Sunday, 12 June 2011

TUBERCULOSIS: Portugal: Screening for tuberculosis and prediction of disease in healthcare workers

Author: Jose Torres CostaRui SilvaFelix RingshausenAlbert Nienhaus
Credits/Source: Journal of Occupational Medicine and Toxicology 2011, 6:19

Results of systematic screening of healthcare workers (HCWs) for tuberculosis (TB) with the tuberculin skin test (TST) and interferon-gamma release assays (IGRA) in a Portuguese hospital from 2007 to 2010 are reported.

Methods: All HCWs are offered screening for TB. Screening is repeated depending on risk assessment.
TST and QuantiFERON Gold In-Tube (QFT) are used simultaneously. X-ray is performed when TST is >10 mm, IGRA is positive or typical symptoms exist.

Results: The cohort comprises 2,889 HCWs. TST and IGRA were positive in 29.5%, TST-positive but IGRA-negative results were apparent in 43.4%. Active TB was diagnosed in twelve HCWs - eight cases were detected during screening and four cases were predicted by IGRA as well as by TST.
However, the progression rate in IGRA-positive was higher than in TST-positive HCWs (0.4% vs. 0.2%, p-value 0.06).

Conclusions: The TB burden in this cohort was high (129.8 per 100,000 HCWs).
However, the progression to active TB after a positive TST or positive IGRA was considerably lower than that reported in literature for close contacts in low-incidence countries. This might indicate that old LTBI prevails in these HCWs.

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