Incidence of occupational latent tuberculosis infection in South African healthcare workers

Adams, Shahieda; Ehrlich, Rodney; Baatjies, Roslynn; Zyl-Smit, Richard van; Said-Hartley, Qonita; Dawson, Rodney; Dheda, Keertan

doi:10.1183/09031936.00138414

Cited by 46 publications

(43 citation statements)

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“…Occupational exposure to TB is a major health risk for healthcare workers - healthcare workers are three times more likely to acquire TB than the general population [10, 11] and an estimated 81 % of TB cases among healthcare workers are attributable to exposure in healthcare settings [12]. Furthermore, the high prevalence of latent TB Infection (LTBI) among healthcare workers [13] (84 %, 69 % and 62 % using the tuberculin skin test, QuantiFERON-TB Gold-In-Tube and T-SPOT.TB, respectively), especially when compared to the general population, also points to TB being an occupationally acquired disease [14]. The HIV epidemic equally affects healthcare workers, with estimates of the HIV prevalence among healthcare workers ranging from 11.5 to 20.0 % [15].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

et al. 2016

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BackgroundDespite the availability of TB infection control guidelines, and good levels of healthcare worker knowledge about infection control, often these measures are not well implemented. This study sought to determine the factors associated with healthcare workers’ good TB infection control practices in primary health care facilities in the Free State Province, South Africa.MethodsA cross-sectional self-administered survey among nurses (n = 202) and facility-based community healthcare workers (n = 34) as well as facility observations were undertaken at all 41 primary health care facilities in a selected district of the Free State Province.ResultsThe majority of respondents were female (n = 200; 87.7 %) and the average age was 44.19 years (standard deviation ±10.82). Good levels of knowledge were recorded, with 42.8 % (n = 101) having an average score (i.e. 65–79 %) and 31.8 % (n = 75) a good score (i.e. ≥ 80 %). Most respondents (n = 189; 80.4 %) had positive attitudes towards TB infection control practices (i.e. ≥ 80 %). While good TB infection control practices were reported by 72.9 % (n = 161) of the respondents (i.e. ≥75 %), observations revealed this to not necessarily be the case. For every unit increase in attitudes, good practices increased 1.090 times (CI:1.016–1.169). Respondents with high levels of knowledge (≥80 %) were 4.029 (CI: 1.550–10.469) times more likely to have good practices when compared to respondents with poor levels of knowledge (<65 %). The study did not find TB/HIV-related training to be a predictor of good practices.ConclusionsPositive attitudes and good levels of knowledge regarding TB infection control were the main factors associated with good infection control practices. Although many respondents reported good infection control practices - which was somewhat countered by the observations - there are areas that require attention, particularly those related to administrative controls and the use of personal protective equipment.

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Section: Introductionmentioning

confidence: 99%

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

et al. 2016

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“…ELISPOT and ELISA readers), and reporting of the results back to peripheral healthcare centres. Both tests have been shown to have high reversion rates [10].…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of C-Tb: a novel RD-1-specific skin test for the diagnosis of tuberculosis infection

et al. 2015

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C-Tb, a novel Mycobacterium tuberculosis and 6-kDa early secretory antigenic target/10-kDa culture filtrate protein (ESAT-6/CFP-10)-specific skin test, has high specificity in bacille Calmette-Guerinvaccinated healthy controls. However, the sensitivity of C-Tb has hitherto not been determined. The objective was to determine the sensitivity of C-Tb in patients with active tuberculosis (TB) in comparison with the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT).C-Tb and TST were randomly administered in a double-blinded fashion to one or the other forearm in 253 patients with active TB with or without HIV co-infection. QFT-GIT testing was performed prior to skin testing.Using a receiver operating characteristic curve-derived cut-point of 5 mm, C-Tb sensitivity was similar to QFT-GIT (73.9 (95% CI 67.8-79.3) versus 75.1 (95% CI 69.3-80.2)), and similar in HIV-infected and HIV-uninfected patients (76.7 (95% CI 69.0-83.3) versus 69.5 (95% CI 59.2-78.5)). However, sensitivity was significantly diminished in HIV-infected patients with CD4 counts <100 cells·mm -3 . C-Tb and QFT-GIT combined had significantly higher sensitivity than C-Tb alone ( p<0.0001). C-Tb was safe with no significant adverse events. The 5 mm cut-point corresponded to that found in the previously published specificity study (TESEC-04).C-Tb has similar sensitivity compared with QFT-GIT for the diagnosis of M. tuberculosis infection. Sensitivity was reduced only in HIV-infected patients with severe immunosuppression. Further studies in different settings are required to validate the proposed 5 mm cut-point. @ERSpublications C-Tb has similar sensitivity compared with QFT-GIT for the diagnosis of M. tuberculosis infection

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“…This has a bearing on morbidity and mortality as well as nosocomial transmission of TB to health care workers and patients without TB. 81,82 Finally, to confirm the diagnosis and direct therapy, appropriate ancillary testing for other causes of CAP should be undertaken including tests for Pneumocystis jirovecii (PJP), viruses, fungi (including PJP), and bacteria (including blood and sputum culture, and serological and antigen-based testing for Legionella and atypical bacteria).…”

Section: Confirmatory Microbiological Tests For M Tuberculosis (►Figmentioning

confidence: 99%

The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

Dheda

Makambwa

Esmail

2020

Semin Respir Crit Care Med

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AbstractAccording to World Health Organization estimates, tuberculosis (TB) and lower respiratory tract infections (LRTIs) are both among the top 10 global causes of death. TB and community-acquired pneumonia (CAP), if mortality estimates are combined, would rank as the third most common cause of death globally. It is estimated that each year there are approximately 10 million new cases of TB that are associated with approximately 1.2 million deaths, and almost 450 million new episodes of LRTI (synonymous with CAP) with approximately 4 million associated deaths. Globally, Streptococcus pneumoniae remains the most common cause of CAP. However, although well documented, it is not widely appreciated that in several parts of the world, including sub-Saharan Africa, Asia, and South America, Mycobacterium tuberculosis is an important cause of CAP, if not the most common organism isolated in such settings. Thus, CAP due to M. tuberculosis is not uncommon in some parts of the world with up to a third of cases being attributable to M. tuberculosis. Consequently, TB remains an important clinical entity in the intensive care unit in these settings. Despite its frequency and importance, there are very limited data about TB CAP. In this review we discussed the epidemiology, immunopathogenesis, clinical presentation, diagnosis, management, prognosis, and prevention of TB CAP. The utility of newer diagnostic approaches is highlighted.

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Incidence of occupational latent tuberculosis infection in South African healthcare workers

Cited by 46 publications

References 20 publications

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

Factors associated with good TB infection control practices among primary healthcare workers in the Free State Province, South Africa

Sensitivity of C-Tb: a novel RD-1-specific skin test for the diagnosis of tuberculosis infection

The Great Masquerader: Tuberculosis Presenting as Community-Acquired Pneumonia

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