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Vol. 16. Issue 1.
Pages 5-21 (January - February 2010)
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Vol. 16. Issue 1.
Pages 5-21 (January - February 2010)
Artigo Original/Original Article
Open Access
Tuberculose – Risco de transmissão continuada em profissionais de saúde
Tuberculosis – Risk of continued transmission in healthcare workers
Visits
5313
José Torres Costa1,2,3,
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
, Rui Silva1,2,3, Raul Sá1, Maria João Cardoso4, José Ferreira1, Carla Ribeiro1, Mário Miranda1,2,3, José Luís Plácido1,2
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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Resumo

Introdução: 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.

Objectivos: Rastreio sistemático de TB e TL nos profissionais de saúde com contacto com doentes ou funcionários com TB e risco de contágio.

Material e métodos: 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 ≥10mm e <15mm e RX tórax. O diagnóstico foi efectuado de acordo com as recomendações da SPP.

Resultados: 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 <10mm em 250, ≥10 e <15mm em 175 (QTF positivo em 36) e ≥15mm em 65. Dos profissionais rastreados, 280 tinham PT anterior ≥15mm, 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%).

Conclusões: 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.

Rev Port Pneumol 2010; XVI (1): 5-21

Palavras-chave:
Tuberculose
tuberculose latente
Mantoux
prova de tuberculina
interferão-gama
profissionais de saúde
Abstract

Introduction: 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.

Aims: Systematic screening for TB and TL in healthcare workers with contact with patients or other workers with TB and risk of contagion.

Material and methods: 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 ≥10mm and <15mm and chest X-ray. The diagnoses were performed according to the recommendations of the Portuguese Pulmonolgy Society (SPP).

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 <10mm in 250, ≥10 and <15mm in 175 (QTF positive in 36) and ≥15mm in 65. Of the screened workers, 280 had a previous PT ≥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%).

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.

Rev Port Pneumol 2010; XVI (1): 5-21

Key-words:
Tuberculosis
latent tuberculosis
Mantoux
tuberculin skin test
interferon-gamma
healthcare workers
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