Tuberculosis in hospital department health care workers
Tuberculose em profissionais de saúde de um serviço hospitalar
Sandra Saleiro1,
, Ana Rosa Santos1, Otília Vidal1, Teresa Carvalho2, José Torres Costa3, José Agostinho Marques1
Corresponding author
sandrasaleiro@portugalmail.pt
Hospital de São João – Alameda Prof. Hernâni Monteiro, 4202-451 PortoTelefone: 225512215.
Hospital de São João – Alameda Prof. Hernâni Monteiro, 4202-451 PortoTelefone: 225512215.
1 Serviço de Pneumologia – Hospital de São João / Pulmonology Unit – Hospital de São João Director de Serviço: Prof. Doutor José Agostinho Marques / Director: Prof. Doutor José Agostinho Marques
2 Serviço de Microbiologia – Hospital de São João / Microbiology Unit – Hospital de São João Directora de Serviço: Prof. Doutora Maria José Vaz / Director: Prof. Doutora Maria José Vaz
3 Serviço de Saúde Ocupacional – Hospital de São João / Occupational Health Unit – Hospital de São João Director de Serviço: Prof. Doutor José Torres Costa / Director: Prof. Doutor José Torres Costa
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"afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Pneumologia – Hospital de São João / Pulmonology Unit – Hospital de São João Director de Serviço: Prof. Doutor José Agostinho Marques / Director: Prof. Doutor José Agostinho Marques" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Microbiologia – Hospital de São João / Microbiology Unit – Hospital de São João Directora de Serviço: Prof. Doutora Maria José Vaz / Director: Prof. Doutora Maria José Vaz" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Saúde Ocupacional – Hospital de São João / Occupational Health Unit – Hospital de São João Director de Serviço: Prof. Doutor José Torres Costa / Director: Prof. Doutor José Torres Costa" "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ 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class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Tuberculosis (TB) is considered an occupational disease in health care workers (HCW) and its transmission in health care facilities is an important concern. Some hospital departments are at higher risk of infection.</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To describe TB cases detected after TB screening in HCW from a hospital department (Ear, Nose and Throat – ENT) who had had contact with active TB cases.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">All HCW (73) from Hospital São João's ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Those who had symptoms underwent chest X-ray and mycobacteriological sputum exam.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Of 73 HCW who underwent TB screening, TB diagnosis was established in 9 (8 female; median age: 30 years; 1 doctor, 6 nurses, 2 nursing auxiliaries). Pulmonary TB was found in 8 and extra- -pulmonary TB in 1. Microbiology diagnosis was obtained in 7 cases by sputum smear, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2; culture exam in bronchial lavage, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4 and histological exam of pleural tissue, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1. In 4 cases, <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> genomic DNA was extracted from cultures and molecular typing was done. All cases had identical MIRU types, which allowed identification of the epidemiological link.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Nosocomial TB is prominent and efforts should be made to implement successful infection control measures in health care facilities and an effective TB screening program in HCW. Molecular typing of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> facilitates cluster identification.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A tuberculose é considerada uma doença ocupacional nos profissionais de saúde e a sua transmissão, nas instituições de saúde, constitui um problema importante. Alguns serviços hospitalares estão particularmente expostos a risco de infecção.</p> <span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracterizar os casos de tuberculose detectados na sequência de um rastreio efectuado aos profissionais de saúde de um serviço hospitalar (otorrinolaringologia) que contactaram com casos de tuberculose activa. Material e métodos: Procedeu-se à realização de rastreio de tuberculose a todos os funcionários (73) do serviço de Otorrinolaringologia do Hospital de São João que contactaram com dois doentes internados com tuberculose activa. A todos aqueles que referiram sintomas foi realizada radiografia torácica e exame micobacteriológico de expectoração.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dos 73 profissionais de saúde submetidos ao rastreio, foi estabelecido o diagnóstico de tuberculose em 9 (8 do sexo feminino; idade mediana: 30 anos; uma médica, seis enfermeiros e dois auxiliares de acção médica). Em 8 profissionais de saúde foi diagnosticada tuberculose pulmonar, tratando-se o outro caso de tuberculose extra-pulmonar. O diagnóstico microbiológico foi obtido em 7 casos pelos seguintes métodos: exame micobacteriológico directo de expectoração, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2; exame cultural de lavado brônquico, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4; exame histológico de tecido pleural, n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1. Em 4 casos, o DNA do <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> foi extraído das culturas, tendo sido efectuada tipagem molecular. Todos estes casos apresentaram tipagem idêntica, o que permite a identificação de uma ligação epidemiológica.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A tuberculose nosocomial é relevante, sendo necessário efectuar um esforço para implementar, com sucesso, medidas de controlo de infecção nas instituições de saúde, assim como um programa eficaz de rastreio de tuberculose entre os profissionais de saúde. A tipagem molecular do <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> facilita a identificação de clusters de infecção.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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