Brucella exposure risk events in 10 clinical laboratories, New York City, USA, 2015 to 2017

Joel Ackelsberg, Anna Liddicoat, Taryn Burke, Wendy A. Szymczak, Michael H. Levi, Belinda E. Ostrowsky, Camille Hamula, Gopi Patel, Virginia Kopetz, Jessie Saverimuttu, Emilia Mia Sordillo, David D'Souza, Elizabeth A. Mitchell, William Lowe, Reeti Khare, Yi Wei Tang, Anabella Lucca Bianchi, Christina Egan, Michael J. Perry, Scott HughesJennifer L. Rakeman, Eleanor Adams, Grishma A. Kharod, Rebekah Tiller, Elke Saile, Stephen Lee, Edimarlyn Gonzalez, Brett Hoppe, Ira M. Leviton, Susan Hacker, Kuey Fen Ni, Reina L. Orsini, Sangam Jhaveri, Irving Mazariegos, Tanis Dingle, Brian Koll, Robyn A. Stoddard, Renee Galloway, Alex Hoffmaster, Annie Fine, Ellen Lee, Catherine Dentinger, Emily Harrison, Marcelle Layton

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

From 2015 to 2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events (Brucella events) in 7 clinical laboratories (CLs). Most patients had traveled to countries where brucellosis is endemic and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as the clinicians did not consider brucellosis until they were notified that bacteremia with Brucella was suspected. In 3 Brucella events, the CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization- time of flight mass spectrometry (MALDI-TOF MS), which has a limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events, which accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including by procedures that could generate infectious aerosols. During 3 Brucella events, the CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each CL, the CL had previously isolated Brucella. Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred. Laboratory assessments were conducted after the Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF MS for identification until BTAs have been ruled out.

Original languageEnglish (US)
Article numbere01096-19
JournalJournal of Clinical Microbiology
Volume58
Issue number2
DOIs
StatePublished - Jan 1 2020

Keywords

  • Biosafety
  • Brucellosis
  • Laboratory-acquired infection
  • Risk assessment

ASJC Scopus subject areas

  • Microbiology (medical)

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    Ackelsberg, J., Liddicoat, A., Burke, T., Szymczak, W. A., Levi, M. H., Ostrowsky, B. E., Hamula, C., Patel, G., Kopetz, V., Saverimuttu, J., Sordillo, E. M., D'Souza, D., Mitchell, E. A., Lowe, W., Khare, R., Tang, Y. W., Bianchi, A. L., Egan, C., Perry, M. J., ... Layton, M. (2020). Brucella exposure risk events in 10 clinical laboratories, New York City, USA, 2015 to 2017. Journal of Clinical Microbiology, 58(2), [e01096-19]. https://doi.org/10.1128/JCM.01096-19