1
|
Islam MS, Gurley ES, Banu S, Hossain K, Heffelfinger JD, Amin Chowdhury KI, Ahmed S, Afreen S, Islam MT, Rahman SMM, Rahman A, Pearson ML, Chai SJ. Prevalence and incidence of tuberculosis infection among healthcare workers in chest diseases hospitals, Bangladesh: Putting infection control into context. PLoS One 2023; 18:e0291484. [PMID: 37756289 PMCID: PMC10529546 DOI: 10.1371/journal.pone.0291484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at increased risk of tuberculosis infection (TBI). We estimated the prevalence and incidence of TBI and risk factors among HCWs in Bangladeshi hospitals to target TB infection prevention and control (IPC) interventions. METHODS During 2013-2016, we conducted a longitudinal study among HCWs in four chest disease hospitals. At baseline, we administered a questionnaire on sociodemographic and occupational factors for TB, tuberculin skin tests (TST) in all hospitals, and QuantiFERON ®-TB Gold in-Tube (QFT-GIT) tests in one hospital. We assessed factors associated with baseline TST positivity (induration ≥10mm), TST conversion (induration increase ≥10mm from baseline), baseline QFT-GIT positivity (interferon-gamma ≥0.35 IU/mL), and QFT-GIT conversion (interferon-gamma <0.35 IU/mL to ≥0.35 IU/mL). We included factors with a biologically plausible relationship with TBI identified in prior studies or having an association (p = <0.20) in the bivariate analyses with TST positivity or QFT-GIT positivity in multivariable generalized linear models. The Kaplan-Meier was used to estimate the cumulative TBI incidence rate per 100 person-years. RESULTS Of the 758 HCWs invited, 732 (97%) consented to participate and 731 completed the one-step TST, 40% had a positive TST result, and 48% had a positive QFT-GIT result. In multivariable models, HCWs years of service 11-20 years had 2.1 (95% CI: 1.5-3.0) times higher odds of being TST-positive and 1.6 (95% CI 1.1-2.5) times higher odds of QFT-GIT-positivity at baseline compared with those working ≤10 years. HCWs working 11-20 years in pulmonary TB ward had 2.0 (95% CI: 1.4-2.9) times higher odds of TST positivity, and those >20 years had 2.5 (95% CI: 1.3-4.9) times higher odds of QFT-GIT-positivity at baseline compared with those working <10 years. TBI incidence was 4.8/100 person-years by TST and 4.2/100 person-years by QFT-GIT. Females had 8.5 (95% CI: 1.5-49.5) times higher odds of TST conversion than males. CONCLUSIONS Prevalent TST and QFT-GIT positivity was associated with an increased number of years working as a healthcare worker and in pulmonary TB wards. The incidence of TBI among HCWs suggests ongoing TB exposure in these facilities and an urgent need for improved TB IPC in chest disease hospitals in Bangladesh.
Collapse
Affiliation(s)
- Md. Saiful Islam
- icddr,b, Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Emily S. Gurley
- icddr,b, Dhaka, Bangladesh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | | | - James D. Heffelfinger
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | | | | | | | | | | | | | - Michele L. Pearson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Shua J. Chai
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| |
Collapse
|
2
|
Decreased annual risk of tuberculosis infection in South Korean healthcare workers using interferon-gamma release assay between 1986 and 2005. BMC Infect Dis 2021; 21:1161. [PMID: 34784896 PMCID: PMC8594200 DOI: 10.1186/s12879-021-06855-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background Tuberculosis (TB) has been a major public health problem in South Korea. Although TB notification rate in Korea is gradually decreasing, still highest among the member countries of the Organization for Economic Cooperation and Development. To effectively control TB, understanding the TB epidemiology such as prevalence of latent tuberculosis infection (LTBI) and annual risk of TB infection (ARI) are important. This study aimed to identify the prevalence of LTBI and ARI among South Korean health care workers (HCWs) based on their interferon-gamma release assays (IGRA). Methods This was single center, cross-sectional retrospective study in a tertiary hospital in South Korea. We performed IGRA in HCWs between May 2017 and March 2018. We estimated ARI based on IGRA results. Logistic regression model was used to identify factors affecting IGRA positivity. Results A total of 3233 HCWs were analyzed. Median age of participants was 38.0 and female was predominant (72.6%). Overall positive rate of IGRA was 24.1% and IGRA positive rates age-group wise were 6.6%, 14.4%, 34.3%, and around 50% in the age groups 20s, 30s, 40s, and 50s and 60s, respectively. The ARIs was 0.26–1.35% between 1986 and 2005; rate of TB infection has gradually decreased in the last two decades. Multivariable analysis indicated that older age, healed TB lesion in x-ray, and male gender were risk factors for IGRA positivity, whereas working in high-risk TB departments was not. Conclusions Results showed that ARI in South Korean HCWs gradually decreased over two decades, although LTBI remained prevalent. Our results suggest that the LTBI test result of HCWs might be greatly affected by age, rather than occupational exposure, in intermediate TB burden countries. Thus, careful interpretation considering the age structure is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06855-5.
Collapse
|
3
|
Islam MS, Chughtai AA, Nazneen A, Chowdhury KIA, Islam MT, Tarannum S, Islam SMH, Banu S, Seale H. A tuberculin skin test survey among healthcare workers in two public tertiary care hospitals in Bangladesh. PLoS One 2020; 15:e0243951. [PMID: 33332458 PMCID: PMC7745963 DOI: 10.1371/journal.pone.0243951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
In Bangladesh, there is currently no data on the burden of latent TB infection (LTBI) amongst hospital healthcare workers (HCWs). This study aimed to determine the prevalence of LTBI and compare the prevalence among HCWs in two public tertiary care hospitals. Between September 2018 and August 2019, we conducted a cross-sectional study in two public tertiary care general hospitals. Using a survey and tuberculin skin test (TST), we assessed risk factors for LTBI, adjusting for known and plausible confounders. In addition, a facility assessment was undertaken to understand the implementation of relevant IPC measures. The prevalence of LTBI among HCWs was 42%. HCWs spent a median of 6 hours (SD = 1.76, IQR 2.00) per day and attended an average of 1.87 pulmonary TB patients per week. HCWs did not receive any TB IPC training, the wards lacked a symptom checklist to screen patients for TB, and no masks were available for coughing patients. Seventy-seven percent reportedly did not use any facial protection (masks or respirators) while caring for patients. In the multivariable model adjusting for hospital level clustering effect, TST positivity was significantly higher among HCWs aged 35-45 years (aOR1.36, 95% CI: 1.06-1.73) and with >3 years of service (aOR 1.67, 95% CI: 1.62-1.72). HCWs working in the medicine ward had 3.65 (95% CI: 2.20-6.05) times, and HCWs in the gynecology and obstetrics ward had 2.46 (95% CI: 1.42-4.27) times higher odds of TST positivity compared to HCWs working in administrative areas. This study identified high prevalence of LTBI among HCWs. This may be due to the level of exposure to pulmonary TB patients, and/or limited use of personal protective equipment along with poor implementation of TB IPC in the hospitals. Considering the high prevalence of LTBI, we recommend the national TB program consider providing preventative therapy to the HCWs as the high-risk group, and implement TB IPC in the hospitals.
Collapse
Affiliation(s)
- Md Saiful Islam
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
- School of Population Health, University of New South Wales, Sydney, Australia
| | | | - Arifa Nazneen
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | | | | | - Sayeeda Tarannum
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - S. M. Hasibul Islam
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Sayera Banu
- Infectious Diseases Division, Program for Emerging Infections, icddr,b, Dhaka, Bangladesh
| | - Holly Seale
- School of Population Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
4
|
Hsu HY, Hsieh CC, Tseng YC, Hung CH, Chen KT, Wang CH, Tseng YT. Increased Long-Term Risks of Occupational Diseases in Homecare Nurses: A Nationwide Population-Based Retrospective Cohort Study. WOMEN'S HEALTH REPORTS 2020; 1:259-269. [PMID: 33786488 PMCID: PMC7784797 DOI: 10.1089/whr.2019.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/13/2022]
Abstract
Background: The work of homecare nurses is different from that of general hospital nurses; therefore, it is necessary to understand the risks of occupational diseases in homecare nurses. Materials and Methods: In this retrospective cohort research conducted from 2000 to 2013, nursing staff comprised the sample obtained from the National Health Insurance Research Database. Nursing staff were subgrouped according to practice site into homecare, medical center, regional hospital, and local community hospital nurses. The control group included 4,108 subjects. Results: The risk of severe kidney disease was higher in homecare nurses than in medical center nurses (hazard ratio [HR]: 7.3, 95% confidence interval [CI]: 2.45-21.78) and regional hospital nurses (HR: 3.30, 95% CI: 1.37-7.96). The risk of severe liver disease was higher in homecare nurses than in medical center nurses (HR: 1.92, 95% CI: 1.10-3.35) and regional hospital nurses (HR: 2.06, 95% CI: 1.17-3.62). Conclusions: The prevalence of occupational diseases was higher in homecare nurses than in noncaregivers. The correlation between different practice environments and disease prevalence rates revealed that various types of nurses can be ranked in the following order based on the prevalence of the aforementioned diseases: homecare nurses > local community hospital nurses > regional hospital nurses > medical center nurses.
Collapse
Affiliation(s)
- Hua-Yin Hsu
- Department of Nursing, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan (R.O.C.)
| | - Chia-Chi Hsieh
- Department of Nursing, Chang Bing Show-Chwan Memorial Hospital, Changhua, Taiwan (R.O.C.)
| | - Yi-Chen Tseng
- Department of Obstetrics and Gynecology, China Medical University, An Nan Hospital, Tainan, Taiwan (R.O.C.)
| | - Chiu-Hsia Hung
- Department of Nursing, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan (R.O.C.)
| | - Kow-Tong Chen
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Chun-Hsiang Wang
- Department of Hepatogastroenterology and Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan (R.O.C.)
| | - Yuan-Tsung Tseng
- Department of Medical Research, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan (R.O.C.)
| |
Collapse
|
5
|
Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020581. [PMID: 31963207 PMCID: PMC7027002 DOI: 10.3390/ijerph17020581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
Healthcare workers (HCWs) have increased risk for latent tuberculosis infection (LTBI) and tuberculosis (TB) disease due to their occupational exposure. For some years now, interferon-γ release assays (IGRAs) have replaced the tuberculin skin test for the diagnosis of LTBI in many countries. This review examined the occupational risk of LTBI in HCWs with IGRA testing in low incidence countries. A systematic review and meta-analysis of studies from 2005 onwards provide data regarding the prevalence of LTBI in HCWs. In addition, the pooled effect estimates were calculated for individual regions and occupational groups. 57 studies with 31,431 HCWs from four regions and a total of 25 countries were analysed. The prevalence of LTBI varied from 0.9 to 85.5%. The pooled estimation found the lowest prevalence of LTBI for North American and West Pacific countries (<5%), and the highest prevalence for Eastern Mediterranean countries (19.4%). An increased risk for LTBI was found only for administrative employees. Studies on the occupational risk of LTBI continue to show increased prevalence of HCWs, even in low-incidence countries. Good quality studies will continue to be needed to describe occupational exposure.
Collapse
|
6
|
Cui Z, Lin D, Chongsuvivatwong V, Graviss EA, Chaiprasert A, Palittapongarnpim P, Lin M, Ou J, Zhao J. Hot and Cold Spot Areas of Household Tuberculosis Transmission in Southern China: Effects of Socio-Economic Status and Mycobacterium tuberculosis Genotypes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101863. [PMID: 31137811 PMCID: PMC6572207 DOI: 10.3390/ijerph16101863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022]
Abstract
The aims of the study were: (1) compare sociodemographic characteristics among active tuberculosis (TB) cases and their household contacts in cold and hot spot transmission areas, and (2) quantify the influence of locality, genotype and potential determinants on the rates of latent tuberculosis infection (LTBI) among household contacts of index TB cases. Parallel case-contact studies were conducted in two geographic areas classified as "cold" and "hot" spots based on TB notification and spatial clustering between January and June 2018 in Guangxi, China, using data from field contact investigations, whole genome sequencing, tuberculin skin tests (TSTs), and chest radiographs. Beijing family strains accounted for 64.6% of Mycobacterium tuberculosis (Mtb) strains transmitted in hot spots, and 50.7% in cold spots (p-value = 0.02). The positive TST rate in hot spot areas was significantly higher than that observed in cold spot areas (p-value < 0.01). Living in hot spots (adjusted odds ratio (aOR) = 1.75, 95%, confidence interval (CI): 1.22, 2.50), Beijing family genotype (aOR = 1.83, 95% CI: 1.19, 2.81), living in the same room with an index case (aOR = 2.29, 95% CI: 1.5, 3.49), travelling time from home to a medical facility (aOR = 4.78, 95% CI: 2.96, 7.72), history of Bacillus Calmette-Guérin vaccination (aOR = 2.02, 95% CI: 1.13 3.62), and delay in diagnosis (aOR = 2.56, 95% CI: 1.13, 5.80) were significantly associated with positive TST results among household contacts of TB cases. The findings of this study confirmed the strong transmissibility of the Beijing genotype family strains and this genotype's important role in household transmission. We found that an extended traveling time from home to the medical facility was an important socioeconomic factor for Mtb transmission in the family. It is still necessary to improve the medical facility infrastructure and management, especially in areas with a high TB prevalence.
Collapse
Affiliation(s)
- Zhezhe Cui
- Department of Tuberculosis Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
| | - Dingwen Lin
- Department of Tuberculosis Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
| | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, The Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, TX 77030, USA.
| | - Angkana Chaiprasert
- Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | | | - Mei Lin
- Department of Tuberculosis Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
| | - Jing Ou
- Department of Tuberculosis Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
| | - Jinming Zhao
- Department of Tuberculosis Control, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning 530028, China.
| |
Collapse
|
7
|
Shi CL, Xu JC, Chen H, Ye ZJ, Chen XN, Tang PJ, Ma LL, Tang ZX, Wu MY, Xu P. Risk factors of latent tuberculosis infection and immune function in health care workers in Suzhou, China. J Thorac Dis 2018; 10:6742-6752. [PMID: 30746219 DOI: 10.21037/jtd.2018.10.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The Chinese government has pay attention about tuberculosis infection among medical staff in infectious disease hospitals, but the effects have not yet been reported. This study will explore latent infection and immune function in the medical staff and systematically analyze the associated influencing factors. Methods Ninety-four medical staffs were enrolled and 20 medical staffs were defined as low risk group and others were high risk group. We used IFN-γ release assay and flow cytometry to analyze the latent TB infection status and immune function. Logistic regression analyses were performed to identify the independent risk factors of latent TB infection. Results This study explored and compared the infection status of medical workers and found that the rate of positive TB-IGRA results was higher among high risk group than in low risk group. Working environment, occupational history and work type were risk factors for TB infection in hospital. This study also found that high risk group had higher IFN-γ expression and a lower ratio of CD4+ to CD8+ T cells and further analysis found that this immune disorder is associated with wards and occupations. Conclusions This study through rigorous sample collection and analysis found the risk factors of latent tuberculosis infection in health care workers. This finding may provide a theoretical basis to be used by the countries with a high TB burden to further improve their strategies for the prevention of TB infections in hospitals and may give an indication for improving the personal health of medical staff in infectious disease hospitals.
Collapse
Affiliation(s)
- Cui-Lin Shi
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Jun-Chi Xu
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Hui Chen
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Zhi-Jian Ye
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Xin-Nian Chen
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Pei-Jun Tang
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Li-Ling Ma
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Zai-Xiang Tang
- Department of Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
| | - Mei-Ying Wu
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| | - Ping Xu
- Key Laboratory of Tuberculosis Prevention and Therapy, The Fifth People's Hospital of Suzhou, Suzhou 215000, China
| |
Collapse
|
8
|
Doan TN, Eisen DP, Rose MT, Slack A, Stearnes G, McBryde ES. Interferon-gamma release assay for the diagnosis of latent tuberculosis infection: A latent-class analysis. PLoS One 2017; 12:e0188631. [PMID: 29182688 PMCID: PMC5705142 DOI: 10.1371/journal.pone.0188631] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Accurate diagnosis and subsequent treatment of latent tuberculosis infection (LTBI) is essential for TB elimination. However, the absence of a gold standard test for diagnosing LTBI makes assessment of the true prevalence of LTBI and the accuracy of diagnostic tests challenging. Bayesian latent class models can be used to make inferences about disease prevalence and the sensitivity and specificity of diagnostic tests using data on the concordance between tests. We performed the largest meta-analysis to date aiming to evaluate the performance of tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) for LTBI diagnosis in various patient populations using Bayesian latent class modelling. METHODS Systematic search of PubMeb, Embase and African Index Medicus was conducted without date and language restrictions on September 11, 2017 to identify studies that compared the performance of TST and IGRAs for LTBI diagnosis. Two IGRA methods were considered: QuantiFERON-TB Gold In Tube (QFT-GIT) and T-SPOT.TB. Studies were included if they reported 2x2 agreement data between TST and QFT-GIT or T-SPOT.TB. A Bayesian latent class model was developed to estimate the sensitivity and specificity of TST and IGRAs in various populations, including immune-competent adults, immune-compromised adults and children. A TST cut-off value of 10 mm was used for immune-competent subjects and 5 mm for immune-compromised individuals. FINDINGS A total of 157 studies were included in the analysis. In immune-competent adults, the sensitivity of TST and QFT-GIT were estimated to be 84% (95% credible interval [CrI] 82-85%) and 52% (50-53%), respectively. The specificity of QFT-GIT was 97% (96-97%) in non-BCG-vaccinated and 93% (92-94%) in BCG-vaccinated immune-competent adults. The estimated figures for TST were 100% (99-100%) and 79% (76-82%), respectively. T-SPOT.TB has comparable specificity (97% for both tests) and better sensitivity (68% versus 52%) than QFT-GIT in immune-competent adults. In immune-compromised adults, both TST and QFT-GIT display low sensitivity but high specificity. QFT-GIT and TST are equally specific (98% for both tests) in non-BCG-vaccinated children; however, QFT-GIT is more specific than TST (98% versus 82%) in BCG-vaccinated group. TST is more sensitive than QFT-GIT (82% versus 73%) in children. CONCLUSIONS This study is the first to assess the utility of TST and IGRAs for LTBI diagnosis in different population groups using all available data with Bayesian latent class modelling. Our results challenge the current beliefs about the performance of LTBI screening tests, and have important implications for LTBI screening policy and practice. We estimated that the performance of IGRAs is not as reliable as previously measured in the general population. However, IGRAs are not or minimally affected by BCG and should be the preferred tests in this setting. Adoption of IGRAs in settings where BCG is widely administered will allow for a more accurate identification and treatment of LTBI.
Collapse
Affiliation(s)
- Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Damon P. Eisen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Morgan T. Rose
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Slack
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Grace Stearnes
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Emma S. McBryde
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| |
Collapse
|
9
|
The QuantiFERON-TB Gold In-Tube Assay in Neuro-Ophthalmology. J Neuroophthalmol 2017; 37:242-246. [DOI: 10.1097/wno.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Little LM, Graviss EA, Foroozan R, Lee AG. Screening for tuberculosis in neuro-ophthalmology. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1248407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
11
|
Nijhawan AE, Iroh PA, Brown LS, Winetsky D, Porsa E. Cost analysis of tuberculin skin test and the QuantiFERON-TB Gold In-tube test for tuberculosis screening in a correctional setting in Dallas, Texas, USA. BMC Infect Dis 2016; 16:564. [PMID: 27733123 PMCID: PMC5062880 DOI: 10.1186/s12879-016-1901-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) disproportionately affects immigrants, HIV-infected individuals, and those living in crowded settings such as homeless shelters and correctional facilities. Although the majority of jails and prisons use a tuberculin skin test (TST) for latent tuberculosis infection (LTBI) screening, limited data exist on the clinical performance and costs of the TST compared to interferon gamma release assays (IGRAs) in this setting. METHODS A prospective pilot study comparing cost between TST and an IGRA (QuantiFERON Gold In-tube, QFT-GIT) for the detection of LTBI in a convenience sample of inmates entering the Dallas County Jail (DCJ) was conducted June-October 2014. Participants completed a risk questionnaire, TST placement, QFT-GIT testing, and were offered opt-out HIV-Ab testing. LTBI prevalence based on TST and QFT-GIT results, an evaluation of discordant results and a cost analysis are presented. RESULTS A total of 529 subjects were enrolled. The majority were male (75 %), and 46 % were Black, 29 % White, and 24 % Hispanic. Most (85 %) had been previously incarcerated. Over 28 % of participants were released prior to TST reading, with paired QFT-GIT and TST results available for 351 subjects. Of these, nine (2.6 %) tested positive by TST and 47 (13.4 %) tested positive by QFT-GIT. It costs $23.27 more per inmate per year to screen with QFT-GIT than TST in this population, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT ($1247 v $460). CONCLUSIONS We found a substantially higher rate of QFT-GIT positivity compared to TST in this sample of individuals entering the Dallas County Jail. Although no gold standard exists, this finding may indicate under-recognized LTBI in this setting. QFT-GIT as an initial screening tool was more time-efficient, had four-fold fewer labor costs and provided results on more individuals when compared with the TST. The overall cost of QFT-GIT was $23.27 more per inmate per year, though the cost per LTBI case detected was nearly three times higher for TST than QFT-GIT. Further research is needed to determine the long-term performance of IGRA testing in the correctional setting and the public health implications of pairing QFT-GIT screening with other tests for communicable diseases.
Collapse
Affiliation(s)
- Ank E Nijhawan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA. .,Parkland Health & Hospital System, Dallas, Texas, USA.
| | - Princess A Iroh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Larry S Brown
- Department of Health Systems Research, Parkland Health & Hospital System, Dallas, Texas, USA
| | - Daniel Winetsky
- Rutgers University Correctional Health Care, Rutgers University, Trenton, NJ, USA
| | - Esmaeil Porsa
- Office of Strategy and Integration, Parkland Health and Hospital System, Dallas, Texas, USA
| |
Collapse
|
12
|
Durando P, Garbarino S, Orsi A, Alicino C, Dini G, Toletone A, Ciprani F, Conte G, Santorsa R, Icardi G. Prevalence and predictors of latent tuberculosis infection among Italian State Policemen engaged in assistance to migrants: a national cross-sectional study. BMJ Open 2016; 6:e012011. [PMID: 27697871 PMCID: PMC5073613 DOI: 10.1136/bmjopen-2016-012011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Better knowledge about tuberculosis (TB) and latent TB infection (LTBI) epidemiology is a crucial step for the development of effective strategies towards the control and elimination of this deadliest and persistent health threat. No study has investigated LTBI epidemiology in policemen who act as an interface with cross-border migrants. METHODS A survey to measure the LTBI prevalence and assess the demographic, professional and clinical features potentially associated with tuberculin skin test (TST) positivity was performed in Italian State Police (ISP) employees engaged, even occasionally, in relief activities, hospitality, photographical identification, escorting and accompanying of migrants, regardless of contact with active TB cases. Variables potentially associated with TST positivity were evaluated with univariate and multivariate analysis. RESULTS From September to December 2014, 4225 ISP workers underwent TST screening and completed the questionnaire for data collection, according to study procedures. The TST was positive in 9.9% of individuals: no active TB cases were registered among the entire study population. Age, previous BCG vaccination and work category resulted independently associated with TST positivity. CONCLUSIONS This is the first study providing updated data about LTBI epidemiology among ISP employees engaged in assistance to migrants and furnish preliminary evidence of possible associations between TST positivity and different conditions that need to be deeply investigated with prospective studies.
Collapse
Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | - Sergio Garbarino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | | | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Fabrizio Ciprani
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giuseppe Conte
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Roberto Santorsa
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| |
Collapse
|
13
|
Parlane NA, Gupta SK, Rubio-Reyes P, Chen S, Gonzalez-Miro M, Wedlock DN, Rehm BHA. Self-Assembled Protein-Coated Polyhydroxyalkanoate Beads: Properties and Biomedical Applications. ACS Biomater Sci Eng 2016; 3:3043-3057. [PMID: 33445349 DOI: 10.1021/acsbiomaterials.6b00355] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Polyhydroxyalkanoates (PHAs) are biological polyesters that can be naturally produced by a range of bacteria as water-insoluble inclusions composed of a PHA core coated with PHA synthesis, structural, and regulatory proteins. These naturally self-assembling shell-core particles have been recently conceived as biomaterials that can be bioengineered as biologically active beads for medical applications. Protein engineering of PHA-associated proteins enabled the production of PHA-protein assemblies exhibiting biologically active protein-based functions relevant for applications as vaccines or diagnostics. Here we provide an overview of the recent advances in bioengineering of PHA particles toward the display of biomedically relevant protein functions such as selected disease-specific antigens as diagnostic tools or for the design of particulate subunit vaccines against infectious diseases such as tuberculosis, meningitis, pneumonia, and hepatitis C.
Collapse
Affiliation(s)
- Natalie A Parlane
- AgResearch, Hopkirk Research Institute, Palmerston North 4442, New Zealand
| | - Sandeep K Gupta
- AgResearch, Hopkirk Research Institute, Palmerston North 4442, New Zealand
| | - Patricia Rubio-Reyes
- Institute of Fundamental Sciences, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
| | - Shuxiong Chen
- Institute of Fundamental Sciences, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
| | - Majela Gonzalez-Miro
- Institute of Fundamental Sciences, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
| | - D Neil Wedlock
- AgResearch, Hopkirk Research Institute, Palmerston North 4442, New Zealand
| | - Bernd H A Rehm
- Institute of Fundamental Sciences, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand.,MacDiarmid Institute for Advanced Materials and Nanotechnology, Kelburn Parade, Wellington 6140, New Zealand
| |
Collapse
|
14
|
Doosti-Irani A, Ayubi E, Mostafavi E. Tuberculin and QuantiFERON-TB-Gold tests for latent tuberculosis: a meta-analysis. Occup Med (Lond) 2016; 66:437-445. [PMID: 27121635 DOI: 10.1093/occmed/kqw035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Up to now, there has been no universal consensus on the agreement between the tuberculin skin test (TST) and the QuantiFERON-TB-Gold test (QFT) in the detection of latent tuberculosis infection (LTBI) among high-risk populations. AIMS To estimate the agreement between TST and QFT among health care workers (HCWs). METHODS A meta-analysis in which all major electronic databases, including Medline, Scopus, Web of Sciences and Ovid, were searched until June 2014. All cross-sectional and cohort studies addressing the agreement between TST and the QFT were included. The extracted data were analysed and the results were reported using random effect models. RESULTS The overall kappa statistic between TST and the QFT was 0.27 [95% confidence interval (CI) 0.22, 0.32] and the adjusted kappa statistic for prevalence and bias was 0.41 (95% CI 0.32, 0.50). The kappa for subjects with and without bacillus Calmette-Guérin (BCG) vaccination was 0.27 (95% CI 0.18, 0.36) and 0.31 (95% CI 0.15, 0.46) respectively. The figures were 0.30 (95% CI 0.16, 0.43) and 0.82 (95% CI 0.74, 0.90) for prevalence-adjusted and bias-adjusted kappa, respectively. CONCLUSIONS The overall agreement between TST and QFT in the detection of LTBI among HCWs was poor. After adjusting for the prevalence and bias indices, kappa statistics reached fair agreement. The utility of each of these two tests is dependent on the prevalence and burden of tuberculosis as well as the BCG vaccination status.
Collapse
Affiliation(s)
- A Doosti-Irani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, 6446-14155 Tehran, Iran.,Department of Epidemiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - E Ayubi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, 6446-14155 Tehran, Iran.,Department of Epidemiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran
| | - E Mostafavi
- Department of Epidemiology, Pasteur Institute of Iran, 1316943551 Tehran, Iran.,Research Center for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, 6556153145 Hamadan, Iran
| |
Collapse
|
15
|
Hochberg NS, Rekhtman S, Burns J, Ganley-Leal L, Helbig S, Watts NS, Brandeis GH, Ellner JJ, Horsburgh CR. The complexity of diagnosing latent tuberculosis infection in older adults in long-term care facilities. Int J Infect Dis 2016; 44:37-43. [PMID: 26802447 DOI: 10.1016/j.ijid.2016.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES In the USA, tuberculosis disease rates are highest in older adults. Diagnostic testing for latent tuberculosis infection (LTBI) has not been evaluated carefully in this group. The aim of this study was to define the relationship between tuberculin skin test (TST) results, T-SPOT.TB results, and T-cell responses to Mycobacterium tuberculosis antigens. METHODS Long-term care facility residents with known prior TST results (positive or negative) were retested with TSTs and T-SPOT.TB. Prior exposure to M. tuberculosis was assessed by quantifying T-cell activation to mycobacterial antigens in vitro. RESULTS The median age of the 37 participants was 77 years (range 57-98 years). Among 18 participants with a prior positive TST, three (16.7%) had a negative TST when retested (TST reversion); two had a negative T-SPOT.TB. Of the 15 who were historically and currently TST-positive, four (26.7%) had a negative T-SPOT.TB and one (6.7%) had a borderline result. Percentages of CD4+ T-cells responding to mycobacterial antigens were higher in participants with positive TST and T-SPOT.TB (18.2%) compared to those with a positive TST but negative T-SPOT.TB (6.4%, p=0.16) and negative TST and T-SPOT.TB (5.9%, p<0.001). CONCLUSIONS LTBI testing in older adults is complicated by TST reversion and TST-positive/T-SPOT.TB-negative discordance, which may reflect clearance of infection or waning immunity.
Collapse
Affiliation(s)
- Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USA; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
| | - Sergey Rekhtman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julianne Burns
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lisa Ganley-Leal
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USA
| | - Sina Helbig
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USA
| | - Nathaniel S Watts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Gary H Brandeis
- Department of Medicine, Section of Geriatric Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jerrold J Ellner
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Rm 2012 Boston, MA 02118, USA
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Crossa A, Kessler J, Harris TG. Enhanced Tuberculosis Infection Treatment Outcomes after Implementation of QuantiFERON®-Gold Testing. PLoS One 2015; 10:e0138349. [PMID: 26371760 PMCID: PMC4570766 DOI: 10.1371/journal.pone.0138349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/28/2015] [Indexed: 12/02/2022] Open
Abstract
Background Use of the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection (LTBI) among individuals who received the Bacille Calmette-Guérin (BCG) vaccine is complicated by its potential cross-reaction with TST antigens which may cause false-positive results and lead to patient and physician reluctance to initiate LTBI treatment. QuantiFERON®-TB Gold (QFT-G) lacks this cross-reaction. We sought to study the impact of implementing QFT-G testing in 2006 on LTBI treatment initiation and completion at NYC chest clinics. Methods QFT-G results from 10/2006–12/2008 in NYC Department of Health and Mental Hygiene chest clinics were obtained from the electronic medical record system. The proportions of patients who initiated and completed treatment among patients tested with QFT-G were compared to those tested with TST from 10/2004–9/2006. Results Among 36,167 patients tested with QFT-G, 2,300 (6%) tested positive, 33,327 (93%) tested negative, and 540 (1%) had an indeterminate result. Among those who had a positive QFT-G test and deemed eligible, 985 (80%) initiated LTBI treatment and 490 (40%) completed treatment. Historically, among patients tested with TST, 7,073 (19%) tested positive (p<0.0001 compared to QFT-G); 3,182 (79%) of those eligible initiated LTBI treatment and 1,210 (30%) completed treatment (p<0.0001 compared to QFT-G). Conclusions QFT-G implementation increased the proportion of patients completing LTBI treatment. Additional studies are needed in more settings to determine whether using QFT-G leads to a sustained increase in treatment completion.
Collapse
Affiliation(s)
- Aldo Crossa
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
- * E-mail:
| | - Jason Kessler
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
- Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Tiffany G. Harris
- New York City Department of Health and Mental Hygiene, New York, New York, United States of America
| |
Collapse
|
17
|
Ratnatunga CN, Thevanesam V, Nandadeva D, Madegedara D, Athula Kumara K. Cross-sectional screening of healthcare workers at a regional chest clinic with an interferon gamma release assay: first report from Sri Lanka. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
18
|
Mohammad HA, Esmail MA, Abdelftah MT, Soliman W, mohammad A, esmail E. Comparison of the 2-step tuberculin skin test and QuantiFERON-TB Gold in-Tube test in the screening of latent tuberculosis infection in cancer patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
19
|
Bagheri Amiri F, Saifi M, Gouya MM, Rohani M, Mostafavi E. Comparison of an interferon-gamma release assay and the tuberculin skin test for diagnosis of latent tuberculosis in homeless people in Iran: a cross-sectional study. Infect Dis (Lond) 2015; 47:536-41. [PMID: 25832455 DOI: 10.3109/23744235.2015.1026934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate of the concordance between the results of the tuberculin skin test (TST) and an interferon-γ release assay (QuantiFERON test, QFT-GIT) for diagnosis of latent tuberculosis infection (LTBI) in homeless people in Tehran city, Iran. METHODS This cross-sectional study was conducted from June to August 2012. Homeless people were eligible to participate in the study if they were 18-60 years old. RESULTS Among 569 homeless people, 46.22% (95% confidence interval (CI) = 42.16-50.33%) and 20.39% (95% CI = 17.28-23.9%) were QFT-GIT and TST positive, respectively. Among these participants, the prevalence of LTBI with positivity of at least one of the tests was 52.2%. The overall agreement between QFT-GIT and TST was 62.21% (kappa = 0.21, 95% CI = 0.13-0.29, p < 0.001). Factors associated with positive results in QFT-GIT and TST were older age, being male, having a longer history of homelessness and having a history of incarceration in the last 10 years. CONCLUSIONS A high prevalence of LTBI was seen among homeless people in this study. There was a poor concordance between QFT-GIT and TST among this group. To better assess the utility of QFT-GIT in detection of LTBI further studies with a low prevalence of LTBI in this group are recommended.
Collapse
|
20
|
Interferon-γ Release Assay vs. Tuberculin Skin Test for Tuberculosis Screening in Exposed Healthcare Workers: A Longitudinal Multicenter Comparative Study. Infect Control Hosp Epidemiol 2015; 36:569-74. [DOI: 10.1017/ice.2015.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEHealthcare workers (HCWs), especially those caring for patients with tuberculosis (TB), are at high risk of acquiring that disease. The poor specificity of tuberculin skin testing (TST) prompted us to evaluate the effectiveness of the interferon-γ release assay (IGRA) in comparison with TST in a large prospective, multicenter, 1-year study of HCWs with occupational exposure to TB.METHODSHCWs from high-risk units at 14 university hospitals were invited to participate and underwent both TST and IGRA (first Quantiferon TB Gold-IT®, QFT-G, then T-SPOT.TB® if QFT-G was indeterminate) at baseline and after 1 year. We collected demographic characteristics, country of birth, history of TB, immunosuppression, past exposure to TB, history of BCG vaccination, results of most recent TST, job category, and duration of current function.RESULTSAmong 807 HCWs enrolled, current or past TST at baseline was positive (≥15 mm) in 282 (34.9%); the IGRA was positive in 113 (14.0%) and indeterminate in 3 (0.4%). After 1 year, 594 HCWs had both an IGRA and TST (or prior TST≥15 mm) at baseline and an IGRA and TST (if indicated). The conversion rate was 2.5% (9 of 367) with TST and 7.6% (45 of 594) with IGRA, with poor agreement between the 2 tests. Using only QFT-G, conversion (9.9%) and reversion (17.8%) rates were higher for baseline QFT-G positive quantitative values <1 IU/mL.CONCLUSIONTST and the IGRA yielded discordant results. The value of IGRA in addition to TST remains undetermined; the two should be jointly interpreted in decision-making (clinical trial registration NCT00797836).Infect Control Hosp Epidemiol 2015;00(0): 1–6
Collapse
|
21
|
Lamberti M, Uccello R, Monaco MGL, Muoio M, Feola D, Sannolo N, Nienhaus A, Chiodini P. Tuberculin skin test and Quantiferon test agreement and influencing factors in tuberculosis screening of healthcare workers: a systematic review and meta-analysis. J Occup Med Toxicol 2015; 10:2. [PMID: 25670962 PMCID: PMC4323208 DOI: 10.1186/s12995-015-0044-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022] Open
Abstract
Objective A systematic review and meta-analysis was conducted to evaluate the agreement between Tuberculin Skin Test (TST) and Quantiferon (QFT) in screening for tuberculosis (TB) infection among healthcare workers (HCWs) and to estimate associations between TST and QFT agreement and variables of interest, such as Bacillus Calmette-Guérin (BCG) vaccination and incidence of TB. Methods Cross-sectional and longitudinal studies on HCWs, published in English until October 2013, comparing TST and QFT results, were selected. For each study Cohen’s κ value and a 95% confidence interval were calculated. Summary measures and indexes of heterogeneity between studies were calculated. Results 29 studies were selected comprising a total of 11,434 HCWs. Cohen’s κ for agreement between TST and QFT for 24 of them was 0.28 (95% CI 0.22 to 0.35), with the best value in high TB incidence countries and the lowest rate of BCG vaccination. Conclusion Currently, there is no gold standard for TB screening and the most-used diagnostic tools show low agreement. For evidence-based health surveillance in HCWs, occupational physicians need to consider a number of factors influencing screening results, such as TB incidence, vaccination status, age and working seniority.
Collapse
Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Rossella Uccello
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Maria Grazia Lourdes Monaco
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Daniela Feola
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Albert Nienhaus
- Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Principles of Prevention and Rehabilitation Department (GPR), Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
| |
Collapse
|
22
|
Babayigit C, Ozer B, Ozer C, Inandi T, Duran N, Gocmen O. Performance of QuantiFERON-TB Gold In-Tube test and Tuberculin Skin Test for diagnosis of latent tuberculosis infection in BCG vaccinated health care workers. Med Sci Monit 2014; 20:521-9. [PMID: 24681806 PMCID: PMC3976198 DOI: 10.12659/msm.889943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Tuberculin skin test (TST) has been used for years as an aid in diagnosing latent tuberculosis infection (LTBI) but it suffers from a number of well-documented performance and logistic problems. Quantiferon-TB Gold In Tube test (QFT-GIT) has been reported to have better sensitivity and specifity than TST. In this study, it was aimed to compare the performance of a commercial IFN-γ release assay (QFT-GIT) with TST in the diagnosis of HCWs at risk for latent TB infection in BCG vaccinated population. Material/Methods Hundred healthy volunteer health care workers were enrolled. All were subjected to TST and QFT-GIT. Results were compared among Health Care Workers (HCWs) groups in terms of profession, workplace, working duration. Results TST is affected by previous BCG vaccinations and number of cases with QFT-GIT positivity is increased in accordance with the TST induration diameter range. QFT-GIT result was negative in 17 of 32 TST positive (≥15 mm) cases and positive in 4 of 61 cases whose TST diameters are between 6–14 mm, that is attritutable to previous BCG vaccination(s). It was negative in all cases with TST diameters between 0–5 mm. HCWs with positive QFT-GIT results were significantly older than the ones with negative results. Furthermore duration of work was significantly longer in QFT-GIT positive than in negative HCWs. Conclusions There was a moderate concordance between QFT-GIT and TST, when TST result was defined as positive with a ≥15 mm diameter of induration. We suggest that QFT-GIT can be used as an alternative to TST for detection of LTBI, especially in groups with high risk of LTBI and in population with routine BCG vaccination program.
Collapse
Affiliation(s)
- Cenk Babayigit
- Department of Chest Diesases and Tuberculosis, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Burcin Ozer
- Department of Microbiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Cahit Ozer
- Department of Family Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Tacettin Inandi
- Department of Public Health, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Nizami Duran
- Department of Microbiology and Clinical Microbiology, Mustafa Kemal University, Antakya-Hatay, Turkey
| | - Orhan Gocmen
- Department of Tuberculosis Control Dispensary, Mustafa Kemal University, Hatay, Turkey
| |
Collapse
|
23
|
Dorman SE, Belknap R, Graviss EA, Reves R, Schluger N, Weinfurter P, Wang Y, Cronin W, Hirsch-Moverman Y, Teeter LD, Parker M, Garrett DO, Daley CL. Interferon-γ release assays and tuberculin skin testing for diagnosis of latent tuberculosis infection in healthcare workers in the United States. Am J Respir Crit Care Med 2014; 189:77-87. [PMID: 24299555 DOI: 10.1164/rccm.201302-0365oc] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE IFN-γ release assays (IGRAs) are alternatives to tuberculin skin testing (TST) for diagnosis of latent tuberculosis infection. Limited data suggest IGRAs may not perform well for serial testing of healthcare workers (HCWs). OBJECTIVES Determine the performance characteristics of IGRAs versus TST for serial testing of HCWs. METHODS A longitudinal study involving 2,563 HCWs undergoing occupational tuberculosis screening at four healthcare institutions in the United States, where the average tuberculosis case rate ranged from 4 to 9 per 100,000 persons. QuantiFERON-TB Gold In-Tube (QFT-GIT), T-SPOT.TB (T-SPOT), and TST were performed at baseline and every 6 months for 18 months between February 2008 and March 2011. MEASUREMENTS AND MAIN RESULTS A total of 2,418 HCWs completed baseline testing, which was positive for 125 (5.2%) by TST, 118 (4.9%) by QFT-GIT, and 144 (6.0%) by T-SPOT. A baseline positive TST with negative IGRAs was associated with bacillus Calmette-Guérin (BCG) vaccination (odds ratio: 25.1 [95% confidence interval: 15.5, 40.5] vs. no BCG). Proportions of participants with test conversion during the study period were 138 of 2,263 (6.1%) for QFT-GIT, 177 of 2,137 (8.3%) for T-SPOT, and 21 of 2,293 (0.9%) for TST (P < 0.001 for QFT-GIT vs. TST and for T-SPOT vs. TST; P = 0.005 for QFT-GIT vs. T-SPOT). Of the QFT-GIT and T-SPOT converters, 81 of 106 (76.4%) and 91 of 118 (77.1%), respectively, were negative when retested 6 months later. There was negative/positive discordance for 15 of 170 (8.8%) participants by QFT-GIT and for 19 of 151 (12.6%) by T-SPOT when blood was drawn 2 weeks later. CONCLUSIONS Most conversions among HCWs in low TB incidence settings appear to be false positives, and these occurred six to nine times more frequently with IGRAs than TST; repeat testing of apparent converters is warranted.
Collapse
Affiliation(s)
- Susan E Dorman
- 1 Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Evaluation of gamma interferon immune response elicited by the newly constructed PstS-1(285-374):CFP10 fusion protein to detect Mycobacterium tuberculosis infection. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:552-60. [PMID: 24521785 DOI: 10.1128/cvi.00726-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The PstS1 antigen is highly immunogenic, principally when combined with CFP10 during both latent and active TB infection. In the present study, a selected pstS1 gene fragment was cloned, fused with CFP10, and expressed in Escherichia coli. The product [PstS-1(285-374):CFP10] was compared to the recombinant fused RD1 (region of deletion 1) protein (ESAT-6:CFP10) in detecting Mycobacterium tuberculosis infection in 108 recent contacts of pulmonary tuberculosis (TB) cases, considering a positive tuberculin skin test (TST) to be the baseline. The release of gamma interferon (IFN-γ) in 22-h whole-blood and 5-day lymphocyte stimulation assays primed with each antigen was determined. All contacts were clinically followed for up to 1 year, and 87% of the tuberculin skin test-positive (TST(positive)) patients accepted preventative treatment. Concerning the IFN-γ response to PstS-1(285-374):CFP10 in the 22-h and 5-day assays, a slight increase in contact-TST(positive) detection was observed (23/54 and 26/54) compared to the level seen with the RD1 protein (18/54 and 24/54) whereas in the TST(negative) group, similarly lower numbers (≤5/48) of responders were achieved for both antigens, except for RD1 in the 5-day assay (8/48). By combining the IFN-γ responders to both antigens in the 5-day assays, slightly higher increases in positivity were found in the TST(positive) (32/54) and TST(negative) (10/48) groups. Two of 12 untreated TST(positive) contacts progressed to active TB and were concordantly positive in all assays, except for one contact who lacked positivity in the RD1 5-day assay. We demonstrated for the first time that PstS-1(285-374):CFP10 slightly increased contact positivity and detection of active disease progression, suggesting its potential application as a TB infection marker.
Collapse
|
25
|
Nienhaus A, Ringshausen FC, Costa JT, Schablon A, Tripodi D. IFN-γ release assay versus tuberculin skin test for monitoring TB infection in healthcare workers. Expert Rev Anti Infect Ther 2014; 11:37-48. [DOI: 10.1586/eri.12.150] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
26
|
Uto T, Yasuda K, Sagisaka S, Sato J, Imokawa S, Uemura N, Suda T, Chida K. Serial QuantiFERON TB-2G testing over a four-year period in healthcare workers at a city hospital. Intern Med 2014; 53:1119-24. [PMID: 24881734 DOI: 10.2169/internalmedicine.53.1288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the performance and practicality of QuantiFERON TB-2G (QFT-2G) testing for screening healthcare workers (HCWs) at a city hospital in Japan without a tuberculosis (TB)-specific ward. METHODS We performed a chart review of 951 HCWs (251 men and 700 women) who underwent QFT-2G testing as a part of their pre-employment or annual employee screening between April 2007 and March 2010. RESULTS The initial QFT-2G test was interpreted as positive in 28 (2.9%) HCWs, negative in 884 HCWs (92.9%) and indeterminate in 39 HCWs (4.1%). During the four-year study period, 37 HCWs were diagnosed as being positive at least once. Nine (0.98%) of the 923 HCWs with indeterminate or negative results on the initial testing converted to a positive status, including 6/479 (1.25%) nurses, 2/100 (2.0%) office staff members and 1/147 (0.68%) physicians. No HCWs with a positive result had a history of tuberculosis (TB) or any apparent contact with active TB patients and did not opt for treatment of latent TB. Seven (25%) of the 28 HCWs who were determined to be positive on the initial testing reverted to an indeterminate or negative status. CONCLUSION In a series of annual serial QFT-2G tests, some HCWs exhibited conversion and/or reversion. Therefore, caution is required when interpreting mild fluctuations in interferon-γ responses.
Collapse
Affiliation(s)
- Tomohiro Uto
- Department of Respiratory Medicine, Iwata City Hospital, Japan
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Hung WT, Lee SSJ, Sy CL, Wu KS, Chen JK, Tsai HC, Chen YS. Prevalence of latent tuberculosis infection in BCG-vaccinated healthcare workers by using an interferon-gamma release assay and the tuberculin skin test in an intermediate tuberculosis burden country. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 48:147-52. [PMID: 24071516 DOI: 10.1016/j.jmii.2013.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 06/13/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The risk of healthcare workers (HCWs) acquiring tuberculosis (TB) infection is high. We determined the prevalence of latent TB infection (LTBI) in HCWs with a high Bacille Calmette-Guérin (BCG) vaccine coverage in an intermediate TB burden country by using an interferon-gamma release assay [QuantiFERON-TB Gold (QFT-G)] and by using the tuberculin skin test (TST). Risk factors associated with a positive test were determined. METHODS This prospective cross-sectional study enrolled HCWs from a medical center in Taiwan. Participants were grouped into workers without exposure (Group 1) and workers who self-reported a history of TB exposure (Group 2). All participants completed a questionnaire to collect demographic information and risk factors for acquiring TB. The QFT-G test and the TST were administered and risk factors for a positive test were analyzed. RESULTS We recruited 193 HCWs [149 (77.2%) female workers] with a mean age of 35.6 years. All were BCG-vaccinated. The prevalence of LTBI was 88.8% (based on the TST) and 14.5% (based on the QFT-G test). There was no difference between HCWs with and without known exposure to TB. Agreement between the tests was poor (i.e., the kappa value was less than 0.05). Multivariable logistic regression showed that only the QFT-G test was associated with age (35 years or greater) (adjusted OR, 2.53; p = 0.03). CONCLUSION By using the QFT-G test or TST, this study found a similar prevalence of LTBI in HCWs with and without known exposure to TB. This suggests that in intermediate TB burden countries exposure to TB may occur within the hospital and within the community. Compared to the TST, the QFT-G test was correlated better with age, which is a known risk factor for latent TB infection.
Collapse
Affiliation(s)
- Wan-Ting Hung
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Len Sy
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuang-Sheng Wu
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jui-Kuang Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Chin Tsai
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
28
|
Zhang X, Jia H, Liu F, Pan L, Xing A, Gu S, Du B, Sun Q, Wei R, Zhang Z. Prevalence and Risk Factors for Latent Tuberculosis Infection among Health Care Workers in China: A Cross-Sectional Study. PLoS One 2013; 8:e66412. [PMID: 23823871 PMCID: PMC3688921 DOI: 10.1371/journal.pone.0066412] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/06/2013] [Indexed: 11/23/2022] Open
Abstract
Background Health care workers (HCWs) are at risk of latent tuberculosis infection (LTBI). In China, tuberculosis (TB) is a major public health problem, but the prevalence of LTBI in HCWs especially in the hospital for pulmonary diseases has not been assessed enough. The aim of this study was to determine the prevalence and putative risk factors of LTBI among HCWs in a chest hospital and a TB research institute in China. Methodology/Principal Findings A cross-sectional study was conducted among HCWs in China in 2012. LTBI was assessed by T-SPOT.TB, and information on HCWs was collected using a standardised questionnaire. Risk factors for LTBI were analyzed by univariate and multivariate regression. The overall prevalence of LTBI among HCWs was 33.6%. Analyzed by job category, the highest prevalence was found among laboratory staff (43.4%). In the different workplaces, the proportion of LTBI was significantly higher among the high risk workplaces (37.4%) compared to the low risk workplaces. The duration of employment had a significant impact on the prevalence of LTBI. Positive T-SPOT.TB test results accounted for 17.6%, 16.8%, 23.5%, 41.8% and 41.6% in groups of ≤2, 3–5, 6–10, 11–20, and >20 working years respectively. In multivariate analysis, job categories (Laboratory staff [2.76 (95% CI: 1.36; 5.60)], technician staff [2.02 (95% CI: 1.12; 3.64)]); working duration as a HCW for 11 to 20 years [3.57 (95% CI: 1.46; 8.71)], and 20 years above [3.41 (95% CI: 1.28; 9.11)]; and the history of household TB contact [2.47 (95% CI: 1.15; 5.33)] were associated with increased risk of LTBI. Conclusions/Significance Prevalence of LTBI estimated by T-SPOT.TB is high among Chinese HCWs and working duration, job category and the history of household TB contact were associated with increased risk. These data highlight adequate infection control measures should be undertaken.
Collapse
Affiliation(s)
- Xia Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Hongyan Jia
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Fei Liu
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Liping Pan
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Aiying Xing
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Shuxiang Gu
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Boping Du
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qi Sun
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Rongrong Wei
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Zongde Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
- * E-mail:
| |
Collapse
|
29
|
Gran G, Aßmus J, Dyrhol-Riise AM. Screening for latent tuberculosis in Norwegian health care workers: high frequency of discordant tuberculin skin test positive and interferon-gamma release assay negative results. BMC Public Health 2013; 13:353. [PMID: 23590619 PMCID: PMC3637593 DOI: 10.1186/1471-2458-13-353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) presents globally a significant health problem and health care workers (HCW) are at increased risk of contracting TB infection. There is no diagnostic gold standard for latent TB infection (LTBI), but both blood based interferon-gamma release assays (IGRA) and the tuberculin skin test (TST) are used. According to the national guidelines, HCW who have been exposed for TB should be screened and offered preventive anti-TB chemotherapy, but the role of IGRA in HCW screening is still unclear. Methods A total of 387 HCW working in clinical and laboratory departments in three major hospitals in the Western region of Norway with possible exposure to TB were included in a cross-sectional study. The HCW were asked for risk factors for TB and tested with TST and the QuantiFERON®TB Gold In-Tube test (QFT). A logistic regression model analyzed the associations between risk factors for TB and positive QFT or TST. Results A total of 13 (3.4%) demonstrated a persistent positive QFT, whereas 214 (55.3%) had a positive TST (≥ 6 mm) and 53 (13.7%) a TST ≥ 15 mm. Only ten (4.7%) of the HCW with a positive TST were QFT positive. Origin from a TB-endemic country was the only risk factor associated with a positive QFT (OR 14.13, 95% CI 1.37 - 145.38, p = 0.026), whereas there was no significant association between risk factors for TB and TST ≥ 15 mm. The five HCW with an initial positive QFT that retested negative all had low interferon-gamma (IFN-γ) responses below 0.70 IU/ml when first tested. Conclusions We demonstrate a low prevalence of LTBI in HCW working in hospitals with TB patients in our region. The “IGRA-only” seems like a desirable screening strategy despite its limitations in serial testing, due to the high numbers of discordant TST positive/IGRA negative results in HCW, probably caused by BCG vaccination or boosting due to repetitive TST testing. Thus, guidelines for TB screening in HCW should be updated in order to secure accurate diagnosis of LTBI and offer proper treatment and follow-up.
Collapse
|
30
|
Jo KW, Jeon K, Kang YA, Koh WJ, Kim KC, Kim YH, Yoo KH, Lee SH, Yim JJ, Choi SB, Choi WI, Choi JC, Hwang YI, Shim TS. Poor correlation between tuberculin skin tests and interferon-γ assays in close contacts of patients with multidrug-resistant tuberculosis. Respirology 2013; 17:1125-30. [PMID: 22758779 DOI: 10.1111/j.1440-1843.2012.02218.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The results of tuberculin skin tests (TST) and QuantiFERON TB-Gold In-Tube (QFT-GIT) assays were compared in close contacts of patients with multidrug-resistant tuberculosis (MDR-TB). METHODS Close contacts of patients with bacteriologically confirmed MDR-TB (n = 101) were assessed. Most contacts were members of the households of patients, and 79 (78.2%) had received Bacille Calmette-Guerin (BCG) vaccination. Samples from each contact were tested using the TST and the QFT-GIT assay on the same day, and the concordance between these results was assessed using kappa (κ) coefficients. RESULTS Forty-eight subjects (47.5%) showed positive responses on TST, using a 10-mm induration cut-off, and 54 (53.5%) were positive for the QFT-GIT assay. Of the 48 individuals who were TST positive, 34 (70.8%) were positive for the QFT-GIT assay. Of the 53 subjects who were TST negative, 33 (62.5%) were negative for the QFT-GIT assay. The overall agreement between the two tests (κ coefficient) was 0.33. The κ coefficient was higher in the 22 subjects who had not received BCG vaccination (κ = 0.48) than in the 79 subjects who had received BCG vaccination (κ = 0.29). CONCLUSION The TST and QFT-GIT assays showed poor correlation in close contacts of patients with MDR-TB, especially those contacts who had received BCG vaccination.
Collapse
Affiliation(s)
- Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul 138-736, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Tiernan JF, Gilhooley S, Jones ME, Chalmers JD, McSparron C, Laurenson IF, Hill AT. Does an interferon-gamma release assay change practice in possible latent tuberculosis? QJM 2013; 106:139-46. [PMID: 23159840 DOI: 10.1093/qjmed/hcs185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND AIMS Suspected latent tuberculosis infection (LTBI) is a common reason for referral to TB clinics. Interferon-gamma release assays (IGRAs) are more specific than tuberculin skin tests (TSTs) for diagnosing LTBI. The aim of this study is to determine if IGRA changes practice in the management of cases referred to a TB clinic for possible LTBI. DESIGN AND METHODS A prospective study was performed over 29 months. All adult patients who had TST, CXR & IGRA were included. The original decision regarding TB chemoprophylaxis was made by TB team consensus, based on clinical history and TST. Cases were then analysed with the addition of IGRA to determine if this had altered management. An independent physician subsequently reviewed the cases. RESULTS Of 204 patients studied, 68 were immunocompromised. 120 patients had positive TSTs. Of these, 36 (30%) had a positive QFT and 84 (70%) had a negative QFT. Practice changed in 78 (65%) cases with positive TST, all avoiding TB chemoprophylaxis due to QFT. Of the immunocompromised patients, 17 (25%) underwent change of practice. No cases of active TB have developed. CONCLUSION This study demonstrates a significant change of clinical practice due to IGRA use. Our findings support the NICE 2011 recommendations.
Collapse
Affiliation(s)
- J F Tiernan
- Department of Respiratory Medicine and TB Clinic, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Midlothian EH16 4SA, UK.
| | | | | | | | | | | | | |
Collapse
|
32
|
Kowalska JD, Czeszko-Paprocka H, Burkacka EF, Horban A. Interferon gamma release assay for identification of latent Mycobacterium tuberculosis infection in HIV hospital staff – The association between occupational and non-occupational exposure. HIV & AIDS REVIEW 2013. [DOI: 10.1016/j.hivar.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
33
|
Oni T, Gideon HP, Bangani N, Tsekela R, Seldon R, Wood K, Wilkinson KA, Goliath RT, Ottenhoff THM, Wilkinson RJ. Smoking, BCG and employment and the risk of tuberculosis infection in HIV-infected persons in South Africa. PLoS One 2012; 7:e47072. [PMID: 23056584 PMCID: PMC3467259 DOI: 10.1371/journal.pone.0047072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/07/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The increased susceptibility to latent tuberculosis infection (LTBI) of HIV-1-infected persons represents a challenge in TB epidemic control. However few studies have evaluated LTBI predictors in a generalized HIV/TB epidemic setting. METHODS The study recruited 335 HIV-infected participants from Khayelitsha, Cape Town between February 2008 and November 2010. Tuberculin skin tests and interferon-gamma release assays were performed on all participants and active TB excluded using a symptom screen, TB microscopy and culture. RESULTS LTBI prevalence was 52.7% and 61.2% (TST and IGRA respectively). Being a recent TB contact (OR 2.07; 95% C.I. 1.15-3.69) was associated with TST positivity. Participants with a CD4>200 had a two-fold higher risk of IGRA positivity compared to those with CD4 counts <200 (OR 2.07; 95% C.I. 0.99-4.34). There was also a 19% increase in IGRA positivity risk for every additional year of schooling and a strong association between years of schooling and employment (p = 0.0004). A decreased risk of IGRA positivity was observed in persons with a BCG scar (OR 0.46; 95% C.I. 0.31-0.69) and in smokers (OR 0.47; 95% C.I. 0.23-0.96). CONCLUSION We report the novel findings of a decreased risk of IGRA positivity in HIV-infected smokers possibly due to decreased interferon production, and in the persons with a BCG scar suggesting a protective role for BCG in this population. We also found an increased risk of TST positivity in employed persons, possibly due to ongoing transmission in public modes of transport.
Collapse
Affiliation(s)
- Tolu Oni
- Clinical Infectious Disease Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
[Prevalence of latent tuberculosis infection among health care workers from the emergency department of Meaux hospital using an interferon gamma release assay]. Presse Med 2011; 40:e516-20. [PMID: 21549552 DOI: 10.1016/j.lpm.2011.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/22/2010] [Accepted: 03/08/2011] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the prevalence of the latent tuberculosis infection (LTBI) among health care workers (HCW) of the emergency ward of Meaux hospital, by comparing it with two witnesses units: the orthopaedic surgery ward (referral service to low risk) and the respiratory ward (referral service to high risk). METHODS From July to December 2008, on a voluntary basis, anonymised blood samples of any HCW of the three departments were carried out by the occupational health service. Determination of interferon gamma was released by the test "QuantiFERON-TB Gold" (QFT). RESULTS Of the 137 eligible subject sampled, 16 had a positive QFT test: nine in the emergency ward, six in the respiratory ward and one in the orthopaedic surgery ward. The proportion of HCW with a positive QFT test was not significantly different between the three wards. DISCUSSION This study shows that HCWs of the emergency ward of the Meaux hospital are not working in a department where the risk of LTBI is high. CONCLUSION Our study shows that, in a territory of health where the incidence of the tuberculosis disease is superior to the national average, the emergency department of Meaux hospital does not belong to an area at high risk of LTBI. It underlines the interest of QFT test for the screening of LTBI among vaccinated persons.
Collapse
|
35
|
Comparing the performance of QuantiFERON-TB Gold and Mantoux test in detecting latent tuberculosis infection among Iranian health care workers. Int J Occup Med Environ Health 2011; 24:359-66. [DOI: 10.2478/s13382-011-0046-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 09/15/2011] [Indexed: 11/20/2022] Open
Abstract
Abstract
Collapse
|
36
|
Jong Lee K, Ae Kang Y, Mi Kim Y, Cho SN, Wook Moon J, Suk Park M, Kyu Kim S, Chang J, Sam Kim Y. Screening for latent tuberculosis infection in South Korean healthcare workers using a tuberculin skin test and whole blood interferon-gamma assay. ACTA ACUST UNITED AC 2010; 42:672-8. [PMID: 20482459 DOI: 10.3109/00365548.2010.485575] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study compared the results of a tuberculin skin test (TST) and a whole-blood interferon-gamma release assay (IGRA) to screen latent tuberculosis (TB) infection (LTBI) according to risk of TB exposure in South Korea. A cross-sectional comparison of 82 healthcare workers (HCWs) was performed from June 2009 to January 2010. Participants were grouped according to their risk for TB exposure: group 1, frequent and direct contact with active TB patients (n = 35); group 2, no known history of direct contact with active TB patients (n = 47). For the TST (10-mm induration cut-off), the positive response rate was 42.9% in group 1 and 34.0% in group 2 (p = 0.42). For the IGRA, the positive response rate was 40% in group 1 and 10.6% in group 2 (p = 0.002). Results obtained from the TST and the IGRA were not in significant agreement. The working duration of HCWs in TB-related departments was the only significant risk factor for LTBI (odds ratio 1.03; p = 0.031). Further, the IGRA can more accurately discriminate LTBI compared to the TST, based on the risk of TB exposure. These results suggest that the IGRA is diagnostically useful for LTBI in South Korean HCWs.
Collapse
Affiliation(s)
- Kyung Jong Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Predictors of persistently positive Mycobacterium-tuberculosis-specific interferon-gamma responses in the serial testing of health care workers. BMC Infect Dis 2010; 10:220. [PMID: 20653946 PMCID: PMC2916913 DOI: 10.1186/1471-2334-10-220] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 07/23/2010] [Indexed: 11/10/2022] Open
Abstract
Background Data on the performance of Mycobacterium-tuberculosis-specific interferon-(IFN)-γ release assays (IGRAs) in the serial testing of health care workers (HCWs) is limited. The objective of the present study was to determine the frequency of IGRA conversions and reversions and to identify predictors of persistent IGRA positivity among serially tested German HCWs in the absence of recent extensive tuberculosis (TB) exposure. Methods In this observational cohort-study HCWs were prospectively recruited within occupational safety and health measures and underwent a tuberculin skin test (TST) and the IGRA QuantiFERON®-TB Gold In-Tube (QFT-GIT) at baseline. The QFT-GIT was repeated 18 weeks later in the median. QFT-GIT conversions (and reversions) were defined as baseline IFN-γ < 0.35 IU/ml and follow-up IFN-γ ≥ 0.35 IU/ml (and vice versa). Predictors of persistently positive QFT-GIT results were calculated by logistic regression analysis. Results In total, 18 (9.9%) and 15 (8.2%) of 182 analyzed HCWs were QFT-GIT-positive at baseline and at follow-up, respectively. We observed a strong overall agreement between baseline and follow-up QFT-GIT results (κ = 0.70). Reversions (6/18, 33.3%) occurred more frequently than conversions (3/162, 1.9%). Age and positive prior and recent TST results independently predicted persistent QFT-GIT positivity. Furthermore, the chance of having persistently positive QFT-GIT results raised about 3% with each additional 0.1 IU/ml increase in the baseline IFN-γ response (adjusted odds ratio 1.03, 95% confidence interval 1.01-1.04). No active TB cases were detected within an observational period of more than two years. Conclusions The QFT-GIT's utility for the application in serial testing was limited by a substantial proportion of reversions. This shortcoming could be overcome by the implementation of a borderline zone for the interpretation of QFT-GIT results. However, further studies are needed to clearly define the within-subject variability of the QFT-GIT and to confirm that increasing age, concordantly positive TST results, and the extend of baseline IFN-γ responses may predict the persistence of QFT-GIT positivity over time in serially tested HCWs with only a low or medium TB screening risk in a TB low-incidence setting.
Collapse
|
38
|
Schablon A, Harling M, Diel R, Nienhaus A. Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study. BMC Infect Dis 2010; 10:107. [PMID: 20429957 PMCID: PMC2877045 DOI: 10.1186/1471-2334-10-107] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 04/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI. METHODS We tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation. RESULTS A positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession. CONCLUSION The prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour.
Collapse
Affiliation(s)
- Anja Schablon
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Department of Occupational Health Research, Pappelallee 35-37, 22089 Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Martinistraße 52, 20246 Hamburg, Germany
| | - Melanie Harling
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Department of Occupational Health Research, Pappelallee 35-37, 22089 Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Martinistraße 52, 20246 Hamburg, Germany
| | - Roland Diel
- Department of Pulmonary Medicine, Hannover Medical School (MHH), Carl-Neuberg-Straße1, 30625 Hannover, Germany
| | - Albert Nienhaus
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Martinistraße 52, 20246 Hamburg, Germany
| |
Collapse
|
39
|
Dyrhol-Riise AM, Gran G, Wentzel-Larsen T, Blomberg B, Haanshuus CG, Mørkve O. Diagnosis and follow-up of treatment of latent tuberculosis; the utility of the QuantiFERON-TB Gold In-tube assay in outpatients from a tuberculosis low-endemic country. BMC Infect Dis 2010; 10:57. [PMID: 20210999 PMCID: PMC2842274 DOI: 10.1186/1471-2334-10-57] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 03/08/2010] [Indexed: 11/17/2022] Open
Abstract
Background Interferon-gamma (IFN-γ) Release Assays (IGRA) are more specific than the tuberculosis skin test (TST) in the diagnosis of latent tuberculosis (TB) infection (LTBI). We present the performance of the QuantiFERON®-TB Gold In-tube (QFT-TB) assay as diagnostic test and during follow-up of preventive TB therapy in outpatients from a TB low-endemic country. Methods 481 persons with suspected TB infection were tested with QFT-TB. Thoracic X-ray and sputum samples were performed and a questionnaire concerning risk factors for TB was filled. Three months of isoniazid and rifampicin were given to patients with LTBI and QFT-TB tests were performed after three and 15 months. Results The QFT-TB test was positive in 30.8% (148/481) of the total, in 66.9% (111/166) of persons with origin from a TB endemic country, in 71.4% (20/28) previously treated for TB and in 100% (15/15) of those diagnosed with active TB with no inconclusive results. The QFT-TB test was more frequently positive in those with TST ≥ 15 mm (47.5%) compared to TST 11-14 mm (21.3%) and TST 6-10 mm (10.5%), (p < 0.001). Origin from a TB endemic country (OR 6.82, 95% CI 1.73-26.82), recent stay in a TB endemic country (OR 1.32, 95% CI 1.09-1.59), duration of TB exposure (OR 1.59, 95% CI 1.14-2.22) and previous TB disease (OR 11.60, 95% CI 2.02-66.73) were all independently associated with a positive QFT-TB test. After preventive therapy, 35/40 (87.5%) and 22/26 (84.6%) were still QFT-TB positive after three and 15 months, respectively. IFN-γ responses were comparable at start (mean 6.13 IU/ml ± SD 3.99) and after three months (mean 5.65 IU/ml ± SD 3.66) and 15 months (mean 5.65 IU/ml ± SD 4.14), (p > 0.05). Conclusion Only one third of those with suspected TB infection had a positive QFT-TB test. Recent immigration from TB endemic countries and long duration of exposure are risk factors for a positive QFT-TB test and these groups should be targeted through screening. Since most patients remained QFT-TB positive after therapy, the test should not be used to monitor the effect of preventive therapy. Prospective studies are needed in order to determine the usefulness of IGRA tests during therapy.
Collapse
Affiliation(s)
- Anne M Dyrhol-Riise
- Department of Medicine, Section of Infectious diseases, Haukeland University Hospital, Bergen, N-5021, Norway.
| | | | | | | | | | | |
Collapse
|
40
|
Costa JT, Silva R, Sá R, Cardoso MJ, Ribeiro C, Nienhaus A. Comparação do teste de libertação do interferão-γ e da prova de tuberculina no rastreio de profissionais de saúde. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30022-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
41
|
Babu S, Bhat SQ, Kumar NP, Kumaraswami V, Nutman TB. Regulatory T cells modulate Th17 responses in patients with positive tuberculin skin test results. J Infect Dis 2010; 201:20-31. [PMID: 19929695 DOI: 10.1086/648735] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The factors governing latency in tuberculosis are not well understood but appear to involve both the pathogen and the host. We have used tuberculin skin test (TST) positivity as a tool to study cytokine responses in latent tuberculosis. METHODS To identify the host factors that are important in the maintenance of TST positivity, we examined mycobacteria-specific immune responses of TST-positive (latent tuberculosis) or TST-negative individuals in South India, where TST positivity can define tuberculosis latency. RESULTS Although purified protein derivative-specific and Mycobacterium tuberculosis culture filtrate antigen-specific Th1 and Th2 cytokines were not statistically significantly different between the 2 groups, the Th17 cytokines (interleukin 17 and interleukin 23) were statistically significantly decreased in TST-positive individuals, compared with those in TST-negative individuals. This Th17 cytokine modulation was associated with statistically significantly increased expression of cytotoxic T lymphocyte antigen 4 (CTLA-4) and Foxp3. Although CTLA-4 blockade failed to restore full production of interleukin 17 and interleukin 23 in TST-positive individuals, depletion of regulatory T cells significantly increased production of these cytokines. CONCLUSION TST positivity is characterized by increased activity of regulatory T cells and a coincident down-regulation of the Th17 response.
Collapse
Affiliation(s)
- Subash Babu
- National Institutes of Health-International Center for Excellence in Research, India.
| | | | | | | | | |
Collapse
|
42
|
Park YK, Lee SH, Kim SY, Ryoo SW, Kim CK, Kim HJ, Cho EH, Yoo BH, Lee JK, Ko WJ. Interferon-γ Release Assay among Tuberculin Skin Test Positive Students in Korean High Schools. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.68.6.328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Young Kil Park
- Department of Microbiology, Korean Institute of Tuberculosis, Seoul, Korea
| | - Seung Heon Lee
- Department of Microbiology, Korean Institute of Tuberculosis, Seoul, Korea
| | - Su Young Kim
- Department of Microbiology, Korean Institute of Tuberculosis, Seoul, Korea
| | - Sung Weon Ryoo
- Department of Microbiology, Korean Institute of Tuberculosis, Seoul, Korea
| | - Chang Ki Kim
- Department of Microbiology, Korean Institute of Tuberculosis, Seoul, Korea
| | - Hee Jin Kim
- Department of Microbiology, Korean Institute of Tuberculosis, Seoul, Korea
| | - Eun Hee Cho
- Division of HIV and Tuberculosis Control, Center for Disease Control, Korea Centers for Disease Control & Prevention, Seoul, Korea
| | - Byung Hee Yoo
- Division of HIV and Tuberculosis Control, Center for Disease Control, Korea Centers for Disease Control & Prevention, Seoul, Korea
| | - Jong-Koo Lee
- Division of HIV and Tuberculosis Control, Center for Disease Control, Korea Centers for Disease Control & Prevention, Seoul, Korea
| | - Won-Jung Ko
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
43
|
Diel R, Loddenkemper R, Nienhaus A. Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis. Chest 2009; 137:952-68. [PMID: 20022968 DOI: 10.1378/chest.09-2350] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Test accuracy of interferon-gamma release assays (IGRAs) for diagnosing TB differs when using older or precommercial tools and inconsistent diagnostic criteria. This metaanalysis critically appraises studies investigating sensitivity and specificity of the commercial T-Spot.TB and the QuantiFERON-TB Gold In-Tube Assay (QFT-IT) among definitely confirmed TB cases. We searched Medline, EMBASE, and Cochrane bibliographies of relevant articles. Sensitivities, specificities, and indeterminate rates were pooled using a fixed effect model. Sensitivity of the tuberculin skin test (TST) was evaluated in the context of IGRA studies. In addition, the rates of indeterminates of both IGRAs were assessed. The pooled sensitivity of TST was 70% (95% CI, 0.67-0.72) compared with 81% (95% CI, 0.78-0.83) for the QFT-IT and 88% (95% CI, 0.85-0.90) for the T-Spot.TB. Sensitivity increased to 84% (95%CI, 0.81-0.87) and 89% (95% CI, 0.86-0.91) for the QFT-IT and T-Spot.TB, respectively, when restricted to performance in developed countries. In contrast, specificity of the QFT-IT was 99% (95% CI, 0.98-1.00) vs 86% for the T-Spot.TB (95% CI, 0.81-0.90). The pooled rate of indeterminate results was low, 2.1% (95% CI, 0.02-0.023) for the QFT-IT and 3.8% (95% CI, 0.035-0.042) for the T-Spot.TB, increasing to 4.4% (95% CI, 0.039-0.05) and 6.1% (95% CI, 0.052-0.071), respectively, among immunosuppressed hosts. The newest commercial IGRAs are superior, in comparison with the TST, for detecting confirmed active TB disease, especially when performed in developed countries.
Collapse
Affiliation(s)
- Roland Diel
- Department of Pulmonary Medicine, Hannover Medical School (MHH), Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | | | | |
Collapse
|
44
|
Tripodi D, Brunet-Courtois B, Nael V, Audrain M, Chailleux E, Germaud P, Naudin F, Muller JY, Bourrut-Lacouture M, Durand-Perdriel MH, Gordeeff C, Guillaumin G, Houdebine M, Raffi F, Boutoille D, Biron C, Potel G, Roedlich C, Geraut C, Schablon A, Nienhaus A. Evaluation of the tuberculin skin test and the interferon-gamma release assay for TB screening in French healthcare workers. J Occup Med Toxicol 2009; 4:30. [PMID: 19948042 PMCID: PMC2790451 DOI: 10.1186/1745-6673-4-30] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 11/30/2009] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-gamma Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients. METHODS Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST >/= 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered. RESULTS All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST >/= 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation. CONCLUSION The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.
Collapse
Affiliation(s)
- Dominique Tripodi
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | | | - Virginie Nael
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Marie Audrain
- Department of Immunology, University Hospital of Nantes, France
| | - Edmond Chailleux
- Department of Pneumology, Laënnec Hospital, University Hospital of Nantes, France
| | - Patrick Germaud
- Department of Pneumology, Laënnec Hospital, University Hospital of Nantes, France
| | - Frederique Naudin
- Tuberculosis Public Health Clinic, 6 rue Hippolyte Durand Gasselin, Nantes, France
| | | | | | | | - Claire Gordeeff
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Guyonne Guillaumin
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Marietherese Houdebine
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Francois Raffi
- Department of the Infectious and Tropical illnesses, Hospital, CHU Nantes, France
| | - David Boutoille
- Department of the Infectious and Tropical illnesses, Hospital, CHU Nantes, France
| | - Charlotte Biron
- Department of the Infectious and Tropical illnesses, Hospital, CHU Nantes, France
| | - Gilles Potel
- Emergency Department, University Hospital of Nantes, France
| | - Claude Roedlich
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Christian Geraut
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, France
| | - Anja Schablon
- Accident Insurance and Prevention in the Health and Welfare Services, Germany
| | - Albert Nienhaus
- Accident Insurance and Prevention in the Health and Welfare Services, Germany
| |
Collapse
|
45
|
Sawanyawisuth K, Chaiear N, Sawanyawisuth K, Limpawattana P, Bourpoern J, Reechaipichitkul W, Takahashi K. Can workplaces be predictors for recent onset latent tuberculosis in health care workers? J Occup Med Toxicol 2009; 4:20. [PMID: 19627620 PMCID: PMC2727517 DOI: 10.1186/1745-6673-4-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2009] [Accepted: 07/24/2009] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To study the association of workplaces and recent onset latent tuberculosis (LTB) in health care workers (HCW). METHODS A case-control study was conducted at Srinagarind Hospital, Khon Kaen University, Thailand. We recruited HCW who had results of tuberculin test within 2 consecutive years from 2001-2008 and also had fixed workplaces (working hours more than 40 hours/week). Cases were subjects with tuberculin conversion, while controls were subjects with negative results of tuberculin test in two consecutive years. Tuberculin conversion was defined if a subject had a negative baseline tuberculin test and a positive tuberculin test in the next consecutive years. Baseline characteristics, workplaces (office, in-patient unit, out-patient unit, intensive care, operating room, and laboratory unit), tuberculosis related variables, and prevention strategies were studied. Multiple logistic regression analysis was used to identify predictors for tuberculin conversion. RESULTS There were 624 subjects who met the criteria and 163 subjects had tuberculin conversion (26.1%; case group). The median age and male/female ratio of both groups were 39 years old and about 1:4. The cases group had higher percentage of subjects who worked at in- and out-patient department (30.7 vs 20.2 and 17.2 vs 12.2, respectively), had history of tuberculosis exposure in the past year (32.1 vs 16.1), and had history of prevention by any method and by surgical mask (49.4 vs 37.0 and 54.3 vs 38.3, respectively). Workings at in- and out-patient unit and history of tuberculosis exposure in the past year were significant predictors for tuberculin conversion (adjusted odds ratio and [95% confidence interval] of 1.99 [1.25-3.17], 1.91 [1.10-3.17], and 2.26 [1.47-4.96], respectively). SUMMARY Workplaces in health care facilities do increase risks of LTB in HCW, particularly in in- and out-patient unit. Policy development regarding tuberculosis infection control programs focused on workplace prevention in health care facilities in Thailand is needed.
Collapse
Affiliation(s)
- Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
| | | | | | | | | | | | | |
Collapse
|
46
|
Ringshausen FC, Schlösser S, Nienhaus A, Schablon A, Schultze-Werninghaus G, Rohde G. In-hospital contact investigation among health care workers after exposure to smear-negative tuberculosis. J Occup Med Toxicol 2009; 4:11. [PMID: 19505310 PMCID: PMC2698921 DOI: 10.1186/1745-6673-4-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Accepted: 06/08/2009] [Indexed: 11/17/2022] Open
Abstract
Background Smear-negative pulmonary tuberculosis (TB) accounts for a considerable proportion of TB transmission, which especially endangers health care workers (HCW). Novel Mycobacterium-tuberculosis-specific interferon-γ release assays (IGRAs) may offer the chance to define the burden of TB in HCW more accurately than the Mantoux tuberculin skin test (TST), but the data that is available regarding their performance in tracing smear-negative TB in the low-incidence, in-hospital setting, is limited. We conducted a large-scale, in-hospital contact investigation among HCW of a German university hospital after exposure to a single case of extensive smear-negative, culture-positive TB with pulmonary involvement. The objective of the present study was to evaluate an IGRA in comparison to the TST and to identify risk factors for test positivity. Methods Contacts were prospectively enrolled, evaluated using a standardized questionnaire, the IGRA QuantiFERON®-TB Gold in Tube (QFT-GIT) and the TST, and followed-up for two years. Active TB was ruled out by chest x-ray in QFT-GIT-positive subjects. Independent predictors of test positivity were established through the use of logistic regression analysis. Results Out of the 143 subjects analyzed, 82 (57.3%) had close contact, but only four (2.8%) experienced cumulative exposure to the index case >40 hours. QFT-GIT results were positive in 13 subjects (9.1%), while TST results were positive in 40 subjects (28.0%) at an induration >5 mm. Overall agreement was poor between both tests (kappa = 0.15). Age was the only predictor of QFT-GIT-positivity (Odds ratio 2.7, 95% confidence interval 1.32–5.46), while TST-positivity was significantly related to Bacillus Calmette-Guérin vaccination and foreign origin. Logistic regression analysis showed no relation between test results and exposure. No secondary cases of active TB were detected over an observational period of two years. Conclusion Our findings suggest a low contagiosity of the particular index case. The frequency of positive QFT-GIT results may in fact reflect the pre-existing prevalence of latent TB infection among the study population. TB transmission seems unlikely and contact tracing not generally warranted after cumulative exposure <40 hours. However, the substantially lower frequency of positive QFT-GIT results compared to the TST may contribute to enhanced TB control in health care.
Collapse
Affiliation(s)
- Felix C Ringshausen
- Department of Medicine III - Pneumology, Allergology and Sleep Medicine, University Hospital Bergmannsheil, Bochum, Germany.
| | | | | | | | | | | |
Collapse
|