Artigo Original/Original Article
Tuberculose – Risco de transmissão continuada em profissionais de saúde
Tuberculosis – Risk of continued transmission in healthcare workers
José Torres Costa1,2,3,
, Rui Silva1,2,3, Raul Sá1, Maria João Cardoso4, José Ferreira1, Carla Ribeiro1, Mário Miranda1,2,3, José Luís Plácido1,2
Corresponding author
zecatoco@sapo.pt
Correspondência/Correspondence to: José Torres da Costa, Estrada de St.ª Luzia, n.º 269 4900-408 Viana do Castelo, Portugal
Correspondência/Correspondence to: José Torres da Costa, Estrada de St.ª Luzia, n.º 269 4900-408 Viana do Castelo, Portugal
1 Serviço de Saúde Ocupacional, Hospital S. João, EPE – Porto/Occupational Health Unit, Hospital S. João, EPE – Porto, Portugal
2 Serviço de Imunoalergologia, Hospital S. João, EPE – Porto/Allergology and Clinical Immunology Unit, Hospital S. João, EPE – Porto, Portugal
3 Faculdade de Medicina, Universidade do Porto/Faculty of Medicine, Universidade do Porto, Portugal
4 Serviço de Patologia Clínica, Hospital S. João, EPE – Porto/Clinical Pathology Unit, Hospital S. João, EPE – Porto, Portugal
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"José Torres" "apellidos" => "Costa" "email" => array:1 [ 0 => "zecatoco@sapo.pt" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cr0005" ] ] ] 1 => array:3 [ "nombre" => "Rui" "apellidos" => "Silva" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] 2 => array:3 [ "nombre" => "Raul" "apellidos" => "Sá" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 3 => array:3 [ "nombre" => "Maria João" "apellidos" => "Cardoso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "af0020" ] ] ] 4 => array:3 [ "nombre" => "José" "apellidos" => "Ferreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 5 => array:3 [ "nombre" => "Carla" "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 6 => array:3 [ "nombre" => "Mário" "apellidos" => "Miranda" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "af0015" ] ] ] 7 => array:3 [ "nombre" => "José Luís" "apellidos" => "Plácido" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Serviço de Saúde Ocupacional, Hospital S. João, EPE – Porto/Occupational Health Unit, Hospital S. João, EPE – Porto, Portugal" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Serviço de Imunoalergologia, Hospital S. João, EPE – Porto/Allergology and Clinical Immunology Unit, Hospital S. João, EPE – Porto, Portugal" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Faculdade de Medicina, Universidade do Porto/Faculty of Medicine, Universidade do Porto, Portugal" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Serviço de Patologia Clínica, Hospital S. João, EPE – Porto/Clinical Pathology Unit, Hospital S. João, EPE – Porto, Portugal" "etiqueta" => "4" "identificador" => "af0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência/Correspondence to:</span> José Torres da Costa, Estrada de St.ª Luzia, n.º 269 4900-408 Viana do Castelo, Portugal" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Tuberculosis – Risk of continued transmission in healthcare workers" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-05" "fechaAceptado" => "2009-07-22" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570101" "palabras" => array:6 [ 0 => "Tuberculose" 1 => "tuberculose latente" 2 => "Mantoux" 3 => "prova de tuberculina" 4 => "interferão-gama" 5 => "profissionais de saúde" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570100" "palabras" => array:6 [ 0 => "Tuberculosis" 1 => "latent tuberculosis" 2 => "Mantoux" 3 => "tuberculin skin test" 4 => "interferon-gamma" 5 => "healthcare workers" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdução:</span> 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.</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Objectivos:</span> Rastreio sistemático de TB e TL nos profissionais de saúde com contacto com doentes ou funcionários com TB e risco de contágio.</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material e métodos:</span> 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 ≥<span class="elsevierStyleHsp" style=""></span>10mm e <<span class="elsevierStyleHsp" style=""></span>15mm e RX tórax. O diagnóstico foi efectuado de acordo com as recomendações da SPP.</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Resultados:</span> Nos 13 rastreios efectuados foram englobados 792 profissionais (563 ♀; 229 ♂). Destes, 75 apresentavam sintomas e 31 alterações radiológi-cas. A PT foi efectuada em 490 profissionais, sendo <<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm em 250, ≥<span class="elsevierStyleHsp" style=""></span>10 e <<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm em 175 (QTF positivo em 36) e ≥<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm em 65. Dos profissionais rastreados, 280 tinham PT anterior ≥<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm, 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%).</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusões:</span> 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.</p><p id="sp0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (1): 5-21</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction:</span> 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.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aims:</span> Systematic screening for TB and TL in healthcare workers with contact with patients or other workers with TB and risk of contagion.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods:</span> 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 ≥<span class="elsevierStyleHsp" style=""></span>10mm and <<span class="elsevierStyleHsp" style=""></span>15mm and chest X-ray. The diagnoses were performed according to the recommendations of the Portuguese Pulmonolgy Society (SPP).</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">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 <<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm in 250, ≥<span class="elsevierStyleHsp" style=""></span>10 and <<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm in 175 (QTF positive in 36) and ≥<span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm in 65. Of the screened workers, 280 had a previous PT ≥<span class="elsevierStyleHsp" style=""></span>15 mm, 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%).</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (1): 5-21</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia/Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis and the health care worker: a historical perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.A. 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Horsburgh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa031667" "Revista" => array:6 [ "tituloSerie" => "New Engl J Med" "fecha" => "2004" "volumen" => "350" "paginaInicial" => "2060" "paginaFinal" => "2067" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15141044" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bb0080" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamento da Tuberculose Latente – revisão das normas. Comissão de Trabalho de Tuberculose da Sociedade Portuguesa de Pneumologia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Duarte" 1 => "J. Amado" 2 => "H. Lucas" 3 => "J.M. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Ferreira" 1 => "R. Silva" 2 => "R. Sá" 3 => "M. Miranda" 4 => "J.L. Plácido" 5 => "J. Torres Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "Tuberculose em profissionais de saúde, comunicação oral no 7.º" "conferencia" => "Congresso Nacional de Saúde Ocupacional, Póvoa de Varzim" "serieFecha" => "2008" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bb0115" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of latent tuberculosis infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Discrepancy between the tuberculin skin test and the whole -blood interferon gamma assay for the diagnosis of latent tuberculosis in-fection in an intermediate tuberculosis -burden country" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:2 [ 0 => "Y.A. Kang" 1 => "H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.293.22.2785" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2005" "volumen" => "293" "numero" => "22" "paginaInicial" => "2785" "paginaFinal" => "2787" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15941809" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bb0145" "etiqueta" => "29." 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Article information
ISSN: 08732159Original language: Portuguese
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