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First Case of TB Transmission From Cadaver to Embalmer

WebMD Health News

Jan. 26, 2000 (Atlanta) -- In a case showing the resilience of tuberculosis (TB), researchers at Johns Hopkins University in Baltimore have uncovered what they believe is the first case of an embalmer contracting the bacterial infection from a cadaver. The report appears in the Jan. 27 issue of The New England Journal of Medicine.

"I think the importance is, at least as far as we're aware," lead author Timothy R. Sterling, MD, tells WebMD, "it's the first reported case of tuberculosis being transmitted from a cadaver to a mortician or an embalmer." Sterling is an associate professor of infectious diseases at John Hopkins School of Medicine.

TB is the second leading cause of death from an infectious disease, according to Johns Hopkins University. Around the world, 2 million people die of TB annually, and up to 8 million new cases of it are diagnosed each year. Therapy requires a multidrug regimen of four drugs, but the disease can be beat. In the U.S., TB rates are at the lowest ever recorded, Sterling says.

Sterling says there have been two previous studies similar to this case, one showing funeral directors had a higher rate of tuberculosis than the general population, and the other showing embalmers had a higher rate of positive skin tests for TB than other funeral workers. However, neither of these studies looked at where the TB actually came from, and neither dealt with a person who had active tuberculosis.

A positive skin test just means the bacteria have entered a person's body. If it becomes active, though, it is dangerous then to the host and to others. "We don't know how the tuberculosis was transmitted," Sterling tells WebMD. "We've raised several hypotheses because we do know the most common route of TB transmission is through the air ... [and] there are several things that occur during the embalming process that could possibly generate infectious aerosols."

In the embalming process, blood and other body fluids are removed from the cadaver and preservatives and disinfectants are injected back into the body. The aspirated body fluids are then emptied into drains. Either of the activities could have generated the infectious aerosols, tiny particles that enter the body through the nose or mouth and lodge in the lungs.

Sterling also writes, "the frothing of fluids through the cadaver's nose and mouth, or the release of trapped air bubbles through these orifices during cadaveric spasms may also have generated aerosols."

The discovery was made because of an ongoing TB surveillance initiative by the Baltimore City Health Department. Every case discovered by the city undergoes DNA "fingerprinting" at Johns Hopkins. It was there that researchers followed up two similar "fingerprints" to see if they could find how the disease was transmitted, and if there was further risk.

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