Tuberculosis – Risk of continued transmission in healthcare workers

Torres Costa, José; Silva, Rui; Sá, Raul; João Cardoso, Maria; Ferreira, José; Ribeiro, Carla; Miranda, Mário; Luís Plácido, José

doi:10.1016/S2173-5115(10)70016-6

Article information

Abstract

Introduction

Control of tuberculosis (TB) in healthcare workers requires an early recognition of contacts, the adoption of efficient protective measures and screening for cases of latent tuberculosis (TL) and recent TL.

Aims

Systematic screening for TB and TL in healthcare workers with contact with patients or other workers with TB and risk of contagion.

Material and methods

In a hospital with approximately 5400 workers 13 screenings were performed September 2007– December 2008 due to risk of continued TB. These consisted of clinical observation, tuberculin skin test (PT), Quantiferon®-TB Gold (QTF) test if PT ≥10mm and <15mm and chest X-ray. The diagnoses were performed according to the recommendations of the Portuguese Pulmonolgy Society (SPP).

Results

792 workers (563 ♂; 229 ♀) were included in the 13 screenings. Of these, 75 presented symptoms and 31 had radiology abnormalities. PT was performed in 490 workers, with results <10mm in 250, ≥10 and <15mm in 175 (QTF positive in 36) and ≥15mm in 65. Of the screened workers, 280 had a previous PT ≥15mm, and therefore it was not repeated. 1 case of active TB was diagnosed in a worker, as well as 408 cases of TL (51.5%) and 42 cases of recent TL (5.3%).

Conclusions

TB is considered an occupational disease in healthcare workers. The screening of contacts and TL cases is an important tool for an early diagnosis of active disease and for identifying the cases with higher risk of future disease.

Key-words:

Tuberculosis

latent tuberculosis

Mantoux

tuberculin skin test

interferon-gamma

healthcare workers

Resumo

Introdução

O controlo da tuberculose (TB) em profissionais de saúde passa pelo reconhecimento precoce dos contactos, adopção de medidas de protecção eficazes e despiste dos casos de tuberculose latente (TL) e latente recente.

Objectivos

Rastreio sistemático de TB e TL nos profissionais de saúde com contacto com doentes ou funcionários com TB e risco de contágio.

Material e métodos

Num hospital com aproximadamente 5400 funcionários, entre Setembro de 2007 e Dezembro de 2008, realizaram-se 13 rastreios de risco de TB continuada. Estes foram constituídos por observação clínica, realização de prova de tuberculina (PT), teste de Quantiferon®-TB Gold (QTF) se PT ≥10mm e <15mm e RX tórax. O diagnóstico foi efectuado de acordo com as recomendações da SPP.

Resultados

Nos 13 rastreios efectuados foram englobados 792 profissionais (563 ♀; 229 ♂). Destes, 75 apresentavam sintomas e 31 alterações radiológicas. A PT foi efectuada em 490 profissionais, sendo <10 mm em 250, ≥10 e <15mm em 175 (QTF positivo em 36) e ≥15mm em 65. Dos profissionais rastreados, 280 tinham PT anterior ≥15mm, pelo que não foi repetida. Durante o rastreio foi diagnosticado um caso de TB activa num profissional, 408 casos de TL (51,5%) e 42 de TL recente (5,3%).

Conclusões

A TB é considerada como doença profissional nos profissionais da saúde. O rastreio dos contactos e dos casos de TL é uma importante ferramenta para o diagnóstico precoce de doença activa e para a identificação dos casos de maior risco de doença futura.

Palavras-chave:

Tuberculose

tuberculose latente

Mantoux

prova de tuberculina

interferão-gama

profissionais de saúde

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