Isolate from dead patient infects worker in lab

Meningitis not cause of source-patient death

The meningococcal isolate that caused a fatal infection in a 52-year-old veteran laboratorian at the Michigan Department of Health in Lansing last year came from a teen-ager who had died in another state of a different disease.

A 19-year-old female Michigan State University student died of toxic shock syndrome while visiting family in New Jersey over the Christmas holiday break. Though the toxic shock was subsequently determined to be unrelated to meningitis, health officials sent an isolate from the patient’s ear to help Michigan officials determine if they had an outbreak strain in their area.

"They sent it here to our laboratory to see if it matched any other type of meningococcal organisms that we had so they could determine if there was an outbreak type situation," says Geralyn Lasher, director of communications at the Michigan department of health. "However, the Michigan State student did not die of meningococcal disease. The New Jersey medical examiner determined that she died of toxic shock syndrome, so this was basically an organism that she carried but was not having any ill effects from."

The sample was received via mail at the Michigan lab on Dec. 21, 2000. The laboratorian, who had worked in the lab since 1972, ran some tests on the specimen the next day but reported nothing unusual, Lasher says. "On Sunday, she began [experiencing] symptoms and on Monday, Christmas Day, she was taken to the hospital. She died shortly after arriving in the emergency department. Through testing we were able to determine that she died from meningococcemi," Lasher says.

The infecting strain identically matched the one from the source patient, but the source of transmission remains a mystery. "Even if she had survived this very aggressive infection, we still might not know how she was contaminated," she says. "Certainly, aerosolization is a possibility, but we will never know for certain how it happened."

As a result of the case, precautions in Michigan state labs have been increased and workers are being offered the meningitis vaccine, both measures that go beyond current recommendations by the Centers for Disease Control and Prevention. "Our procedure for handling the meningococcal organism up to this incident, has been just as CDC recommended, working with it on a table top as a level 2 organism," Lasher says. "We are still working with the CDC as far as possible changes nationwide, but here in Michigan at our state laboratories, we have moved it up to a level 3. It will be treated under a biocontainment hood, and individuals who come into contact with it would be gloved, masked, and wearing goggles."

The death of such an experienced laboratorian was particularly unsettling, especially since co-workers and supervisors said the woman had outstanding lab technique.

"Being sensitive to the lab population is the most important and well-founded message we can have from this," says Michael Bell, MD, a medical epidemiologist in the CDC’s division of health care quality promotion. "There is a population at risk there, and they should not fall below the radar of the infection control service. It is easy is to do because they are generally bright people who seem like they are on top of things."