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Lung Disease & Respiratory Health Center

First Case of TB Transmission From Cadaver to Embalmer

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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.

"With that information in hand," Sterling tells WebMD, "they tried to find if there was a link between the two people, and they saw that the embalmer had signed the man's death certificate." There was no known evidence, Sterling writes, that the two people had any contact before the embalming, thus no evidence the transmission had occurred before the embalming. The embalmer reportedly had 15 years' experience, always wore gloves, and usually wore a mask.

"Tuberculosis ... has been around for thousands of years, and that speaks to how well it's been able to adapt to many different situations. There are still many things about tuberculosis we don't know," Sterling tells WebMD. But it is known, he writes, that a study of embalmed cadavers for medical school anatomy classes showed tuberculosis "organisms remain viable and therefore infectious for at least 24 to 48 hours after an infected cadaver has been embalmed."

As for embalmers, Sterling says stronger guidelines may be in order: "I think a very good first step would be the use of universal precautions, which would be gloves and a mask, just using it always. Universal precautions implies that you cannot figure out just from visual inspection who may or may not have an infection, whether it's tuberculosis or HIV, so you use the same precautions every time because you just don't know," he tells WebMD.

Kelly Smith, the spokesman for the National Funeral Directors Association says, "it's not a big deal. Funeral directors have known about the threat of TB for generations." He says funeral directors "are aware of the importance of universal precautions ... [especially] when dealing with highly communicable, potentially lethal diseases such as hepatitis, tuberculosis, and HIV."

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