspicions" when a patient presented with respiratory illness, Dr Sage said.
"But this form was so unusual, it wasn't diagnosed."
KILLER BACTERIA
* Tuberculosis is caused by bacteria.
* Usually infecting the lungs, it can also infect many other parts of the body.
* Typical symptoms include a constant blood-tinged cough, and fever.
* It is thought TB kills well over one million people worldwide each year.
* Most of those deaths are in developing countries.
NEW ZEALAND CASES
* There were 290 TB cases in New Zealand last year.
* The number of reported cases fluctuates yearly; last year's figure was the lowest in 20 years. The highest number of cases was 446.
* There were 54 reported TB cases in the Auckland District Health Board's area last year.
* Between two and eight people die of the disease each year in the Auckland DHB's catchment.