Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital

Abstract

BackgroundAccording to the World Health Organization, China is one of 22 countries with serious tuberculosis (TB) infections and one of the 27 countries with serious multidrug-resistant TB strains. Despite the decline of tuberculosis in the overall population, healthcare workers (HCWs) are still at a high risk of infection. Compared with high-income countries, the TB prevalence among HCWs is higher in low- and middle-income countries. Low-dose computed tomography (LDCT) is becoming more popular due to its superior sensitivity and lower radiation dose. However, there have been no reports about active pulmonary tuberculosis (PTB) among HCWs as assessed with LDCT. The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers.MethodsThis study retrospectively analysed the physical examination data of healthcare workers in the Beijing Chest Hospital from September 2012 to December 2015. Low-dose lung CT examinations were performed in all cases. The comparisons between active and inactive PTB according to the CT findings were made using the Pearson chi-square test or the Fisher’s exact test. Comparisons between the incidences of active PTB in high-risk areas and non-high-risk areas were performed using the Pearson chi-square test. Analyses of active PTB were performed according to different ages, numbers of years on the job, and the risks of the working areas. Active PTB as diagnosed by the LDCT examinations alone was compared with the final comprehensive diagnoses, and the sensitivity and positive predictive value were calculated.ResultsA total of 1 012 participants were included in this study. During the 4-year period of medical examinations, active PTB was found in 19 cases, and inactive PTB was found in 109 cases. The prevalence of active PTB in the participants was 1.24%, 0.67%, 0.81%, and 0.53% for years 2012 to 2015. The corresponding incidences of active PTB among the tuberculosis hospital participants were 0.86%, 0.41%, 0.54%, and 0.26%. Most HCWs with active TB (78.9%, 15/19) worked in the high-risk areas of the hospital. There was a significant difference in the incidences of active PTB between the HCWs who worked in the high-risk and non-high-risk areas (odds ratio [OR], 14.415; 95% confidence interval (CI): 4.733 – 43.896). Comparisons of the CT signs between the active and inactive groups via chi-square tests revealed that the tree-in-bud, cavity, fibrous shadow, and calcification signs exhibited significant differences (P = 0.000, 0.021, 0.001, and 0.024, respectively). Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis, whereas fibrous shadow and calcification opacities are the main features of inactive pulmonary tuberculosis. Comparison with the final comprehensive diagnoses revealed that the sensitivity and positive predictive value of the diagnoses of active PTB based on LDCT alone were 100% and 86.4%, respectively.ConclusionsHealthcare workers in tuberculosis hospi...

Exposure to Occupational Hazards among Health Care Workers in Low- and Middle-Income Countries: A Scoping Review

“…There were four studies examining active tuberculosis among health care workers in this review [ 66 , 69 , 71 , 72 ]. A study conducted in India reported a pulmonary tuberculosis incidence rate of 314 per 100,000 person-years among health care workers and that this was 1.86 times higher than that of the general population [ 66 ].…”

“…Another study conducted in South Africa reported a tuberculosis incidence rate of 1985 per 100,000 person-years among health care workers, which was double the incidence of tuberculosis in the general population [ 69 ]. A study conducted in China used low-dose lung CT examinations to detect active tuberculosis, and reported that the incidence and prevalence rates of active tuberculosis in health care workers were >2.8 times and >4.1 times greater than that of the general population, respectively [ 72 ].…”

“…The risk factors for acquiring tuberculosis identified in this review were working in high-risk areas (tuberculosis facilities/wards, medical wards, outpatient departments, microbiology laboratories, radiology departments), belonging to certain occupation groups (nurses, microbiology laboratory technicians, and radiology technicians), working for >10 years, increasing age, and having co-morbidities such as diabetes and HIV [ 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 ].…”

The use of a borderline zone for the interpretation of interferon-gamma release assay results for serial screening of healthcare workers

“…Although computed tomography (CT) has been reported to be useful in LTBI screenings, it is not yet included in the guidelines, and cost and risk versus effectiveness should be considered [23][24][25][26][27][28]. LDCT has a lower radiation dose than high-resolution computed tomography (HRCT), which has been shown to be useful in TB contact screening [26,29]. In this study, we found that it is necessary to rule out the possibility of TB by performing LDCT at the time of LTBI examination as well as CXR for QFT-GIT-positive HCWs.…”

Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections

“…The other two patterns of TB lung infection spread, bronchogenic (bronchiolitis) and haematogenous (miliary TB), are well known [18][19][20][21][22].…”