Artigo Original/Original Article
Comparação do teste de libertação do interferão-γ e da prova de tuberculina no rastreio de profissionais de saúde
Comparison of interferon-γ release assay and tuberculin test for screening in healthcare workers
José Torres Costa1,2,3,
, Rui Silva1,2,3, Raul Sá1, Maria João Cardoso4, Carla Ribeiro1, Albert Nienhaus5
Corresponding author
zecatoco@sapo.pt
Correspondência/Correspondence to: José Castela Torres Costa, Estrada de St.ª Luzia 269, 4900-408 Viana do Castelo,
Correspondência/Correspondence to: José Castela Torres Costa, Estrada de St.ª Luzia 269, 4900-408 Viana do Castelo,
1 Occupational Health Division, Hospital São João Alameda Professor Hernâni Monteiro, Porto – Portugal
2 Allergy and Clinical Immunology Division Hospital São João Alameda Professor Hernâni Monteiro, Porto – Portugal
3 Faculty of Medicine, Porto University Alameda Professor Hernâni Monteiro, Porto – Portugal
4 Hospital São João, Clinical Pathology Division Alameda Professor Hernâni Monteiro, Porto – Portugal
5 Accidents Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany
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"identificador" => "af0020" ] ] ] 4 => array:3 [ "nombre" => "Carla" "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 5 => array:3 [ "nombre" => "Albert" "apellidos" => "Nienhaus" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "af0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Occupational Health Division, Hospital São João Alameda Professor Hernâni Monteiro, Porto – Portugal" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Allergy and Clinical Immunology Division Hospital São João Alameda Professor Hernâni Monteiro, Porto – Portugal" "etiqueta" => "2" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Faculty of Medicine, Porto University Alameda Professor Hernâni Monteiro, Porto – Portugal" "etiqueta" => "3" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Hospital São João, Clinical Pathology Division Alameda Professor Hernâni Monteiro, Porto – Portugal" "etiqueta" => "4" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Accidents Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany" "etiqueta" => "5" "identificador" => "af0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "*" "correspondencia" => "<span class="elsevierStyleBold">Correspondência</span>/<span class="elsevierStyleItalic"><span class="elsevierStyleBold">Correspondence to:</span></span> José Castela Torres Costa, Estrada de St.ª Luzia 269, 4900-408 Viana do Castelo," ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Comparison of interferon-γ release assay and tuberculin test for screening in healthcare workers" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-05" "fechaAceptado" => "2009-07-23" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570115" "palabras" => array:5 [ 0 => "Tuberculose" 1 => "profissionais de saúde" 2 => "prova de tuberculina" 3 => "teste de libertação do interferão-γ" 4 => "Portugal" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570114" "palabras" => array:5 [ 0 => "Tuberculosis" 1 => "healthcare workers" 2 => "tuberculin skin test" 3 => "interferon-γ release assay" 4 => "Portugal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Os profissionais de saúde (PS) têm um risco aumentado de tuberculose. O rastreio da tuberculose latente e da tuberculose activa é portanto essencial nos programas de controlo de infecção. Entre Maio de 2007 e Abril de 2009, foram utilizados simultaneamente a prova de tuberculina (PT) e o teste de libertação do interferão-γ (IGRA) em 1686<span class="elsevierStyleHsp" style=""></span>PS. Quando PT ≥<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm ou IGRA positivo, e em PS com contacto com tuberculose ou sintomáticos, foi realizada uma radiografia torácica para excluir tuberculose activa. O IGRA foi positivo em 33,1% e a PT foi ><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm em 78.3% dos PS. A proporção de resultados IGRA positivos aumentou com o diâmetro da PT. Nos PS com PT ><span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm, 49.2% são IGRA positivos. A PT foi positiva em mais do dobro dos casos do IGRA. Assim, foram observados mais frequentemente resultados PT<span class="elsevierStyleHsp" style=""></span>+/IGRA- do que resultados concordantes negativos ou positivos. Em nenhum PS com resultado PT<span class="elsevierStyleHsp" style=""></span>+/IGRA- foi diagnosticada tuberculose activa durante o período do estudo. A vacinação repetida pelo BCG aumentou o número de casos discordantes PT<span class="elsevierStyleHsp" style=""></span>+/IGRA-. Quanto menor o intervalo após a vacinação pelo BCG, maior a discordância PT<span class="elsevierStyleHsp" style=""></span>+/IGRA-. Na população de PS rastreada, foram diagnosticados 9 casos de tuberculose activa, sendo todos PT e IGRA positivos na altura do diagnóstico. Este estudo durou 24 meses, pelo que a taxa de incidência anual média foi de 268/100 000.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">A tuberculose é um problema importante nos PS em Portugal. Considerando as limitações que a PT e IGRA apresentam, a melhor solução parece ser o uso de ambos, utilizando a maior especificidade do IGRA para confirmar uma PT positiva, aproveitando as melhores características de cada teste.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (2): 211-221</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Healthcare workers (HCWs) have an increased risk of tuberculosis (TB). Screening for latent tuberculosis infection and active TB is therefore essential in infection control programs. Tuberculin skin test (TST) and Interferon-γ Release Assay (IGRA) were used simultaneously in 1686 HCWs between May 2007 and April 2009. A chest X-ray was performed in order to exclude active TB when TST was ≥<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm or IGRA was positive and in HCWs with TB contact or symptoms. IGRA was positive in 33.1% and TST was ><span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleHsp" style=""></span>mm in 78.3% of the HCWs. The proportion of positive IGRA results increased with the TST diameter. In those with a TST ><span class="elsevierStyleHsp" style=""></span>15<span class="elsevierStyleHsp" style=""></span>mm, 49.2% were IGRA positive. TST was more than twice as often positive than the IGRA. Therefore, TST<span class="elsevierStyleHsp" style=""></span>+/IGRA- results were more often observed than concordant negative or positive results. In none of the HCWs with a TST<span class="elsevierStyleHsp" style=""></span>+/IGRA- result active TB was diagnosed during the study period. Repeated BCG vaccination increased the number of TST<span class="elsevierStyleHsp" style=""></span>+/IGRA- discordance. The smaller the interval after BCG vaccination, the higher was the TST<span class="elsevierStyleHsp" style=""></span>+/IGRA- discordance.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">In the screened HCWs population, active TB was diagnosed in 9. At the time of diagnosis TST and IGRA were positive in all active TB cases. The study period covers 24 months, therefore the average annual incidence rate was 268/100 000.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">TB burden in HCWs in Portugal is high. Considering the limitations that TST and IGRA present, the best solution seems to be the use of both, using the IGRA higher specificity for confirming a positive TST, taking advantage of the best characteristics of each test.</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010; XVI (2): 211-221</span></p></span>" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tuberculosis in hospital department health care workers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Saleiro" 1 => "A.R. Santos" 2 => "O. Vidal" 3 => "T. 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Article information
ISSN: 08732159Original language: Portuguese
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| 2021 June | 22 | 33 | 55 |
| 2021 May | 20 | 34 | 54 |
| 2021 April | 53 | 52 | 105 |
| 2021 March | 43 | 22 | 65 |
| 2021 February | 43 | 15 | 58 |
| 2021 January | 48 | 21 | 69 |
| 2020 December | 31 | 17 | 48 |
| 2020 November | 41 | 11 | 52 |
| 2020 October | 28 | 25 | 53 |
| 2020 September | 55 | 25 | 80 |
| 2020 August | 40 | 22 | 62 |
| 2020 July | 86 | 14 | 100 |
| 2020 June | 57 | 18 | 75 |
| 2020 May | 53 | 21 | 74 |
| 2020 April | 61 | 20 | 81 |
| 2020 March | 53 | 14 | 67 |
| 2020 February | 48 | 51 | 99 |
| 2020 January | 48 | 21 | 69 |
| 2019 December | 52 | 22 | 74 |
| 2019 November | 63 | 17 | 80 |
| 2019 October | 49 | 16 | 65 |
| 2019 September | 77 | 25 | 102 |
| 2019 August | 65 | 19 | 84 |
| 2019 July | 49 | 18 | 67 |
| 2019 June | 37 | 14 | 51 |
| 2019 May | 44 | 25 | 69 |
| 2019 April | 44 | 22 | 66 |
| 2019 March | 46 | 17 | 63 |
| 2019 February | 32 | 23 | 55 |
| 2019 January | 31 | 14 | 45 |
| 2018 December | 21 | 6 | 27 |
| 2018 November | 4 | 4 | 8 |
| 2018 October | 11 | 9 | 20 |
| 2018 September | 20 | 5 | 25 |
| 2018 August | 54 | 26 | 80 |
| 2018 July | 34 | 17 | 51 |
| 2018 June | 47 | 21 | 68 |
| 2018 May | 53 | 24 | 77 |
| 2018 April | 40 | 28 | 68 |
| 2018 March | 41 | 32 | 73 |
| 2018 February | 20 | 11 | 31 |
| 2018 January | 33 | 12 | 45 |
| 2017 December | 36 | 15 | 51 |
| 2017 November | 44 | 21 | 65 |
| 2017 October | 25 | 15 | 40 |
| 2017 September | 24 | 17 | 41 |
| 2017 August | 17 | 22 | 39 |
| 2017 July | 14 | 8 | 22 |
| 2017 June | 27 | 14 | 41 |
| 2017 May | 32 | 8 | 40 |
| 2017 April | 15 | 3 | 18 |
| 2017 March | 12 | 3 | 15 |
| 2017 February | 8 | 2 | 10 |
| 2017 January | 12 | 4 | 16 |
| 2016 December | 11 | 3 | 14 |
| 2016 November | 8 | 5 | 13 |
| 2016 October | 14 | 5 | 19 |
| 2016 September | 1 | 4 | 5 |
| 2016 August | 5 | 3 | 8 |
| 2016 July | 3 | 2 | 5 |
| 2016 May | 1 | 9 | 10 |
| 2016 April | 3 | 8 | 11 |
| 2016 March | 3 | 13 | 16 |
| 2016 February | 5 | 18 | 23 |
| 2016 January | 12 | 4 | 16 |
| 2015 December | 10 | 3 | 13 |
| 2015 November | 3 | 3 | 6 |
| 2015 October | 2 | 2 | 4 |
Show all
