Medical staff at the state prison did not see the inmate again until
4 weeks later, when he was scheduled to receive chronic care for asthma. At
this medical examination, he received a chest radiograph that showed a cavitary
lesion of the right lower lobe. Despite having TB symptoms, he was placed
back with the general prison population and scheduled for a computerized tomography
(CT) scan 2 weeks later to rule out neoplasia. After the CT scan indicated
cavitary lesions consistent with TB, the man, now the TB index patient, was
placed in airborne infection isolation (AII), and sputum samples were collected.
The AII room was newly constructed and in working condition, according to
maintenance and monitoring documentation. However, because the recommended
N95 respirators5 were not available, prison
health staff used surgical masks when in the AII room with the index patient.
The first laboratory result from the index patient of 4+ smear-positive Mycobacterium tuberculosis was reported in late September,
6 weeks after he had arrived at the prison facility.