{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T08:03:47Z","timestamp":1779869027260,"version":"3.53.1"},"reference-count":39,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Appl Biosaf."],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Sharps injuries pose a significant occupational risk for healthcare and laboratory workers, with hundreds of thousands of incidents reported annually. While protocols for blood-borne pathogens like HIV and hepatitis viruses are well-established, the risk of traumatic inoculation with\n                      <jats:italic toggle=\"yes\">Mycobacterium tuberculosis<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">M. tuberculosis<\/jats:italic>\n                      ) is under-recognized.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This case series reviews six separate instances of healthcare and laboratory personnel across multiple academic health systems in a northeastern U.S. metropolitan region who developed cutaneous tuberculosis following sharps injuries in environments where\n                      <jats:italic toggle=\"yes\">M. tuberculosis<\/jats:italic>\n                      was present. This series was used to identify gaps in current sharps safety guidelines and to propose improved and standardized safety protocols.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      All patients were previously nonsensitized to\n                      <jats:italic toggle=\"yes\">M. tuberculosis<\/jats:italic>\n                      and presented with tuberculous chancre at the inoculation site. Diagnosis was delayed in several cases, resulting in prolonged morbidity and unnecessary exposure to ineffective treatments. Treatment regimens varied considerably across the cases, reflecting a lack of standardized guidelines for managing this rare form of the disease. Furthermore, no established post-exposure prophylaxis (PEP) protocols for\n                      <jats:italic toggle=\"yes\">M. tuberculosis<\/jats:italic>\n                      exist for direct inoculation, in stark contrast to guidelines for airborne TB exposure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This review highlights critical gaps in occupational health and biosafety policy. We conclude that awareness of primary cutaneous tuberculosis as a potential sequela of sharps injuries is essential for early diagnosis and effective management. These findings support the development of standardized diagnostic algorithms and evidence-based PEP recommendations to better protect workers from this preventable hazard.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15356760261440532","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T04:35:31Z","timestamp":1777437331000},"page":"130-137","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["More than Skin Deep: Primary Inoculation with\n                    <i>Mycobacterium tuberculosis<\/i>\n                    as an Occupational Hazard"],"prefix":"10.1177","volume":"31","author":[{"given":"Sarah J.","family":"Lange","sequence":"first","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Styren","sequence":"additional","affiliation":[{"name":"Dartmouth Health, Department of Medicine, Lebanon, New Hampshire, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa A.","family":"Foster","sequence":"additional","affiliation":[{"name":"Beth Israel Lahey Health, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom H.","family":"Winters","sequence":"additional","affiliation":[{"name":"Beth Israel Lahey Health, Boston, Massachusetts, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1008-8734","authenticated-orcid":false,"given":"Karen L.","family":"Huyck","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA."},{"name":"Dartmouth Health, Department of Medicine, Lebanon, New Hampshire, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S404418"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.5334\/aogh.2698"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.51753\/flsrt.1498184"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.26719\/emhj.22.031"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.2147\/RMHP.S434315"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-198103000-00003"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-221938"},{"issue":"6","key":"e_1_3_2_9_1","first-page":"815","article-title":"Cutaneous inoculation tuberculosis: Prosector\u2019s wart occurring in a physician","volume":"23","author":"Allen RK","year":"1979","unstructured":"8.Allen RK, , Pierson DL, , Rodman OG. Cutaneous inoculation tuberculosis: Prosector\u2019s wart occurring in a physician. Cutis 1979;23(6):815\u2013818.","journal-title":"Cutis"},{"issue":"3","key":"e_1_3_2_10_1","article-title":"Tuberculous chancre in the present-day scenario: A case report","volume":"25","author":"Palaniappan V","year":"2022","unstructured":"9.Palaniappan V, , Saravanan G, , Karthikeyan K. Tuberculous chancre in the present-day scenario: A case report. Iran J Dermatol 2022;25(3); doi: 10.22034\/ijd.2021.247769.1214","journal-title":"Iran J Dermatol"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200203050-00004"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2021.12.064"},{"key":"e_1_3_2_13_1","volume-title":"StatPearls Internet","author":"Tobin E","year":"2025","unstructured":"12.Tobin E, , Warda K, , Gropper C, , Apple A, , Vadakekut E. Cutaneous tuberculosis. In: StatPearls Internet. StatPearls Publishing: Treasure Island, FL; 2025. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482220\/"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20142334"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1590\/abd1806-4841.20142998"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.22.0342"},{"issue":"1","key":"e_1_3_2_17_1","first-page":"1","article-title":"Guidelines for safe work practices in human and animal medical diagnostic laboratories. Recommendations of a CDC-convened, biosafety blue ribbon panel","volume":"61","author":"Miller JM","unstructured":"16.Miller JM, , Astles R, , Baszler T, et al. Guidelines for safe work practices in human and animal medical diagnostic laboratories. Recommendations of a CDC-convened, biosafety blue ribbon panel. MMWR (Suppl 2012);61(1):1\u2013102.","journal-title":"MMWR (Suppl 2012)"},{"key":"e_1_3_2_18_1","volume-title":"Handbook on tuberculosis laboratory diagnostic methods in the European Union: updated 2018","author":"European Centre for Disease Prevention and Control","year":"2023","unstructured":"17.European Centre for Disease Prevention and Control. Handbook on tuberculosis laboratory diagnostic methods in the European Union: updated 2018. ECDC: Stockholm; 2023. Available from: https:\/\/data.europa.eu\/doi\/10.2900\/433652"},{"key":"e_1_3_2_19_1","volume-title":"Biosafety in Microbiological and Biomedical Laboratories","author":"U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institutes of Health","year":"2020","unstructured":"18.U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institutes of Health. Biosafety in Microbiological and Biomedical Laboratories, 6th Ed. U.S. Department of Health and Human Services; 2020.","edition":"6"},{"issue":"10","key":"e_1_3_2_20_1","first-page":"1","article-title":"Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)","volume":"52","author":"Sehulster L","year":"2003","unstructured":"19.Sehulster L, , Chinn RYW, , CDC, HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep 2003;52(RR-10):1\u201342.","journal-title":"MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep"},{"issue":"4","key":"e_1_3_2_21_1","first-page":"S221","article-title":"Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a joint statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement","volume":"161","year":"2000","unstructured":"20.Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a joint statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000;161(4 Pt 2):S221\u2013S247.","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clindermatol.2019.01.008"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1985.01660050100024"},{"key":"e_1_3_2_24_1","first-page":"888","volume-title":"Red Book: 2024\u20132027 Report of the Committee on Infectious Diseases","author":"Kimberlin DW","year":"2024","unstructured":"23.Kimberlin DW, , Banerjee R, , Barnett ED, , Lynfield R, , Sawyer MH., eds. Tuberculosis. In: Red Book: 2024\u20132027 Report of the Committee on Infectious Diseases, 33rd ed. American Academy of Pediatrics: Itasca, IL; 2024; pp. 888\u2013920. Available from: https:\/\/publications.aap.org\/redbook\/book\/755\/chapter\/14083107\/Tuberculosis","edition":"33"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw376"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1104875"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/01410768221107122"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202410-2096ST"},{"issue":"48","key":"e_1_3_2_29_1","first-page":"1650","article-title":"Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection","volume":"60","author":"Centers for Disease Control and Prevention (CDC)","year":"2011","unstructured":"28.Centers for Disease Control and Prevention (CDC). Recommendations for use of an isoniazid-rifapentine regimen with direct observation to treat latent Mycobacterium tuberculosis infection. MMWR Morb Mortal Wkly Rep 2011;60(48):1650\u20131653.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"3","key":"e_1_3_2_30_1","first-page":"325","article-title":"Short-course chemotherapy for pulmonary tuberculosis","volume":"111","author":"Fox W","year":"1975","unstructured":"29.Fox W, , Mitchison DA. Short-course chemotherapy for pulmonary tuberculosis. Am Rev Respir Dis 1975;111(3):325\u2013353.","journal-title":"Am Rev Respir Dis"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200510-1666ST"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7108a1"},{"key":"e_1_3_2_33_1","volume-title":"WHO consolidated guidelines on tuberculosis: Module 1: Prevention\u2014Tuberculosis preventive treatment","year":"2024","unstructured":"32.WHO consolidated guidelines on tuberculosis: Module 1: Prevention\u2014Tuberculosis preventive treatment, second ed. World Health Organization: Geneva; 2024. (WHO Guidelines Approved by the Guidelines Review Committee). Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK607290\/"},{"key":"e_1_3_2_34_1","volume-title":"Biosafety in the Laboratory: Prudent Practices for the Handling and Disposal of Infectious Materials","author":"National Research Council (US) Committee on Hazardous Biological Substances in the Laboratory","year":"1989","unstructured":"33.National Research Council (US) Committee on Hazardous Biological Substances in the Laboratory. Biosafety in the Laboratory: Prudent Practices for the Handling and Disposal of Infectious Materials. National Academies Press, US: Washington, DC; 1989. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK218631\/"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/194336548102600106"},{"key":"e_1_3_2_36_1","first-page":"1","volume-title":"Laboratory Biosafety Manual","year":"2020","unstructured":"35.Laboratory Biosafety Manual, 4th ed. World Health Organization: Geneva; 2020; p. 1.","edition":"4"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0121639"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(95)91389-0"},{"key":"e_1_3_2_39_1","unstructured":"38.Ancona N Bernardo J Desmond E et al. Mycobacterium tuberculosis: Assessing your laboratory. Association of Public Health Laboratories (APHL); 2019. Available from: https:\/\/www.aphl.org\/aboutAPHL\/publications\/Documents\/ID_2013Aug_Mycobacterium-Tuberculosis-Assessing-Your-Laboratory.pdf"},{"key":"e_1_3_2_40_1","unstructured":"39.Centers for Disease Control and Prevention. Reported tuberculosis in the United States 2023: reporting area data. Published November 5 2024."}],"container-title":["Applied Biosafety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15356760261440532","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15356760261440532","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15356760261440532","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T07:16:49Z","timestamp":1779866209000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15356760261440532"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6,1]]}},"alternative-id":["10.1177\/15356760261440532"],"URL":"https:\/\/doi.org\/10.1177\/15356760261440532","relation":{},"ISSN":["1535-6760","2470-1246"],"issn-type":[{"value":"1535-6760","type":"print"},{"value":"2470-1246","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]}}}