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The Interferon-Gamma Release Assay versus the Tuberculin Skin Test in the Diagnosis of Mycobacterium tuberculosis Infection in BCG-Vaccinated Children and Adolescents Exposed or Not Exposed to Contagious TB. Vaccines (Basel) 2023; 11:vaccines11020387. [PMID: 36851265 PMCID: PMC9961142 DOI: 10.3390/vaccines11020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Children have an increased risk of developing active tuberculosis (TB) after exposure to Mycobacterium tuberculosis (M.tb), and they are more likely to develop the most severe forms of TB. Rapid diagnosis and treatment of latent M.tb infection (LTBI) is essential to lessen the devastating consequences of TB in children. OBJECTIVE The aim of the study was to evaluate TST (tuberculin skin test) and IGRA (interferon-gamma release assay) utility in identifying LTBI in a cohort of Bacille Calmette-Guérin (BCG)-vaccinated Polish children and adolescents exposed or not exposed to contagious TB. In addition, we asked whether quantitative assessment of IGRA results could be valuable in predicting active TB disease. RESULTS Of the 235 recruited volunteers, 89 (38%) were TST-positive (TST+), 74 (32%) were IGRA-positive (IGRA+), and 62 (26%) were both TST+ and IGRA+. The frequency of TST positivity was significantly higher in the group with (59%) than without TB contact (18%). The percentage of TST+ subjects increased with age from 36% in the youngest children (<2 years) to 47% in the oldest group (>10 years). All positive IGRA results were found solely in the group of children with TB contact. There was a significant increase in the rate of positive IGRA results with age, from 9% in the youngest to 48% in the oldest group. The 10 mm TST cutoff showed good sensitivity and specificity in both TB exposed and nonexposed children and was associated with excellent negative predictive value, especially among nonexposed volunteers. Mean IFN-γ concentrations in IGRA cultures were significantly higher in the group of LTBI compared to the children with active TB disease, both TST+ and TST-. CONCLUSIONS Both TST and IGRA can be used as screening tests for BCG-vaccinated children and adolescents exposed to contagious TB.
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Main S, Triasih R, Greig J, Hidayat A, Brilliandi IB, Khodijah S, Chan G, Wilks N, Parry AE, Nababan B, du Cros P, Dwihardiani B. The prevalence and risk factors for tuberculosis among healthcare workers in Yogyakarta, Indonesia. PLoS One 2023; 18:e0279215. [PMID: 37200338 DOI: 10.1371/journal.pone.0279215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
Healthcare workers (HCWs) are at risk of contracting TB, particularly when in high tuberculosis (TB) burden settings. Routine surveillance data and evidence are limited on the burden of TB amongst HCWs in Indonesia. We aimed to measure the prevalence of TB infection (TBI) and disease among HCWs in four healthcare facilities in Yogyakarta province in Indonesia, and explore risk factors for TBI. A cross-sectional TB screening study targeted all HCWs from four pre-selected facilities (1 hospital, 3 primary care) in Yogyakarta, Indonesia. Voluntary screening included symptom assessment, Chest X-ray (CXR), Xpert MTB/RIF (if indicated) and tuberculin skin test (TST). Analyses were descriptive and included multivariable logistic regression. Of 792 HCWs, 681 consented (86%) to the screening; 59% (n = 401) were female, 62% were medical staff (n = 421), 77% worked in the one participating hospital (n = 524), and the median time working in the health sector was 13 years (IQR: 6-25 years). Nearly half had provided services for people with TB (46%, n = 316) and 9% reported ever having TB (n = 60). Among participants with presumptive TB (15%, n = 99/662), none were diagnosed microbiologically or clinically with active TB disease. TBI was detected in 25% (95% CI: 22-30; n = 112/441) of eligible HCWs with a TST result. A significant association was found between TB infection and being male (adjusted Odds Ratio (aOR) 2.02 (95%CI: 1.29-3.17)), currently working in the participating hospital compared to primary care (aOR 3.15 (95%CI: 1.75-5.66)), and older age (1.05 OR increase per year of life between 19-73 years (95%CI: 1.02-1.06)). This study supports prioritisation of HCWs as a high-risk group for TB infection and disease, and the need for comprehensive prevention and control programs in Indonesia. Further, it identifies characteristics of HCWs in Yogyakarta at higher risk of TBI, who could be prioritised in screening programs if universal coverage of prevention and control measures cannot be achieved.
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Affiliation(s)
- Stephanie Main
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, Victoria, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rina Triasih
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Yogyakarta, Indonesia
- Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta City, Yogyakarta, Indonesia
| | - Jane Greig
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Arif Hidayat
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Yogyakarta, Indonesia
| | - Immanuel Billy Brilliandi
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Yogyakarta, Indonesia
| | - Syarifah Khodijah
- Department of Paediatric, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta City, Yogyakarta, Indonesia
| | - Geoff Chan
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Nova Wilks
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Amy Elizabeth Parry
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Betty Nababan
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Yogyakarta, Indonesia
| | - Philipp du Cros
- Tuberculosis Elimination and Implementation Science Working Group, Burnet Institute, Melbourne, Victoria, Australia
| | - Bintari Dwihardiani
- Centre of Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Yogyakarta, Indonesia
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3
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Wada PY, Costa AG, Araújo-Pereira M, Barreto-Duarte B, Souza AB, Rocha MS, Figueiredo MC, Turner MM, Rolla VC, Kritski AL, Cordeiro-Santos M, Andrade BB, Sterling TR, Rebeiro PF. Possible sex difference in latent tuberculosis infection risk among close tuberculosis contacts. Int J Infect Dis 2022; 122:685-692. [PMID: 35843494 PMCID: PMC10041676 DOI: 10.1016/j.ijid.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES More men than women develop and die of tuberculosis (TB). Fewer data exist on sex differences in latent TB infection (LTBI). We assessed for potential sex differences in LTBI acquisition among close TB contacts. METHODS Regional Prospective Observational Research for TB-Brazil is an observational multi-center cohort of individuals with culture-confirmed pulmonary TB and their close contacts. Participants were enrolled from five sites in Brazil from June 2015 - June 2019. Close contacts were followed for 24 months after enrollment, with LTBI defined as a positive interferon-γ release assay (IGRA; QuantiFERON 3rd or 4th generation) at baseline or 6 months. We performed univariate, bivariate, and multivariable logistic regression and propensity-score weighted models to assess odds ratios (OR) and 95% confidence intervals (CI) for LTBI acquisition by birth sex among close contacts. RESULTS Of 1093, 504 (46%) female close contacts were IGRA positive compared to 295 of 745 (40%) men. The unadjusted OR for IGRA positivity among women vs men was 1.31 (95% CI: 1.08-1.58). Bivariate adjustments yielded ORs in women vs men ranging from 1.19 to 1.33 (P-value range: <0.01-0.07). Multivariable regression and weighted models yielded similar ORs in women vs men, of 1.14 (95% CI: 0.92-1.41) and 1.15 (95% CI: 0.94-1.40), respectively. CONCLUSION The point estimate for LTBI among close TB contacts in Brazil was higher in women, though less pronounced in multivariable models. If the sex difference in LTBI is confirmed in additional settings, studies of possible underlying differences in socio-behavioral factors or TB pathogenesis are warranted.
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Affiliation(s)
- Paul Y Wada
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA.
| | - Allyson G Costa
- Fundação Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Alexandra B Souza
- Fundação Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Brazil; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Michael S Rocha
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - Marina C Figueiredo
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Megan M Turner
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA
| | - Valeria C Rolla
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Afrânio L Kritski
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Dr. Heitor Vieira Dourado, Universidade do Estado do Amazonas, Manaus, Brazil; Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Brazil; Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA; Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil; Curso de Medicina, Universidade Salvador (UNIFACS), Laureate Universities, Salvador, Brazil; Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil; Curso de Medicina, Faculdade de Tecnologia e Ciências (FTC), Salvador, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA; Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, USA.
| | - Peter F Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
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Lu P, Liu Q, Zhou Y, Martinez L, Kong W, Ding X, Peng H, Zhu T, Zhu L, Lu W. Predictors of Discordant Tuberculin Skin Test and QuantiFERON-TB Gold In-tube Results in Eastern China: A Population-based, Cohort Study. Clin Infect Dis 2021; 72:2006-2015. [PMID: 32369577 DOI: 10.1093/cid/ciaa519] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/29/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Discordance between the QuantiFERON-TB Gold In-tube (QFT) and tuberculin skin test (TST) is not well understood. We aimed to identify the factors that determine discordance between the TST and QFT when compared to either TST+QFT+ or TST-QFT- results in a medium tuberculosis (TB) burden setting. METHODS We conducted a population-based study in Eastern China and administered TSTs and QFTs to participants. We calculated kappa values while constructing multivariable logistic regression models to evaluate predictors of test discordance. We analyzed the predictive value of discordant and concordant test results for progression to TB over 6 years of follow-up. RESULTS Overall, 5405 participants were enrolled; 2043 (37.8%) and 1104 (20.4%) were TST and QFT positive, respectively. There was fair agreement between the TST and the QFT (kappa values between 0.30-0.39 at different TST cutoffs). Agreement was lower among participants vaccinated with Bacillus Calmette-Guerin (BCG; κ, 0.17 versus 0.47 in nonvaccinated participants). TST+QFT- results were associated with decreasing age, smoking, undiagnosed diabetes, and BCG vaccination (adjusted odds ratio, 1.45; 95% confidence interval [CI], 1.11-1.90). TST-QFT+ results were associated with increasing age, male sex, smoking, and diagnosed diabetes. Compared to participants with TST-QFT- results, QFT+ and TST+QFT+ participants were 6.3 (95% CI, 1.9-20.4) and 7.5 (95%CI, 2.3-25.1) times more likely to progress to TB, respectively. CONCLUSIONS In this population-based study of over 5000 participants from a medium TB burden region, the test agreement between QFT and TST was fair overall and we found multiple novel predictors of discordant QFT/TST results. QFT provides a substantial improvement to the TST among these populations and was multi-fold better at predicting progression to TB.
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Affiliation(s)
- Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yang Zhou
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Leonardo Martinez
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Wen Kong
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Xiaoyan Ding
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Hong Peng
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Tao Zhu
- Center for Disease Control and Prevention of Danyang City, Zhenjiang, Jiangsu Province, People's Republic of China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, People's Republic of China
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Souza FM, Prado TND, Werneck GL, Luiz RR, Maciel ELN, Faerstein E, Trajman A. Classification and regression trees for predicting the risk of a negative test result for tuberculosis infection in Brazilian healthcare workers: a cross-sectional study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210035. [PMID: 34133620 DOI: 10.1590/1980-549720210035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Healthcare workers (HCWs) have a high risk of acquiring tuberculosis infection (TBI). However, annual testing is resource-consuming. We aimed to develop a predictive model to identify HCWs best targeted for TBI screening. METHODOLOGY We conducted a secondary analysis of previously published results of 708 HCWs working in primary care services in five Brazilian State capitals who underwent two TBI tests: tuberculin skin test and Quantiferon®-TB Gold in-tube. We used a classification and regression tree (CART) model to predict HCWs with negative results for both tests. The performance of the model was evaluated using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), cross-validated using the same dataset. RESULTS Among the 708 HCWs, 247 (34.9%) had negative results for both tests. CART identified that physician or a community health agent were twice more likely to be uninfected (probability = 0.60) than registered or aid nurse (probability = 0.28) when working less than 5.5 years in the primary care setting. In cross validation, the predictive accuracy was 68% [95% confidence interval (95%CI): 65 - 71], AUC was 62% (95%CI 58 - 66), specificity was 78% (95%CI 74 - 81), and sensitivity was 44% (95%CI 38 - 50). CONCLUSION Despite the low predictive power of this model, CART allowed to identify subgroups with higher probability of having both tests negative. The inclusion of new information related to TBI risk may contribute to the construction of a model with greater predictive power using the same CART technique.
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Affiliation(s)
| | | | - Guilherme Loureiro Werneck
- Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil.,McGill University - Montreal (QC), Canada
| | | | | | - Eduardo Faerstein
- Universidade do Estado do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Anete Trajman
- McGill University - Montreal (QC), Canada.,Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
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Girish S, Kinikar A, Pardesh G, Shelke S, Basavaraj A, Chandanwale A, Kadam D, Josh S, Dhumal G, Lokhande N, Deluca A, Gupte N, Gupta A, Bollinger RC, Mave V. Utility of the Interferon-Gamma Release Assay for Latent Tuberculosis Infection Screening among Indian Health-Care Workers. Indian J Community Med 2021; 46:281-284. [PMID: 34321742 PMCID: PMC8281831 DOI: 10.4103/ijcm.ijcm_761_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/31/2021] [Indexed: 11/04/2022] Open
Abstract
Background The utility of interferon-gamma release assays (IGRAs) for latent tuberculosis infection (LTBI) screening among health-care workers (HCWs) in low- and middle-income countries (LMICs) remains unclear. Methods This was a prospective cohort study among HCW trainees undergoing annual LTBI screening via tuberculin skin test (TST) and QuantiFERON® TB Gold Test-in-tube (QFT-GIT) in Pune, India. TST induration ≥ 10 mm and QFT-GIT ≥ 0.35 IU/ml were considered positive. Test concordance was evaluated at entry among the entire cohort and at 1 year among baseline TST-negative participants with follow-up testing. Overall test agreement was evaluated at both timepoints using the kappa statistic: fair (k < 0.40), good (0.41 ≥ k ≤0.60), or strong (k > 0.60). Results Of 200 participants, prevalent LTBI was detected in 42 (21%) via TST and 45 (23%) via QFT-GIT; QFT-GIT was positive in 27/42 (64%) TST-positive and 18/158 (11%) TST-negative trainees. Annual TST conversion was 28% (40/142) and included 11 trainees with baseline TST-/IGRA+; QFT-GIT was positive in 17/40 (43%) TST-positive and 5/102 (5%) TST-negative trainees. Overall test concordance was 84% (k = 0.52; 95% confidence interval [CI]: 0.38-0.66) and 80% (k = 0.44; 95% CI: 0.29-0.59) at baseline and 12 months, respectively. Conclusions We observed good overall agreement between TST and QFT-GIT, and QFT-GIT detected additional LTBI cases among TST-negative trainees with possible early detection of LTBI conversion. Overall, our results support the use of IGRA for annual LTBI screening among HCWs in a high burden LMIC setting.
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Affiliation(s)
- Sunita Girish
- Department of Biochemistry, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Aarti Kinikar
- Department of Paediatrics, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Geeta Pardesh
- Department of Community Medicine, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sangita Shelke
- Department of Community Medicine, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Anita Basavaraj
- Department of Medicine, Government Medical College, Miraj, Maharashtra, India
| | - Ajay Chandanwale
- Department of Orthopaedics, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Dileep Kadam
- Department of Medicine, Smt.Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Samir Josh
- ENT, Byramjee Jeejeebhoy Government Medical College-Sassoon General Hospital, Pune, Maharashtra, India
| | - Gauri Dhumal
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Nilima Lokhande
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Andrea Deluca
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India.,Medicine and Public Health, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - Robert C Bollinger
- Medicine, Public Health, and Nursing, Division of Infectious Diseases, Johns Hopkins University School of Medicine, MD, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins Clinical Trials Unit, Pune, Maharashtra, India.,Medicine and Public Health, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
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Apriani L, McAllister S, Sharples K, Aini IN, Nurhasanah H, Ratnaningsih DF, Indrati AR, Ruslami R, Alisjahbana B, van Crevel R, Hill PC. High risk of Mycobacterium tuberculosis infection among medical and nursing students in Indonesia: a 1-year prospective study. Trans R Soc Trop Med Hyg 2021; 116:10-18. [PMID: 33721022 DOI: 10.1093/trstmh/trab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medical and nursing students entering their clinical programmes are at increased risk for tuberculosis (TB) in TB-endemic settings. Relatively little is known about Mycobacterium tuberculosis infection among such students in high-endemic countries. METHODS We examined M. tuberculosis infection among medical and nursing students starting clinical training in Bandung, Indonesia using interferon-γ release assay (IGRA) QuantiFERON-TB Gold Plus. IGRA-negative students had a repeat test after 1 y and logistic regression was used to identify factors associated with IGRA positivity or conversion. RESULTS There were 379 students included in this study: 248 (65.4%) were medical students and 131 (34.6%) were nursing students. Of 379 students, 70 (18.5%) were IGRA positive at baseline. Of 293 IGRA-negative students with 1-y results, 26 (8.9%) underwent IGRA conversion. Being a medical student (adjusted relative risk [ARR] 5.15 [95% confidence interval {CI} 1.82 to 14.59], p=0.002) and participation in sputum collection or bronchoscopy were associated with IGRA conversion (ARR 2.74 [95% CI 1.29 to 5.79], p=0.008). CONCLUSIONS Medical and nursing students entering clinical training are at high risk of M. tuberculosis infection and need improved infection prevention and control strategies.
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Affiliation(s)
- Lika Apriani
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
| | - Katrina Sharples
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand.,Department of Mathematics and Statistics, University of Otago, 730 Cumberland Street, North Dunedin, Dunedin 9016, New Zealand
| | - Isni Nurul Aini
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Hanifah Nurhasanah
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Dwi Febni Ratnaningsih
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Agnes Rengga Indrati
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl Pasteur No. 38 Bandung 40161, Indonesia
| | - Rovina Ruslami
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman No. 38 Bandung 40161, Indonesia
| | - Bachti Alisjahbana
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl Pasteur No. 38 Bandung 40161, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
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Afonso A, Pires B, Teixeira C, Nogueira A. Tuberculin Skin Testing versus Interferon-Gamma Release Assay among Users of a Public Health Unit in Northeast Portugal. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000514875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The screening of groups with a high risk for developing tuberculosis (TB) is a priority in order to control this disease. Since there is no gold standard for the diagnosis of latent TB infection (LTBI), both the tuberculin skin test (TST) and the interferon-gamma release assays (IGRA) have been used for this purpose. The aim of this study was to determine the proportion of LTBI by using the TST and the IGRA tests, and to assess the risk factors related with discordant results between tests across several risk groups advised for screening in Northeast Portugal. Data were collected from the database of patients with suspected LTBI and advised for the screening in a public health unit (January 2014 to December 2015). The proportion of LTBI was computed using both tests. Logistic regression models assessed risk factors for a positive test and for discordant results between tests. The adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. Out of 367 patients included in the analysis, 79.8% had a positive TST and 46.0% of them had a positive IGRA. In comparison with contacts of active TB cases, healthcare workers and inmates presented higher odds of TST positivity (OR 4.38, 95% CI 1.59–12.09 and OR 4.74, 95% CI 1.45–15.49, respectively), but immunocompromised people presented lower odds of TST positivity (OR 0.14; 95% CI 0.06–0.31). Instead, healthcare workers (OR 0.44, 95% CI 0.24–0.80) and immunocompromised people (OR 0.24, 95% CI 0.10–0.56) presented lower odds of a positive IGRA. There were 42.0% concordant positive results, 16.1% concordant negative results, and 41.9% discordant results, with healthcare workers presenting higher odds of discordant results (OR 3.34, 95% CI 1.84–6.05). The proportion of LTBI estimated by TST and IGRA among people advised for screening in our setting is high, highlighting the need of preventive strategies. Among healthcare workers, TST results should be read with caution as the higher proportion of discordant results with a positive TST suggests the impact of the booster reaction in this group.
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Sabri A, Quistrebert J, Naji Amrani H, Abid A, Zegmout A, Abderrhamani Ghorfi I, Souhi H, Boucaid A, Benali A, Abilkassem R, Kmari M, Hassani A, Lahcen B, Siah S, Schurr E, Boisson-Dupuis S, Casanova JL, Lahlou A, Laatiris A, Louzi L, Ouarssani A, Bourazza A, Aouragh A, Mustapha B, Messaoudi N, Agader A, Cobat A, Abel L, El Baghdadi J. Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Morocco. PLoS One 2019; 14:e0221081. [PMID: 31415649 PMCID: PMC6695119 DOI: 10.1371/journal.pone.0221081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022] Open
Abstract
Increased prevalence of latent tuberculosis infection (LTBI) has been observed among high-risk populations such as healthcare workers (HCWs). The results may depend on the method of LTBI assessment, interferon-gamma release assay (IGRA) and/or tuberculin skin test (TST). Here, we investigated the prevalence and risk factors for LTBI assessed by both IGRAs and TST in HCWs living in Morocco, a country with intermediate tuberculosis (TB) endemicity and high BCG vaccination coverage. HCWs were recruited in two Moroccan hospitals, Rabat and Meknes. All the participants underwent testing for LTBI by both IGRA (QuantiFERON-TB Gold In-Tube, QFT-GIT) and TST. Different combinations of IGRA and TST results defined the LTBI status. Risk factors associated with LTBI were investigated using a mixed-effect logistic regression model. The prevalence of LTBI among 631 HCWs (age range 18-60 years) varied from 40.7% (95%CI 36.9-44.5%) with QFT-GIT to 52% (95%CI 48.2-56.0%) with TST using a 10 mm cut-off. The highest agreement between QFT-GIT and TST (κ = 0.50; 95%CI 0.43-0.56) was observed with the 10 mm cut-off for a positive TST. For a definition of LTBI status using a double positive result for both QFT-GIT and TST, significant associations were found with the following risk factors: being male (OR = 2.21; 95%CI 1.40-3.49; p = 0.0007), belonging to age groups 35-44 years (OR = 2.43; 95%CI 1.45-4.06; p = 0.0007) and even more 45-60 years (OR = 4.81; 95%CI 2.72-8.52; p = 7.10-8), having a family history of TB (OR = 6.62; 95%CI 2.59-16.94; p = 8.10-5), and working at a pulmonology unit (OR = 3.64; 95%CI 1.44-9.23; p = 0.006). Smoking was associated with LTBI status when defined by a positive QFT-GIT result (OR = 1.89; 95%CI 1.12-3.21; p = 0.02). A high prevalence of LTBI was observed among HCWs in two Moroccan hospitals. Male gender, increased age, family history of TB, and working at a pulmonology unit were consistent risk factors associated with LTBI.
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Affiliation(s)
- Ayoub Sabri
- Genetics Unit, Military Hospital Mohamed V, Rabat, Morocco
| | - Jocelyn Quistrebert
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, Paris Descartes University, Paris, France
| | - Hicham Naji Amrani
- Department of Pulmonology, Military Hospital Moulay Ismail, Meknes, Morocco
- Medical and Pharmacological College, Mohamed Benabdellah University, Fes, Morocco
| | - Ahmed Abid
- Department of Pulmonology, Military Hospital Mohammed V, Rabat, Morocco
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
| | - Adil Zegmout
- Department of Pulmonology, Military Hospital Mohammed V, Rabat, Morocco
| | - Ismail Abderrhamani Ghorfi
- Department of Pulmonology, Military Hospital Mohammed V, Rabat, Morocco
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
| | - Hicham Souhi
- Department of Pulmonology, Military Hospital Mohammed V, Rabat, Morocco
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
| | | | - Anas Benali
- Department of Pulmonology, Military Hospital Mohammed V, Rabat, Morocco
| | - Rachid Abilkassem
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Paediatrics, Military Hospital Mohammed V, Rabat, Morocco
| | - Mohamed Kmari
- Department of Paediatrics, Military Hospital Mohammed V, Rabat, Morocco
| | - Amal Hassani
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Paediatrics, Military Hospital Mohammed V, Rabat, Morocco
| | - Belyamani Lahcen
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Emergency Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Samir Siah
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Restorative Plastic Surgery and Burns, Military Hospital Mohammed V, Rabat, Morocco
| | - Erwin Schurr
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Stéphanie Boisson-Dupuis
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, Paris Descartes University, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, United States of America
| | - Jean-Laurent Casanova
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, Paris Descartes University, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, United States of America
- Howard Hughes Medical Institute, New York, New York, United States of America
- Paediatric Haematology-Immunology Unit, Necker Hospital for Sick Children, Paris, France
| | - Amine Lahlou
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Center of Virology and of Infectious and Tropical Diseases, Mohammed V Military Hospital, Rabat, Morocco
| | - Abdelkader Laatiris
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Center of Virology and of Infectious and Tropical Diseases, Mohammed V Military Hospital, Rabat, Morocco
| | - Lhoussain Louzi
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Microbiology, Military Hospital Moulay Ismail, Meknes, Morocco
| | - Aziz Ouarssani
- Department of Pulmonology, Military Hospital Moulay Ismail, Meknes, Morocco
- Medical and Pharmacological College, Mohamed Benabdellah University, Fes, Morocco
| | - Ahmed Bourazza
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Neurology, Military Hospital Mohammed V, Rabat, Morocco
| | - Aziz Aouragh
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Gastroenterology, Military Hospital Mohammed V, Rabat, Morocco
| | - Bensghir Mustapha
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Anesthesiology and Resuscitation, Military Hospital Mohammed V, Rabat, Morocco
| | - Nezha Messaoudi
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Laboratory of Hematology and Immunohematology, Military Hospital Mohammed V, Rabat, Morocco
| | - Aomar Agader
- Medical and Pharmacy School of Rabat, Mohammed V University, Rabat, Morocco
- Department of Paediatrics, Military Hospital Mohammed V, Rabat, Morocco
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, Paris Descartes University, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, United States of America
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM U1163, Paris, France
- Imagine Institute, Paris Descartes University, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, New York, United States of America
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Apriani L, McAllister S, Sharples K, Alisjahbana B, Ruslami R, Hill PC, Menzies D. Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review. Eur Respir J 2019; 53:13993003.01789-2018. [PMID: 30792341 DOI: 10.1183/13993003.01789-2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of latent tuberculosis (TB) infection (LTBI) and TB disease.We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low- and middle-income countries (LMICs), associated factors, and infection control practices. We searched MEDLINE, Embase and Web of Science (January 1, 2005-June 20, 2017) for studies published in any language. We obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.85 studies (32 630 subjects) were included from 26 LMICs. Prevalence of a positive tuberculin skin test (TST) was 14-98% (mean 49%); prevalence of a positive interferon-γ release assay (IGRA) was 9-86% (mean 39%). Countries with TB incidence ≥300 per 100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41-69%; IGRA: pooled estimate 56%, 95% CI 39-73%). Annual incidence estimated from the TST was 1-38% (mean 17%); annual incidence estimated from the IGRA was 10-30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact and job category. Only 15 studies reported on infection control measures in healthcare facilities, with limited implementation.HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.
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Affiliation(s)
- Lika Apriani
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia .,Dept of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Susan McAllister
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Dept of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Montreal Chest Institute, McGill University Montreal, Montreal, QC, Canada
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11
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Erol S, Ciftci FA, Ciledag A, Kaya A, Kumbasar OO. Do higher cut-off values for tuberculin skin test increase the specificity and diagnostic agreement with interferon gamma release assays in immunocompromised Bacillus Calmette-Guérin vaccinated patients? Adv Med Sci 2018; 63:237-241. [PMID: 29427966 DOI: 10.1016/j.advms.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/28/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Immunocompromised patients with latent tuberculosis infection (LTBI) are at high risk of progression to active tuberculosis. Detection and treatment of LTBI in this group of patients are very important to control active tuberculosis. Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are two methods for detection of LTBI. Diagnostic agreement between two tests are poor especially in Bacillus Calmette-Guérin (BCG) vaccinated immunocompromised patients. In this study, we tried to figure out if the use of a higher cut-off for TST increases diagnostic agreement with IGRAs and TST specificity and or not. MATERIALS/METHODS In this retrospective study, BCG vaccinated solid organ transplantation (SOT) candidates and patients scheduled for anti-tumor necrosis factor-alpha (anti- TNFα) treatment patients who underwent both TST and IGRAs between 2011 and 2017 were enrolled in the study. Diagnostic agreement between the two tests was assessed for 5, 10, 15mm cut-off values for all participants, SOT candidates and anti- TNFα treatment subgroups separately. RESULTS Fifty female and 55 male total 105 patients were included. In the anti- TNFα treatment group 92.8% of the patients were receiving at least one immunosuppressive drug. For all participants kappa (κ) values were 0.303, 0.370, 0.321 respectively for 5, 10 and 15mm cut-offs. For SOT candidates κ values were 0.488, 0.422, 0.288 respectively. For anti- TNFα treatment group κ values were 0.235, 0.332, 0.275 respectively. CONCLUSIONS In BCG vaccinated immunocompromised patients, the agreement between TST and QFT-GIT was poor regardless of cut-off value. And increasing the cut-off does not improve agreement.
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Carneiro VL, Bendicho MT, Santos RG, Casela M, Netto EM, Mota STM, Pina ICA, Nascimento RM, Freire SM, Barbosa T. Interferon-gamma release assay performance in northeastern Brazil: influence of the IFNG+874 A>T polymorphism. Braz J Infect Dis 2018; 22:202-207. [PMID: 29787713 PMCID: PMC9425666 DOI: 10.1016/j.bjid.2018.04.004] [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: 01/03/2018] [Revised: 04/11/2018] [Accepted: 04/20/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction Latent tuberculosis infection diagnosis based on the release of interferon-gamma in cultures of peripheral blood cells stimulated with Mycobacterium tuberculosis antigens has replaced the tuberculin skin test in many countries with low tuberculosis prevalence. The IFN-γ production can be influenced by genetic polymorphisms, of which the IFNG + 874 (rs62559044) locus is the most studied. We investigated the possible influence of the IFNG + 874 A/T polymorphism on interferon-gamma test performance. Methods Patients diagnosed with pulmonary tuberculosis (75), volunteers with positive tuberculin skin test (70) and healthy volunteers with negative tuberculin skin test and no history of contact with tuberculosis (57) were evaluated regarding the IFNG + 874 genotype and the IFN-γ levels in whole blood cultures performed using an interferon-gamma commercial kit (QuantiFERON-TB® Gold In-Tube). Results IFN-γ production was not influenced by the IFNG + 874 genotype, regardless of antigen or mitogen-based stimulation, which suggests that other genes may influence IFN-γ production in response to mycobacteria. The IFNG + 874 polymorphism was found to exert no influence over QFT-IT test sensitivity in our study. Conclusions The IFNG + 874 polymorphism was not shown to influence QuantiFERON-TB® Gold In-Tube test performance in an admixed population from northeastern Brazil.
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Affiliation(s)
- Valdirene Leão Carneiro
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil; Universidade do Estado da Bahia, Departamento de Ciências da Vida, Salvador, BA, Brazil.
| | - Maria Teresita Bendicho
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil; Universidade do Estado da Bahia, Departamento de Ciências da Vida, Salvador, BA, Brazil.
| | | | - Marilda Casela
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil.
| | - Eduardo M Netto
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil; Fundação José Silveira, Instituto Brasileiro para a Investigação da Tuberculose, Salvador, BA, Brazil.
| | | | | | | | | | - Theolis Barbosa
- Universidade Federal da Bahia, Instituto de Ciências da Saúde, Salvador, BA, Brazil; Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil; Brazilian Network for Research in Tuberculosis - REDE TB, Brazil.
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13
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Prado TND, Riley LW, Sanchez M, Fregona G, Nóbrega RLP, Possuelo LG, Zandonade E, Locatelli RL, Souza FMD, Rajan JV, Maciel ELN. Prevalence and risk factors for latent tuberculosis infection among primary health care workers in Brazil. CAD SAUDE PUBLICA 2017; 33:e00154916. [PMID: 29267691 DOI: 10.1590/0102-311x00154916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/03/2017] [Indexed: 02/06/2023] Open
Abstract
Health care workers (HCW) are at increased risk of latent tuberculosis infection (LTBI) from occupational exposure to Mycobacterium tuberculosis. The objective was to determine the prevalence of and risk factors for LTBI among primary HCW in five Brazilian cities. We conducted a cross-sectional study, from 2011 to 2013, among primary HCW, using a structured questionnaire and an evaluated for LTBI using the Quantiferon-TB Gold in-tube test. The magnitude of the associations was assessed using hierarchical logistic regression models. Among 708 HCW, the LTBI prevalence was 27% (n = 196; 95%CI: 24%-31%). We found that the following factors were positively associated with LTBI in primary HCW: age > 50 years (OR = 2.94; 95%CI: 1.44-5.99), absence of a BCG scar (OR = 2.10; 95%CI: 1.28-3.43), self-reported ex-smoker status (OR = 1.80; 95%CI: 1.04-3.11), being a nurse (OR = 2.97; 95%CI: 1.13-7.83), being a nurse technician (OR = 3.10; 95%CI: 1.26-7.60), being a community health agent (OR = 2.60; 95%CI: 1.06-6.40), and irregular use of N95 masks (OR = 2.51; 95%CI: 1.11-5.98). In contrast, HCWs who do not work in health care facilities with a TB control program were less likely to have LTBI (OR = 0.66; 95%CI: 0.45-0.97). This study demonstrated a substantial occupational risk of LTBI among primary HCW in Brazil. The Brazilian TB control program, as well as local programs, need to target these high-risk HCW with education, as well as with better personal protective equipment to prevent acquisition of new TB infection.
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Affiliation(s)
| | - Lee W Riley
- School of Public Health, University of California, Berkeley, U.S.A
| | | | - Geisa Fregona
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brasil.,Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, Brasil
| | | | | | - Eliana Zandonade
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, Brasil
| | - Rodrigo Leite Locatelli
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, Brasil
| | | | - Jayant V Rajan
- School of Medicine, University of California, San Francisco, U.S.A
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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.
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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
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15
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Lacerda TC, Souza FMD, Prado TND, Locatelli RL, Fregona G, Lima RDCD, Maciel EL. Tuberculosis infection among primary health care workers. J Bras Pneumol 2017; 43:416-423. [PMID: 29340489 PMCID: PMC5792040 DOI: 10.1590/s1806-37562016000000211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 05/04/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of and determine the risk factors associated with latent Mycobacterium tuberculosis infection (LTBI) among primary health care workers in the city of Vitória, Brazil. METHODS This was a cross-sectional study with data collected through a survey regarding socio-demographic, occupational, clinical, and exposure characteristics, as well as knowledge about tuberculosis, conducted between 2011 and 2012. All participants underwent a tuberculin skin test (TST), and TSTs were read at 72 h by a trained professional. RESULTS A total of 218 primary health care workers participated in the study. The prevalence of TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points was, respectively, 39.4% (95% CI: 32.9-45.9) and 54.1% (95% CI: 47.4-60.7). Regarding occupational categories, community health agents had the highest proportion of TST positivity, regardless of the cut-off point (≥ 10 mm: 47.5%; and ≥ 5 mm: 60.5%). Regarding factors associated with TST results, "having had a previous TST" showed a statistically significant association with TST positivity at the ≥ 10-mm and ≥ 5-mm cut-off points (OR = 2.5 [95% CI: 1.17-5.30] and OR = 2.18 [95% CI: 1.23-3.87], respectively). CONCLUSIONS The prevalence of LTBI was found to be high among the primary health care workers in this sample. Therefore, we recommend the establishment of a periodic screening program for LTBI and implementation of effective biosafety policies for the prevention of this infection among primary health care workers.
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Affiliation(s)
- Thamy Carvalho Lacerda
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Hospital Universitário Cassiano Antonio de Moraes - HUCAM - Universidade Federal do Espírito Santo, Vitória (ES) Brasil
| | | | - Thiago Nascimento do Prado
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Programa de Pós-Graduação em Enfermagem, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Departamento de Enfermagem, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
| | - Rodrigo Leite Locatelli
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
| | - Geisa Fregona
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Hospital Universitário Cassiano Antonio de Moraes - HUCAM - Universidade Federal do Espírito Santo, Vitória (ES) Brasil
| | - Rita de Cássia Duarte Lima
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Departamento de Enfermagem, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
| | - Ethel Leonor Maciel
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
- . Departamento de Enfermagem, Universidade Federal do Espírito Santo, Vitória (ES) Brasil
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Nasreen S, Shokoohi M, Malvankar-Mehta MS. Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0164034. [PMID: 27711155 PMCID: PMC5053544 DOI: 10.1371/journal.pone.0164034] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/19/2016] [Indexed: 12/17/2022] Open
Abstract
Background Tuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure. Objective To estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries. Methods Databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity. Results A total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa. Conclusion The findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.
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Affiliation(s)
- Sharifa Nasreen
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- * E-mail: ;
| | - Mostafa Shokoohi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Monali S. Malvankar-Mehta
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Chaves AS, Rodrigues MF, Mattos AMM, Teixeira HC. Challenging Mycobacterium tuberculosis dormancy mechanisms and their immunodiagnostic potential. Braz J Infect Dis 2015; 19:636-42. [PMID: 26358744 PMCID: PMC9425411 DOI: 10.1016/j.bjid.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/30/2015] [Accepted: 08/17/2015] [Indexed: 12/17/2022] Open
Abstract
Mycobacterium tuberculosis is the etiologic agent of tuberculosis, one of the world's greatest cause of morbidity and mortality due to infectious disease. Many evolutionary mechanisms have contributed to its high level of adaptation as a host pathogen. Prior to become dormant, a group of about 50 genes related to metabolic changes are transcribed by the DosR regulon, one of the most complex and important systems of host-pathogen interaction. This genetic mechanism allows the mycobacteria to persist during long time periods, establishing the so-called latent infection. Even in the presence of a competent immune response, the host cannot eliminate the pathogen, only managing to keep it surrounded by an unfavorable microenvironment for its growth. However, conditions such as immunosuppression may reestablish optimal conditions for bacterial growth, culminating in the onset of active disease. The interactions between the pathogen and its host are still not completely elucidated. Nonetheless, many studies are being carried out in order to clarify this complex relationship, thus creating new possibilities for patient approach and laboratory screening.
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Affiliation(s)
- Alexandre Silva Chaves
- Department of Parasitology, Microbiology and Immunology, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Michele Fernandes Rodrigues
- Department of Parasitology, Microbiology and Immunology, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Ana Márcia Menezes Mattos
- Department of Parasitology, Microbiology and Immunology, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Henrique Couto Teixeira
- Department of Parasitology, Microbiology and Immunology, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil.
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Martínez-Aguilar G, Serrano CJ, Castañeda-Delgado JE, Macías-Segura N, Hernández-Delgadillo N, Enciso-Moreno L, García de Lira Y, Valenzuela-Méndez E, Gándara-Jasso B, Correa-Chacón J, Bastián-Hernández Y, Rodríguez-Morán M, Guerrero-Romero F, Enciso-Moreno JA. Associated Risk Factors for Latent Tuberculosis Infection in Subjects with Diabetes. Arch Med Res 2015; 46:221-7. [DOI: 10.1016/j.arcmed.2015.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/30/2015] [Indexed: 11/24/2022]
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