Brote de tuberculosis en un colegio de primaria: descripción y consideraciones sobre el valor del jugo gástrico en el manejo de microepidemias

Tagarro, Alfredo; Jiménez, Susana; Sanchez, A.; Arroyo, Alicia; Aracil, Javier; Cañete, Alfonso

doi:10.1016/j.eimc.2010.08.006

Cited by 11 publications

(3 citation statements)

References 18 publications

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“…A school tuberculosis outbreak is a public health emergency that requires immediate attention (7)(8)(9)(10)(11). TST, one of the most widely used tests for LTBI, can be difficult to interpret.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of a novel ESAT6-CFP10 skin test for tuberculosis infection in school tuberculosis outbreak in China

Lu,

Xu,

Wang

et al. 2024

Front. Public Health

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BackgroundThe ESAT6-CFP10 (EC) skin test is recommended by the World Health Organization for latent tuberculosis infection (LTBI). However, it is still unknown how the EC skin test performs in students during a school tuberculosis outbreak.MethodsWe conducted an epidemiological investigation to assess the performance of the EC skin test in this high-risk population.ResultsA total of 9 active student patients were confirmed in the same class as the index case, with an incidence rate of 18.0% (9/50). Among the 50 close contacts, 14 (28%) were over 15 years old and had a chest X-ray (CXR), and none of them had abnormal CXR findings. The rates of positive tuberculin skin test (TST) ≥ 5 mm and < 10 mm, ≥ 10 mm and < 15 mm, and ≥ 15 mm were 12.0% (6/50), 16.0% (8/50), and 10.0% (5/50), respectively. On the second screening, 44 students with the same class as the index case had the EC skin test, of which 31 (70.5%) had positive EC tests. All patients had negative sputum smear results, of whom 4 (44.4%) had positive Xpert results; three had a TST induration diameter between 5 mm and 10 mm, but all of them had an EC diameter > 15 mm; 5 (55.6%) had abnormal CXR results, but all the confirmed patients had abnormal CT results; Except for four cases that were diagnosed by Xpert, the remaining five were confirmed by CT scan.ConclusionThe novel EC skin test performed well in students during the school tuberculosis outbreak. In some special conditions, such as when the index case is bacteriologically positive for tuberculosis and the rate of LTBI is higher than the average for the local same-age group, secondary screening is recommended 2–3 months after the first screening. Furthermore, we cannot ignore the role of CT in the diagnosis of early student tuberculosis.

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Section: Discussionmentioning

confidence: 99%

Diagnostic performance of a novel ESAT6-CFP10 skin test for tuberculosis infection in school tuberculosis outbreak in China

Lu,

Xu,

Wang

et al. 2024

Front. Public Health

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“…A tuberculosis outbreak in a school is of particular concern to tuberculosis control in China ( Tagarro et al., 2011 ; Gao and Mei, 2020 ; Lu et al., 2021 ). One reason was that students with a strongly positive TST or a positive IGRA found in the early tuberculosis screening process in schools refused to take preventive treatment and continued to attend classes ( Lu et al., 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Selection of the cutoff value of the tuberculin skin test for diagnosing students who need preventive treatment: A school-based cross-sectional study

Lü

Ding²,

Sun³

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveTuberculosis outbreaks in schools are common in China. This study aimed to introduce and evaluate a new screening process to help control outbreaks.MethodsScreening information of students in three schools with tuberculosis outbreaks was collected. QuantiFERON-TB gold in-tube (QFT) results were used as the reference standard to determine the cutoff value of the tuberculin skin test (TST) for diagnosing students who need to have preventive medication.ResultsA total of 1,232 students and teachers from three different schools that all had more than three student patients with tuberculosis were included in this study. In total, 308 (25.0%) students had an induration diameter ≥10 mm; among students in a class different from the index case, the infection rate was 24.4% (264/1,084), which was lower than the rate among students in the same class (29.7%) (P = 0.157). Students in the same class as the index tuberculosis case had a much higher QFT positivity compared to those in a different class (58.1% vs. 7.7%, P < 0.0001). Diagnostic agreement between TST ≥10 mm and QFT was 36.6%. The diagnostic value reached the highest when the induration diameter of TST was ≥9 mm, with a sensitivity and specificity of 94.1% (95% CI: 89.4%–97.1%) and 27.6% (95% CI: 24.9%–30.4%), respectively. The area under the curve (AUC) was 0.664 (95% CI: 0.637–0.690, P < 0.0001).ConclusionIn tuberculosis outbreaks in schools, if there are three or more cases of students with tuberculosis in a class or if the moderate or strong TST positivity rate is much higher than the normal range in the region, attention should be paid to those with moderately positive TST results. Interferon-gamma release assays (IGRAs) are recommended to be conducted following TST on the day of reading the results, especially among students sharing the same class with the index case. In resource-poor areas lacking IGRAs, the induration diameter of TST can be appropriately reduced from 15 to 9 mm to enhance the sensitivity of TST.

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“…Almost all primary school children (aged 3-5 years) exposed to a Spanish school teacher were TST positive, and one-third was diagnosed with TB [7]. This study shows that prolonged exposure may infect almost every child.…”

Section: Outbreak Reportsmentioning

confidence: 92%

Lessons learnt in Europe on tuberculosis surveillance, outbreaks and BCG vaccination in 2011

et al. 2013

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Brote de tuberculosis en un colegio de primaria: descripción y consideraciones sobre el valor del jugo gástrico en el manejo de microepidemias

Cited by 11 publications

References 18 publications

Diagnostic performance of a novel ESAT6-CFP10 skin test for tuberculosis infection in school tuberculosis outbreak in China

Diagnostic performance of a novel ESAT6-CFP10 skin test for tuberculosis infection in school tuberculosis outbreak in China

Selection of the cutoff value of the tuberculin skin test for diagnosing students who need preventive treatment: A school-based cross-sectional study

Lessons learnt in Europe on tuberculosis surveillance, outbreaks and BCG vaccination in 2011

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