Screening for tuberculosis and prediction of disease in Portuguese healthcare workers

Costa, José Torres; Silva, R.; Ringshausen, Felix C.; Nienhaus, Albert

doi:10.1186/1745-6673-6-19

Cited by 39 publications

(36 citation statements)

References 18 publications

(26 reference statements)

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“…Thus, despite high specificity of the IGRA the diagnostic accuracy is low. Other studies assessing the predictive value in a low-endemic setting have found PPV of IGRA ranging from 0.8% in Portuguese healthcare workers22 and 2.4% among Dutch contacts who did not start preventive therapy8 to approximately 7%–8% in HIV positive10 23 to 28.6% in recently exposed children 21. Generally, above studies are limited by low number of incident TB cases ranging from 2 to 24 cases and variable design and follow-up periods 5 6 10 18 19 21 23.…”

Section: Discussionmentioning

confidence: 93%

Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Hermansen

Lillebæk

Kristensen

et al. 2016

Thorax

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Section: Discussionmentioning

confidence: 93%

Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Hermansen

Lillebæk

Kristensen

et al. 2016

Thorax

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“…For example, Franchi and colleagues evaluated 1,755 HCWs in Italy in 2004, diagnosing LTBI in 6% of cases [18]; in a study conducted in France (a low-incidence country with 5.2 cases of TB per 100,000 inhabitants in 2006), 18.9% of 148 HCWs had a positive IGRA result [19]: and in a study on 134 HCWs in Spain (another low-incidence country), the pevalence of LTBI was 11.2% [20]. By contrast, a study on 2,884 hospital workers in Portugal (a high-incidence country, with 32 cases/100,000/year) reported a very high prevalence of LTBI (i.e., 29.5%) [21]. However, a 2005 meta-analysis reported that the prevalence of LTBI in HCWs ranged 5–55% in high-income countries [22].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of latent tuberculosis infection in healthcare workers at a hospital in Naples, Italy, a low-incidence country

Lamberti

Muoio

Arnese

et al. 2016

J Occup Med Toxicol

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BackgroundHealthcare 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.MethodsFrom 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.ResultsOf 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.ConclusionsAlthough 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 materialThe 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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“…Fifteen studies with a combined sample size of 26,680 participants were included in this analysis (107)(108)(109)(110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121). The incidence of active TB during a median follow-up of 3 years was 2 to 24 per 1,000 person-years for IGRA-negative individuals (Fig.…”

Section: Predictive Value For Progression To Tb Diseasementioning

confidence: 99%

Gamma Interferon Release Assays for Detection of Mycobacterium tuberculosis Infection

et al. 2014

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SUMMARY Identification and treatment of latent tuberculosis infection (LTBI) can substantially reduce the risk of developing active disease. However, there is no diagnostic gold standard for LTBI. Two tests are available for identification of LTBI: the tuberculin skin test (TST) and the gamma interferon (IFN-γ) release assay (IGRA). Evidence suggests that both TST and IGRA are acceptable but imperfect tests. They represent indirect markers of Mycobacterium tuberculosis exposure and indicate a cellular immune response to M. tuberculosis . Neither test can accurately differentiate between LTBI and active TB, distinguish reactivation from reinfection, or resolve the various stages within the spectrum of M. tuberculosis infection. Both TST and IGRA have reduced sensitivity in immunocompromised patients and have low predictive value for progression to active TB. To maximize the positive predictive value of existing tests, LTBI screening should be reserved for those who are at sufficiently high risk of progressing to disease. Such high-risk individuals may be identifiable by using multivariable risk prediction models that incorporate test results with risk factors and using serial testing to resolve underlying phenotypes. In the longer term, basic research is necessary to identify highly predictive biomarkers.

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Screening for tuberculosis and prediction of disease in Portuguese healthcare workers

Cited by 39 publications

References 18 publications

Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Prevalence of latent tuberculosis infection in healthcare workers at a hospital in Naples, Italy, a low-incidence country

Gamma Interferon Release Assays for Detection of Mycobacterium tuberculosis Infection

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