Tuberculosis – Risk of continued transmission in healthcare workers
Tuberculose – Risco de transmissão continuada em profissionais de saúde
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
Correspondence to/Correspondência: Estrada de St.ª Luzia, n.° 269, 4900-408 Viana do Castelo, Portugal.
Correspondence to/Correspondência: Estrada de St.ª Luzia, n.° 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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João, EPE – Porto/Occupational Health Unit, Hospital S. João, EPE – Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Imunoalergologia, Hospital S. João, EPE – Porto/Allergology and Clinical Immunology Unit, Hospital S. João, EPE – Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculdade de Medicina, Universidade do Porto/Faculty of Medicine, Universidade do Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">3</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Serviço de Patologia Clínica, Hospital S. João, EPE – Porto/Clinical Pathology Unit, Hospital S. João, EPE – Porto, Portugal" "etiqueta" => "<span class="elsevierStyleSup">4</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Estrada de St.ª Luzia, n.° 269, 4900-408 Viana do Castelo, Portugal." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tuberculose – Risco de transmissão continuada em profissionais de saúde" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-06-05" "fechaAceptado" => "2009-07-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec160546" "palabras" => array:6 [ 0 => "Tuberculosis" 1 => "latent tuberculosis" 2 => "Mantoux" 3 => "tuberculin skin test" 4 => "interferon-gamma" 5 => "healthcare workers" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec160545" "palabras" => array:6 [ 0 => "Tuberculose" 1 => "tuberculose latente" 2 => "Mantoux" 3 => "prova de tuberculina" 4 => "interferão-gama" 5 => "profissionais de saúde" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">Aims</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Systematic screening for TB and TL in healthcare workers with contact with patients or other workers with TB and risk of contagion.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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 ≥10<span class="elsevierStyleHsp" style=""></span>mm and <15<span class="elsevierStyleHsp" style=""></span>mm and chest X-ray. The diagnoses were performed according to the recommendations of the Portuguese Pulmonolgy Society (SPP).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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 <10<span class="elsevierStyleHsp" style=""></span>mm in 250, ≥10 and <15<span class="elsevierStyleHsp" style=""></span>mm in 175 (QTF positive in 36) and ≥15<span class="elsevierStyleHsp" style=""></span>mm in 65. Of the screened workers, 280 had a previous PT ≥15<span class="elsevierStyleHsp" style=""></span>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> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Introdução</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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> <span class="elsevierStyleSectionTitle">Objectivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Rastreio sistemático de TB e TL nos profissionais de saúde com contacto com doentes ou funcionários com TB e risco de contágio.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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 ≥10<span class="elsevierStyleHsp" style=""></span>mm e <15<span class="elsevierStyleHsp" style=""></span>mm e RX tórax. O diagnóstico foi efectuado de acordo com as recomendações da SPP.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nos 13 rastreios efectuados foram englobados 792 profissionais (563 ♀; 229 ♂). Destes, 75 apresentavam sintomas e 31 alterações radiológicas. A PT foi efectuada em 490 profissionais, sendo <10 <span class="elsevierStyleHsp" style=""></span>mm em 250, ≥10 e <15<span class="elsevierStyleHsp" style=""></span>mm em 175 (QTF positivo em 36) e ≥15<span class="elsevierStyleHsp" style=""></span>mm em 65. Dos profissionais rastreados, 280 tinham PT anterior ≥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> <span class="elsevierStyleSectionTitle">Conclusões</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">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>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
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