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Pop LG, Bacalbasa N, Suciu ID, Ionescu P, Toader OD. Tuberculosis in pregnancy. J Med Life 2021; 14:165-169. [PMID: 34104238 PMCID: PMC8169139 DOI: 10.25122/jml-2021-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) in pregnancy is not only a matter of the past; it is also a current problem. These days, TB appears through mass migration and tourism in countries where it was believed that this condition is eradicated. Adequate knowledge about the medical history of patients, risk factors, diagnosis and treatment of tuberculosis should be part of the armamentarium of each physician involved in clinical practice. TB is mainly found in urban and socially deprived areas. Due to the length of the treatment, there is an increased risk of drug resistance in partially treated patients. Strong knowledge about the history, risk factors, diagnosis and treatment of TB should be part of the armamentarium of each physician. Many practitioners are reluctant to request a chest X-ray in pregnancy due to the fear of harming the fetus. Bypassing a diagnosis can have a devastating effect on the mother and fetus, as well as their family and medical staff. This article discusses the matters of diagnosis and treatment of asymptomatic infection and active TB in pregnancy.
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Affiliation(s)
- Lucian Gheorghe Pop
- Department of Obstetrics and Gynecology, Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Ioan Dumitru Suciu
- Department of General Surgery, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Paris Ionescu
- Department of Obstetrics and Gynecology, Ovidius University, Constanta, Romania
| | - Oana Daniela Toader
- Department of Obstetrics and Gynecology, Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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2
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Barry M. Prevalence of Latent Tuberculosis Infection in the Middle East and North Africa: A Systematic Review. Pulm Med 2021; 2021:6680651. [PMID: 33564476 PMCID: PMC7864757 DOI: 10.1155/2021/6680651] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Data on the prevalence of latent tuberculosis infection (LTBI) in Middle Eastern and North African countries are scarce. We aimed to review all relevant published data in countries belonging to this region to determine the overall prevalence of LTBI in the Middle East and North Africa (MENA) region. METHODS In this systematic review PubMed and Google Scholar databases were searched for observational, prospective, retrospective, cross-sectional, and cohort studies providing prevalence data of LTBI in any MENA country. Studies fulfilling the search criteria were incorporated in the review. Overall prevalence of LTBI with 95% confidence intervals (CI) was calculated using the random-effects model; heterogeneity was assessed using I 2 statistics. Gender and age group-based subgroup analyses were performed to evaluate the basis of heterogeneity. RESULTS The total number of overall LTBI studies identified was 956, of which 31 studies from ten countries within the MENA region were included that represented 12,439 subjects. The overall prevalence was 41.78% (95% CI 31.18% to 52.78%, I 2 = 99.31%). By gender-based subgroup analysis, the prevalence of LTBI was 33.12% (95% CI 18.97% to 49.04%, I 2 = 99.25%) and 32.65% (95% CI 19.79% to 47%, I 2 = 98.89%) in males and females, respectively, while in the age-based subgroup analysis, the prevalence of LTBI was 0.44% (95% CI -0.05% to 0.9%), 3.37% (95% CI 2.23% to 4.74%, I 2 = 0%), and 43.81% (95% CI 33.09% to 54.82%, I 2 = 99.18%) for children, adolescents, and adults, respectively. CONCLUSION This systematic review reveals a high prevalence of LTBI in the MENA region; enhanced LTBI surveillance and prompt infection prevention steps are urgently needed to prevent active tuberculosis, this would help achieve the World Health Organization End TB Strategy 2035, and the United Nations Sustainable Development Goals 2030 target in the MENA region.
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Affiliation(s)
- Mazin Barry
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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3
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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.
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Lu Y, Wang X, Dong H, Wang X, Yang P, Han L, Wang Y, Zheng Z, Zhang W, Zhang L. Bioinformatics analysis of microRNA expression between patients with and without latent tuberculosis infections. Exp Ther Med 2019; 17:3977-3988. [PMID: 30988779 PMCID: PMC6447890 DOI: 10.3892/etm.2019.7424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/06/2019] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis (TB) is a globally prevalent infectious disease. The mechanisms of latent TB infection (LTBI) remain to be fully elucidated and may provide novel approaches for diagnosis. As therapeutic targets and molecular diagnostic markers, microRNAs (miRs) have been studied and utilized in various diseases. In the present study, the differentially expressed miRs (DEMs) in LTBI were screened and analyzed to determine the underlying mechanisms and identify potential biomarkers, thereby contributing to the diagnosis of LTBI. The GSE25435 and GSE29190 datasets from Gene Expression Omnibus were selected for analysis. The 2 datasets were analyzed individually using the Bioconductor package to screen the DEMs with specific cut-off criteria [P<0.01 and |log (fold change)|≥1]. Target gene prediction and interaction network construction were performed using Targetscan, the Search Tool for the Retrieval of Interacting Genes and Proteins and Cytoscape individually, and were merged using the latter tool. The hub genes were finally selected based on their degree of connectivity (DC). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using the KEGG and GENCLIP. A total of 144 DEMs were identified from the 2 datasets. By exploring the overlapping miRs in the two datasets, Homo sapiens (hsa)-miR-29a and hsa-miR-15b were identified to be decreased, while hsa-miR-576-5p, hsa-miR-500 and hsa-miR-155 were identified to be upregulated. hsa-miR-500a-3p and hsa-miR-29a-3p, as well as 4 genes, namely cell division cycle (CDC)42, actin α1, skeletal muscle (ACTA1), phosphatase and tensin homolog (PTEN) and fos proto-oncogene (FOS), were selected as the key factors in this regulatory network. A total of 9 signaling pathways, including phosphoinositide-3 kinase (PI3K)/AKT and 11 biological processes, were identified to be associated with LTBI. In conclusion, the present analysis identified hsa-miR-500a-3p and hsa-miR-29a-3p, as well as CDC42, ACTA1, PTEN and FOS, as the most promising biomarkers and therapeutic candidates for LTBI. The PI3K/AKT signaling pathway is the key signaling pathway implicated in LTBI, and an in-depth investigation of the efficiency of PI3K/AKT signaling inhibitors may be used to prevent a chronic state of infection in LTBI.
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Affiliation(s)
- Yang Lu
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Xinmin Wang
- Department of Urinary Surgery, The First Affiliated Hospital, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Hongchang Dong
- Department of Biochemistry, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Xiaofang Wang
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Pu Yang
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Ling Han
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Yingzi Wang
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Zhihong Zheng
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Wanjiang Zhang
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
| | - Le Zhang
- Department of Pathophysiology, The Key Laboratory for Xinjiang Endemic and Ethnic Diseases, Medical College of Shihezi University, Shihezi, Xinjiang 832000, P.R. China
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Zhang C, Yang L, Zhao N, Zhao Y, Shi C. Insights into Macrophage Autophagy in Latent Tuberculosis Infection: Role of Heat Shock Protein 16.3. DNA Cell Biol 2018; 37:442-448. [PMID: 29461881 DOI: 10.1089/dna.2017.4066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Tuberculosis (TB) is a major bacterial infectious disease worldwide that is predominantly caused by Mycobacterium tuberculosis (Mtb). The comorbidity of multiple drug-resistant TB strains with HIV and diabetes is widespread. In the presence of these diseases, host immunity is weakened, allowing the recovery of dormant bacilli and leading to recurrent TB infection. As an important component of the host innate and adaptive immune responses, macrophage autophagy plays a significant role in protecting the host against TB. However, dormant bacilli can escape from autophagosomes and/or suppress autophagy, thus surviving within the host for an extended period of time, although the underlying mechanism remains elusive. Heat shock protein 16.3 (Hsp16.3, HspX, Rv2031c, and Acr) is one of the immunodominant proteins expressed during latent TB infection (LTBI). It may help maintain the protein stability and long-term viability of Mtb by inhibiting macrophage autophagy, resulting in LBTI. In this review, we discuss how dormant bacilli escape from autophagosomes, and we focus on the role of Hsp16.3 in regulating macrophage autophagy in LTBI so as to provide a firm basis for further studies. Hsp16.3 may represent a potential biomarker of LTBI and novel pharmacological target for anti-tubercular drugs.
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Affiliation(s)
- Caiqin Zhang
- Division of Infection and Immunology, Laboratory Animals Center, Fourth Military Medical University , Xi'an, China
| | - Li Yang
- Division of Infection and Immunology, Laboratory Animals Center, Fourth Military Medical University , Xi'an, China
| | - Ningning Zhao
- Division of Infection and Immunology, Laboratory Animals Center, Fourth Military Medical University , Xi'an, China
| | - Yong Zhao
- Division of Infection and Immunology, Laboratory Animals Center, Fourth Military Medical University , Xi'an, China
| | - Changhong Shi
- Division of Infection and Immunology, Laboratory Animals Center, Fourth Military Medical University , Xi'an, China
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Lamberti M, Muoio MR, Westermann C, Nienhaus A, Arnese A, Ribeiro Sobrinho AP, Di Giuseppe G, Garzillo EM, Crispino V, Coppola N, De Rosa A. Prevalence and associated risk factors of latent tuberculosis infection among undergraduate and postgraduate dental students: A retrospective study. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2017; 72:99-105. [PMID: 27018614 DOI: 10.1080/19338244.2016.1167006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/12/2016] [Indexed: 06/05/2023]
Abstract
To estimate the prevalence of latent tuberculosis (TB) infection (LTBI) in Italian dental students exposed to the same occupational risks as dental health care personnel and to evaluate potential risk factors, a cross-sectional study was conducted on undergraduate and postgraduate students. After clinical evaluation, students were given a tuberculin skin test; in those found positive, an interferon-γ release assay (IGRA) was conducted. Of the 281 students enrolled, 10 were only TST positive; 8 were TST or/and IGRA positive. We found that participants testing positive at TST and/or IGRA, a group in which the risk of false LTBI positives is minimal, were older and had been studying longer. Although the prevalence of LTBI among dental students in our study was low, a risk of acquiring a work-related infection exists even in a country with a low incidence of TB. Thus, dental students should be screened to catch LTBI early on.
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Affiliation(s)
- Monica Lamberti
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Maria Rosaria Muoio
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Claudia Westermann
- b Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Albert Nienhaus
- b Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Antonio Arnese
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Antônio Paulino Ribeiro Sobrinho
- c Department of Operative Dentistry , Dental School, Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - Gabriella Di Giuseppe
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Elpidio Maria Garzillo
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Vincenzo Crispino
- a Department of Experimental Medicine , Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples , Naples , Italy
| | - Nicola Coppola
- d Department of Mental Health and Public Medicine , Section of Infectious Diseases, Second University of Naples , Naples , Italy
| | - Alfredo De Rosa
- e Department of Orthodontics , Second University of Naples , Naples , Italy
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Lamberti M, Muoio M, Arnese A, Borrelli S, Di Lorenzo T, Garzillo EM, Signoriello G, De Pascalis S, Coppola N, Nienhaus A. Prevalence of latent tuberculosis infection in healthcare workers at a hospital in Naples, Italy, a low-incidence country. J Occup Med Toxicol 2016; 11:53. [PMID: 27904647 PMCID: PMC5122022 DOI: 10.1186/s12995-016-0141-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/11/2016] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare workers (HCWs) are at higher risk than the general population of contracting tuberculosis (TB). Moreover, although subjects with latent TB infection (LTBI) are asymptomatic and are not infectious, they may eventually develop active disease. Thus, a fundamental tool of TB control programs for HCWs is the screening and treatment of LTBI. Methods From January 2014 to January 2015, hospital personnel at Azienda Ospedaliera Universitaria, Naples, Italy, were screened for TB. To this end, a tuberculin skin test (TST) was administered as an initial examination, unless when contraindicated, in which case the QuantiFERON® TB-Gold (QFT) assay was performed. Moreover, QFT was carried out on all TST-positive cases to confirm the initial result. Results Of 628 personnel asked to participate, 28 (4.5%) denied consent, 533 were administered TST as the baseline examination, and 67 were tested only with QFT. In the TST group, 73 (13.2%) individuals were found positive, 418 (78.4%) were negative, and 42 (7.9%) were absent for the reading window; QFT confirmed the result in 39 (53.4%) TST-positive individuals. In the QFT-only group, 44 (65.7%) individuals were found positive. All TST- and/or QFT-positive subjects were referred for chest X-ray and examination by an infectious diseases specialist. None were found to have active TB, and were thus diagnosed with LTBI. Conclusions Although Italy is a low-incidence country regarding TB, our findings suggest that the prevalence of LTBI in HCWs may be relatively high. As a result, active screening for TB and LTBI is needed for these workers. Electronic supplementary material The online version of this article (doi:10.1186/s12995-016-0141-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, 80133 Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, 80133 Naples, Italy
| | - Antonio Arnese
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, 80133 Naples, Italy
| | - Sharon Borrelli
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, 80133 Naples, Italy
| | - Teresa Di Lorenzo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, 80133 Naples, Italy
| | - Elpidio Maria Garzillo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Via dei Crecchi 16, 80133 Naples, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Albert Nienhaus
- Institute for Health Services, Research in Dermatology and Nursing, Germany, Institution for Statutory Accident Insurance and Prevention in Healthcare and Welfare Services, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Olivieri R, Scarnera S, Ciabattini A, De Vuono G, Manzi P, Pozzi G, Battista G, Medaglini D. Using IFN-gamma release assay to confirm tuberculin skin test improves the screening of latent tuberculosis infection in Italian healthcare workers. J Occup Med Toxicol 2016; 11:29. [PMID: 27279894 PMCID: PMC4897955 DOI: 10.1186/s12995-016-0117-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/24/2016] [Indexed: 12/01/2022] Open
Abstract
Background Healthcare workers (HCWs) represent a tuberculosis (TB) risk group for a wide range of tasks in healthcare, even in countries with low TB incidence, like Italy. Latent Tuberculosis Infection (LTBI) screening programs are an important tool for TB prevention in these setting. Methods A retrospective study under a LTBI screening program among HCWs at the Siena University Hospital (Italy), was conducted between September 2011 and July 2015. Tuberculin Skin Test (TST) was used as a first level examination; all TST-positive cases were tested with QuantiFERON-TB Gold In-Tube (QFT-GIT) test, together with a group of TST-negative subjects. Results Among the 2136 HCWs screened, 144 (6.7 %) were TST-positive and therefore tested with QFT-GIT, confirming a positive result in 36 cases (25 %). Agreement between two tests was poor (k = 0.092; 95 %, Confidence Interval [CI]- 0.048–0.136, p = 0.002). Among TST-positive cases, discordant results occurred more frequently in BCG vaccinated than unvaccinated HCWs (86.3 %, p < 0.001). The probability of a QFT-GIT-positive result increased according to the TST diameter (p = 0.001). No putative risk factor was associated with LTBI occurrence. Conclusions The use of QFT-GIT test as a second step in TST-positive cases offers an appropriate tool for LTBI detection, especially among BCG-vaccinated HCWs.
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Affiliation(s)
- Raffaela Olivieri
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Sara Scarnera
- Medicina Preventiva e Sorveglianza Sanitaria, Dipartimento di Biotecnologie Mediche, Universita' degli Studi di Siena, Siena, Italy
| | - Annalisa Ciabattini
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Giulia De Vuono
- Medicina Preventiva e Sorveglianza Sanitaria, Dipartimento di Biotecnologie Mediche, Universita' degli Studi di Siena, Siena, Italy
| | - Pietro Manzi
- Direzione Medica di Presidio, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gianni Pozzi
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Giuseppe Battista
- Medicina Preventiva e Sorveglianza Sanitaria, Dipartimento di Biotecnologie Mediche, Universita' degli Studi di Siena, Siena, Italy
| | - Donata Medaglini
- Laboratorio di Microbiologia Molecolare e Biotecnologia, Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
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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.
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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
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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.
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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
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Martinez-Lacasa X, Font R, Gonzalez S, Sallent S, Jaen A, Lite J, Cuchi E. [Usefulness of Quantiferon-TB Gold in Tube® in screening for latent tuberculosis infection in health workers]. Enferm Infecc Microbiol Clin 2015; 33:525-31. [PMID: 25613557 DOI: 10.1016/j.eimc.2014.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/26/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Healthcare workers (HW) are considered a risk group for exposure to tuberculosis. Screening for latent tuberculosis infection (LTBI) is mandatory in all HW. The Tuberculin test (TT) has been used up until now for LTBI screening, but gives a high number of false positives, especially in patients vaccinated with BCG. Diagnostic methods based on detection of specific gamma interferon (IGRA) have recently appeared on the market in order to improve these drawbacks, but pose other dilemmas. The aim of this study is to determine the agreement between the two types of test and to carry out a cost-benefit study of the possible diagnostic strategies. MATERIAL AND METHODS All newly hired HW by the Hospital Universitari Mútua Terrassa between January 2010 and October 2011 we were included in the study, as well as those who had their occupational review. Workers who been in contact with patients admitted with tuberculosis before the initial isolation were also tested. In all cases a parallel TT and serum QuantiFeron-TB Gold-in-Tube(®) (QF-G-IT) assays were performed. TB disease was ruled out in all professional by chest X-ray. The TT was considered positive when it was equal to or more than 10mm and if the QF-G-IT was 0.35 IU/mL. A cost-effectiveness analysis was designed with three possible strategies to detect LTBI in order to find the one with the best cost-benefit. RESULTS A total of 226 HW were studied, with a mean age 30.65 ± 16, of whom 44 (19.4%) had previous BCG vaccination history, and 8 (3.5%) unknown. The TT was positive in 33 (14.6%) cases and the QF-G-IT in 17 (7.5%). The values of the TT and QF-G-IT were both positive in 15 cases. In 18 (8%) The TT was positive in 18 (8%) of cases with a negative QF-G-IT value. The agreement between the two tests was 91%, with a Kappa of 0.55. In vaccinated cases, the correlation was 70.5%, with a Kappa of 0.33, while in unvaccinated it was 98.9% with a Kappa of 0.65. The cheapest screening strategies for LTBI diagnosis were those based on TT, but followed closely by the strategy based on TT with reconfirmation of positives with QF-G-IT. CONCLUSIONS QF-G-IT seems to be a very sensitive technique to detect LTBI and allows false positives due to TT to be detected, particularly in BCG vaccinated HW. In this group QF-G-IT could be the ideal test to detect truly infected staff, and avoid unnecessary chemoprophylaxis. The most cost-benefit strategy was those based in TT with reconfirmation or rejection of positive cases by QF-G-IT.
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Affiliation(s)
- Xavier Martinez-Lacasa
- Unitat de Control de Tuberculosis, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España.
| | - Roser Font
- Unitat de Control de Tuberculosis, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - Susana Gonzalez
- Servei de Prevenció de Riscos Laborals, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - Sonia Sallent
- Servei de Prevenció de Riscos Laborals, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - Angels Jaen
- Fundació per a la Recerca, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - Josep Lite
- Cat Lab, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - Eva Cuchi
- Cat Lab, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
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Lamberti M, Muoio M, Monaco MGL, Uccello R, Sannolo N, Mazzarella G, Garzillo EM, Arnese A, La Cerra G, Coppola N. Prevalence of latent tuberculosis infection and associated risk factors among 3,374 healthcare students in Italy. J Occup Med Toxicol 2014; 9:34. [PMID: 25302073 PMCID: PMC4190494 DOI: 10.1186/s12995-014-0034-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/23/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction The risk of tuberculosis (TB) in healthcare personnel (HCP) is related to its incidence in the general population. Healthcare students involved in clinical training could be exposed to occupational risks similar to those that HCP face. The prevalence of latent tuberculosis infection (LTBI) among undergraduate healthcare students with different working seniority in Italy was analysed. Methods A cross-sectional study under a screening programme for LTBI among undergraduate and postgraduate students attending Medical School at the Second University of Naples was conducted between January 2012 and December 2013 with clinical evaluations, tuberculin skin testing (TST) and, in positive TST students, Interferon-γ release assays (IGRA). Putative risk factors for LTBI were assessed by means of a standardised questionnaire. Results 3,374 students attending the Medical School of the Second University of Naples were submitted to a screening programme for TBC. 3,331 performed TST as a first-level test and 43 performed a Quantiferon test (QFT). 128 students were TST-positive and continued the diagnostic work with QFT, which was positive in 34 students. Of the 43 subjects who took the QFT as a first-level test only 1 was positive. In 35 students positive to the QFT test we formulated the diagnosis of LTBI by clinical and radiographic results. A correlation was found between age, non-Italian born persons, studying age, post-medical school status and LTBI. Conclusions The prevalence of LTBI among healthcare students in our study was very low. In countries with a low incidence of TB, the screening programmes of healthcare students can be useful for early identification and treatment of sporadic cases of LTBI. Electronic supplementary material The online version of this article (doi:10.1186/s12995-014-0034-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monica Lamberti
- 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
| | - Maria Grazia Lourdes Monaco
- 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
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Gennaro Mazzarella
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Elpidio Maria Garzillo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Anonio Arnese
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic Medicine, Second University of Naples, Naples, Italy
| | - Giuseppe La Cerra
- Department of Cardio-Thoracic and Respiratory Science, Second University of Naples, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Second University of Naples, Naples, Italy
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Muzzi A, Seminari E, Feletti T, Scudeller L, Marone P, Tinelli C, Minoli L, Marena C, Mangiarotti P, Strosselli M. Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital. BMC Infect Dis 2014; 14:324. [PMID: 24919953 PMCID: PMC4065580 DOI: 10.1186/1471-2334-14-324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented. Methods All HCWs exposed to a patient with cultural confirmed pulmonary TB and respiratory protection measures were not implemented were included. Data on TST results performed in the past (defined as T0) were recorded. TST was performed twice: first, immediately after exposure to an index patient (T1) and three months later (T2). The period of time between T0 and T1 was used to calculate he annual rate of tuberculosis infection (ARTI), while le period of time between T1 and T2 was used to calculate the post exposure annual rate of tuberculosis infection (PEARTI). Results Fourteen index patients were admitted; sputum smear was positive in 7 (58.3%), 4 (28.6%) were non-Italian born patients. 388 HCWs were exposed to index patients, a median of 27 (12-39) HCW per each index patient. One hundred eighty (46.4%) HCWs received BCG in the past. One hundred twenty two HCWs (31%) were TST positive at a previous routine screening and not evaluated in this subset. Among the remaining 255 HCWs with negative TST test in the past, TST at T1 was positive in 11 (4.3%). ARTI was 1.6 (95% CI 0.9-2.9) per 100 PY. TST at T2 was positive in 9 (3.7%) HCWs, that were TST negative at T1. PEARTI was 26 (95% CI 13.6-50) per 100 PY. At univariate analysis, older age was associated with post exposure latent tuberculosis infection (HR 1.12; 95% CI 1.03-1.22, p=0.01). Conclusions PEARTI was considerably higher among HCWs exposed to index patients than ARTI. These data underscore the overwhelming importance of performing a rapid diagnosis, as well as implementing adequate respiratory protection measures when TB is suspected.
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Affiliation(s)
- Alba Muzzi
- Direzione Medica di Presidio, Fondazione IRCCS Policlinico San Matteo, viale Camillo Golgi 19, Pavia 27100, Italy.
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Guanche Garcell H, Crespo Ramirez E, Kindelan Contreras A, Gutierrez Garcia F. Latent tuberculosis infection in healthcare workers at a community hospital in Qatar. J Infect Public Health 2014; 7:356-9. [PMID: 24702746 DOI: 10.1016/j.jiph.2014.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/01/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022] Open
Abstract
UNLABELLED Routine screening of latent tuberculosis infection (LTBI) is recommended as an essential component in the prevention of TB transmission in healthcare facilities. OBJECTIVE To determine the prevalence of LTBI among healthcare workers (HCWs) in a community hospital. METHODS A descriptive study was carried out at The Cuban Hospital from August 2012 to May 2013 for newly hired medical staff. As part of the preemployment evaluation, the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-G) were performed. The information regarding the demographics, profile, experience as HCWs, any previous contact with TB patients and travels abroad were collected. ANALYSIS Test of independence, Student's t test and Wilcoxon Mann-Whitney were used. For hypothesis testing, a significance level of 0.05 was adopted. RESULTS TST results were positive in 14 subjects (6.9%), of which 11 were nurses, and 12 were females. QFT-G results were positive in six subjects (3.0%), who were older than those with negative results (44.5 vs. 38.9 years) and had more experience as HCW (21.7 vs. 16.8 years). Compared with subjects negative for QFT-G, positive subjects reported a higher frequency of both direct contact with tuberculosis patients (83.3% vs. 25%) and previous travels to countries with high TB incidence. CONCLUSION Incidence of LTBI was low, especially when QFT-G results were considered, highlighting the history of traveling to countries with high TB incidence as an associated key factor.
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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.
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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
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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]
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17
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Gonzalez M, Conlon HA. Updating a Tuberculosis Surveillance Program: Considering All of the Variables. Workplace Health Saf 2013. [DOI: 10.3928/21650799-20130516-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Gonzalez M, Conlon HA. Updating a Tuberculosis Surveillance Program. Workplace Health Saf 2013; 61:271-8; quiz 279. [DOI: 10.1177/216507991306100606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 03/05/2013] [Indexed: 11/15/2022]
Abstract
Tuberculosis surveillance programs have used the same testing methods for almost a century. New testing methods have been approved and are available, but how does a health care provider determine which diagnostic test is best in a given situation? Reviewing research statistics can be confusing, and the types of studies conducted may not be similar to a particular application. Development of an organizational needs assessment based on Centers for Disease Control and Prevention (CDC) requirements, organizational resources, the needs of the employee population, and the logistics of multiple campus sites prior to evaluating the available testing methods can assist occupational health nurses navigate the decision-making process. This article presents an example of a moderately sized health care facility to illustrate how to conduct a needs assessment that results in a decision as to which program best suits the organization.
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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
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20
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Fraisse P. Diagnostic des infections tuberculeuses latentes (sujets sains, sujets immunodéprimés ou amenés à l’être). Rev Mal Respir 2012; 29:277-318. [DOI: 10.1016/j.rmr.2011.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/11/2011] [Indexed: 01/30/2023]
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Worjoloh A, –Maeda MK, Osmond D, Freyre R, Aziz N, Cohan D. Interferon gamma release assay compared with the tuberculin skin test for latent tuberculosis detection in pregnancy. Obstet Gynecol 2011; 118:1363-1370. [PMID: 22105266 PMCID: PMC3232049 DOI: 10.1097/aog.0b013e31823834a9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate agreement and correlation between the tuberculin skin test and an interferon gamma release assay for detecting latent tuberculosis (TB) infection in pregnant women. METHODS We conducted a cross-sectional study of pregnant women initiating prenatal care at a university-affiliated public hospital between January 5, 2009, and March 15, 2010. Eligible women received a questionnaire about TB history and risk factors as well as the tuberculin skin test and phlebotomy for the interferon gamma release assay. Agreement and correlation between tests were estimated, and different cutoffs for interferon gamma release assay positivity were used to assess effect on agreement. Furthermore, predictors of test positivity and test discordance were evaluated using multivariable analysis. RESULTS Of the 220 enrolled women, 199 (90.5%) returned for tuberculin skin test evaluation. Over 70% were Hispanic and 65% were born in a country with high TB prevalence. Agreement between the tuberculin skin test and interferon gamma release assay was 77.39 (κ=0.26). This agreement was not significantly changed using different cutoffs for the assay. Birth bacille Calmette-Guérin vaccination was associated with tuberculin skin test positivity (odds ratio [OR] 4.33, 95% confidence interval [CI] 1.4-13.48, P=.01), but not interferon gamma release assay positivity. There were no statistically significant predictors of the tuberculin skin test and interferon gamma release assay result discordance; however, birth in a high-prevalence country was marginally associated with tuberculin skin test-positive and interferon gamma release assay-negative results (OR 2.94, 95% CI 0.86-9.97 P=.08). CONCLUSION Comparing the tuberculin skin test and interferon gamma release assay results in pregnancy, concordance and agreement were poor. Given that much is still unknown about the performance of interferon gamma release assays in pregnancy, further research is necessary before the tuberculin skin test is abandoned for screening of latent TB infection in pregnancy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ayaba Worjoloh
- Duke University, Hubert-Yeargan Center for Global Health and Department of Obstetrics and Gynecology
| | - Midori Kato –Maeda
- Francis J. Curry National Tuberculosis Center, Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital
| | - Dennis Osmond
- Department of Epidemiology and Biostatistics University of California San Francisco, San Francisco, CA
| | - Rachel Freyre
- University of California San Francisco Department of Obstetrics, Gynecology, and Reproductive Sciences
| | - Natali Aziz
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Stanford, California
| | - Deborah Cohan
- University of California San Francisco Department of Obstetrics, Gynecology, and Reproductive Sciences
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Tabuchi T, Takatorige T, Hirayama Y, Nakata N, Harihara S, Shimouchi A, Fujita K, Yoshida H, Tamura Y, Nagai T, Matsumoto T, Takashima T, Iso H. Tuberculosis infection among homeless persons and caregivers in a high-tuberculosis-prevalence area in Japan: a cross-sectional study. BMC Infect Dis 2011; 11:22. [PMID: 21255421 PMCID: PMC3037881 DOI: 10.1186/1471-2334-11-22] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 01/21/2011] [Indexed: 11/27/2022] Open
Abstract
Background Tuberculosis (TB) is a major public health problem. The Airin district of Osaka City has a large population of homeless persons and caregivers and is estimated to be the largest TB-endemic area in the intermediate-prevalence country, Japan. However, there have been few studies of homeless persons and caregivers. The objective of this study is to detect active TB and to assess the prevalence and risk factors for latent TB infection among homeless persons and caregivers. Methods We conducted a cross-sectional study for screening TB infection (active and latent TB infections) using questionnaire, chest X-ray (CXR), newly available assay for latent TB infection (QuantiFERON-TB Gold In-Tube; QFT) and clinical evaluation by physicians at the Osaka Socio-Medical Center Hospital between July 2007 and March 2008. Homeless persons and caregivers, aged 30-74 years old, who had not received CXR examination within one year, were recruited. As for risk factors of latent TB infection, the odds ratios (OR) and 95% confidence intervals (95% CI) for QFT-positivity were calculated using logistic regression model. Results Complete responses were available from 436 individuals (263 homeless persons and 173 caregivers). Four active TB cases (1.5%) among homeless persons were found, while there were no cases among caregivers. Out of these four, three had positive QFT results. One hundred and thirty-three (50.6%) homeless persons and 42 (24.3%) caregivers had positive QFT results. In multivariate analysis, QFT-positivity was independently associated with a long time spent in the Airin district: ≥10 years versus <10 years for homeless (OR = 2.53; 95% CI, 1.39-4.61) and for caregivers (OR = 2.32; 95% CI, 1.05-5.13), and the past exposure to TB patients for caregivers (OR = 3.21; 95% CI, 1.30-7.91) but not for homeless persons (OR = 1.51; 95% CI, 0.71-3.21). Conclusions Although no active TB was found for caregivers, one-quarter of them had latent TB infection. In addition to homeless persons, caregivers need examinations for latent TB infection as well as active TB and careful follow-up, especially when they have spent a long time in a TB-endemic area and/or have been exposed to TB patients.
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Affiliation(s)
- Takahiro Tabuchi
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, Japan
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Torres Costa J, Silva R, Sá R, Cardoso MJ, Nienhaus A. Results of five-year systematic screening for latent tuberculosis infection in healthcare workers in Portugal. J Occup Med Toxicol 2010; 5:22. [PMID: 20659314 PMCID: PMC2921383 DOI: 10.1186/1745-6673-5-22] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/26/2010] [Indexed: 11/23/2022] Open
Abstract
Introduction The risk of tuberculosis (TB) in healthcare workers (HCWs) is related to its incidence in the general population, and increased by the specific risk as a professional group. The prevalence of latent tuberculosis infection (LTBI) in HCWs in Portugal using the tuberculin skin test (TST) and the interferon-γ release assays (IGRA) was analyzed over a five-year period. Methods A screening programme for LTBI in HCWs was conducted, with clinical evaluations, TST, IGRA, and chest radiography. Putative risk factors for LTBI were assessed by a standardised questionnaire. Results Between September 2005 and June 2009, 5,414 HCWs were screened. The prevalence of LTBI was 55.2% and 25.9% using a TST ≥ 10 mm or an IGRA test result (QuantiFERON-TB Gold In-Tube) INF-γ ≥0.35 IU/mL as a criterion for LTBI, respectively. In 53 HCWs active TB was diagnosed. The number of HCWs with newly detected active TB decreased from 19 in the first year to 6 in 2008. Risk assessment was poorly related to TST diameter. However, physicians (1.7%) and nurses (1.0%) had the highest rates of active TB. Conclusions LTBI and TB burden among HCWs in Portugal is high. The screening of these professionals to identify HCWs with LTBI is essential in order to offer preventive chemotherapy to those with a high risk of future progression to disease. Systematic screening had a positive impact on the rate of active TB in HCWs either by early case detection or by increasing the awareness of HCWs and therefore the precautions taken by them.
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Affiliation(s)
- José Torres Costa
- Occupational Health Division, Hospital S, João, EPE - Porto, Portugal.
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Costs of QuantiFERON®-TB Gold versus tuberculin skin test in Spanish healthcare workers. J Hosp Infect 2010; 75:52-5. [DOI: 10.1016/j.jhin.2009.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 11/13/2009] [Indexed: 11/19/2022]
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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.
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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
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