Tuberculose ativa entre profissionais de saúde em Portugal

Abstract

Objective: To determine the incidence of active tuberculosis (TB) in a cohort of health care workers (HCWs). Methods: Descriptive study of active TB cases identified in an occupational health screening of 6,112 HCWs between 2005 and 2010. Cases of active TB were defined as those in which Mycobacterium tuberculosis was identified by direct microscopy or culture; those in which there were symptoms or clinical signs of TB and necrotizing granuloma, as detected by histology; and those in which the radiological findings were consistent with active TB. Results: Among the 6,112 HCWs evaluated, we identified 62 cases of active TB: pulmonary TB (n = 43); pleural TB (n = 15); lymph node TB (n = 2); pericardial TB (n = 1); and cutaneous TB (n = 1). Seven HCWs were asymptomatic at the time of diagnosis. Of the 62 cases of active TB, 48 developed within the first 10 years of occupational exposure in the workplace, 36 of those occurring within the first 5 years. Physicians and nurses accounted for the highest numbers of cases (22 and 21, respectively). Conclusions: In HCWs employed in Portugal, the TB burden is high. Physicians and nurses are the HCWs who are at the highest risk of developing active TB. We found the risk of developing this disease to be highest in the first years of exposure, as has been reported in previous studies. In high-incidence countries, TB screening of HCWs is important for controlling the transmission of this disease.Keywords: Tuberculosis/diagnosis; Occupational health; Health personnel. Resumo Objetivo: Determinar a incidência de tuberculose (TB) ativa em uma coorte de profissionais de saúde (PS).Métodos: Estudo descritivo dos casos de TB ativa identificados entre 2005 e 2010 no rastreio de medicina do trabalho efetuado em 6.112 PS. Casos de TB ativa foram definidos como aqueles com identificação de Mycobacterium tuberculosis por microscopia direta ou cultura; aqueles com sintomas ou sinais clínicos de TB e granuloma necrotizante, detectado por histologia; e aqueles com achados radiológicos consistentes com TB ativa. Resultados: Dos 6.112 PS avaliados, houve 62 casos de TB ativa (TB pulmonar, em 43; TB pleural, em 15; TB ganglionar, em 2; TB do pericárdio, em 1; TB cutânea, em 1). Sete PS estavam assintomáticos no momento do diagnóstico. Dos 62 casos de TB ativa, a doença ocorreu nos primeiros 10 anos de exposição ocupacional em 48 e nos primeiros 5 anos em 36. A maioria dos casos verificou-se em médicos e enfermeiros (22 e 21, respectivamente). Conclusões: O impacto da TB em PS em Portugal é elevado. Os médicos e enfermeiros são os PS com o maior risco de desenvolver TB ativa. Tal como relatado em estudos prévios, parece haver um risco mais elevado de desenvolver essa doença nos primeiros anos de exposição. Em países de elevada incidência, o rastreio de TB nos PS é importante no controle da transmissão dessa doença.Descritores: Tuberculose/diagnóstico; Saúde do trabalhador; Pessoal de saúde.

Latent Tuberculosis Among Professionals From a Referral Hospital in Oncology

“…The highest prevalence of LTBI was observed in males and females from 25 to 45 years of age. This finding is consistent with those reported in other studies 8,[15][16][17][18][19][20] . In developing countries, 80% of infected individuals are aged from 15 to 59 years old.…”

“…It has been usually accepted that treatment of TBLI reduces the risk for active TB from 60.0 to 90.0%. Prophylactic treatment with isoniazid is recommended for professionals whose infection was acquired in the last 2 years or those who are considered at high risk for active TB 18,19,21 . Several previous studies assessed TST conversion rates among health care workers and students, with rates ranging from 1.4 to 20.7% 16,18,20,28 .…”

Common Mental Disorders Associated with Tuberculosis: A Matched Case-Control Study

“…Individuals with CMDs are frequent users of health services; these individuals often seek physical and psychological support [14]. Health services are often crowded and poorly ventilated environments, which increases the risk of exposure to infections [15]. Our study aimed to investigate whether there is an association between CMDs and pulmonary TB.…”

Factors influencing tuberculosis screening in healthcare workers in Portugal

“…For example, a Portuguese study found that the estimated TB incidence was three-to seven-fold higher in HCWs than in the general population [8]. Latent TB infection (LTBI) diagnosis and treatment constitute the core of TB elimination, integrating the post-2015 strategies of the World Health Organization [9,10].…”