Notes from the Field: Meningeal and Pulmonary Tuberculosis on a Commercial Fishing Vessel — Hawaii, 2017

Erin K. Imada, Emily K. Roberson, Neela D. Goswami, Richard J. Brostrom, Kathleen Moser, Kara Tardivel
2019 Morbidity and Mortality Weekly Report (MMWR)  
In December 2016, U.S. Customs and Border Protection notified the CDC Honolulu Quarantine Station of a crewman on a commercial fishing vessel who was hospitalized with suspected tuberculosis (TB); the crewman, in his mid-30s, was unconsciousness, intubated, and dependent upon mechanical ventilation to maintain his respiratory status. He was a native of a high TB-burden country (one with TB incidence exceeding 10 cases per 100,000 population per year)* in the Pacific region. Nine days earlier,
more » ... ine days earlier, he had been hospitalized in Hawaii following a 1-month history of headache, fever, night sweats, chills, fatigue, weight loss, breathing difficulties, and cough and recent onset of abdominal pain, vomiting, dizziness, and blurred vision. Brain computerized tomography (CT) and magnetic resonance imaging scans showed lesions in the left basal ganglia and left temporal lobe; chest CT showed multiple bilateral lung opacities with central cavitation. Pathology results from a lung biopsy demonstrated acid-fast bacilli with molecular and culture tests positive for Mycobacterium tuberculosis complex, susceptible to all first-line drugs. Cerebrospinal fluid demonstrated low glucose (23 mg/dL), elevated protein (247 mg/dL), and elevated white blood cell count (298 cells/uL) with a relative lymphocytic predominance (50%), consistent with TB meningitis. Testing for human immunodeficiency virus infection was negative, and the patient had no medical comorbidities. The Hawaii Department of Health (Hawaii DOH) was contacted to assist with the investigation. Upon confirmation of infectious TB, U.S. Customs and Border Protection, accompanied by the Hawaii Harbor Police called the vessel to port for contact interviews and TB screening by the CDC Honolulu Quarantine Station and Hawaii DOH. The vessel's crew members included the captain, who was a U.S. citizen, and five crew members from the same country as the patient. A fisheries observer with the National Oceanic and Atmospheric Administration, who was a U.S. citizen, was identified as an additional contact. All seven contacts were evaluated by Hawaii DOH; none reported symptoms or signs of active TB. Four crew members had positive tuberculin skin test readings. These four persons were evaluated by Hawaii DOH and had Corresponding author: Erin K. Imada, ioo6@cdc.gov, 808-282-4359.
doi:10.15585/mmwr.mm6824a5 fatcat:lxvjjdrhq5fblhhg3yt3gjcjkq