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Diel R, Nienhaus A. Risk of tuberculosis transmission by healthcare workers to children - a comprehensive review. GMS Hyg Infect Control 2023; 18:Doc26. [PMID: 38025892 PMCID: PMC10665709 DOI: 10.3205/dgkh000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background Children <15 years are at elevated risk of becoming infected with M. tuberculosis complex (Mtbc). Objective To assess the magnitude of Mtbc transmission by healthcare workers (HCW) to children. Methods Medline, Google Scholar and Cochrane library were searched to select primary studies in which HCW was the presumed index case and exposed infants and children aged below 15 years were screened for latent TB infection (LTBI). Results Of 4,702 abstracts, 19 original case reports covering one HCW each as presumed source case of Mtbc transmission to children, were identified. In sum, 11,511 children, of those 5,881 infants (51.1%), mostly in newborn nurseries, were considered contact persons and underwent tuberculin skin (TST) or Interferon gamma release assay (IGRA) testing. Test positivity was reported in 492/11,511 children (4.3%) coming from 14 studies. When test results considered falsely positive were excluded, the number of latently infected children decreased to 365/10,171 (3.6%). In all studies, the presumed duration of infectivity of the source case was, but the actual intensity and duration of exposure were not, decisive for the initiation of contact investigations. In only two of the studies, the contact time of the children towards the corresponding source case was estimated. Conclusions The results of our review suggest that the risk of Mtbc transmission from HCW to children in healthcare setting is considerably lower than reported in household settings. However, as the preselection of pediatric contacts appeared in most cases to be vague, the data found in the literature probably underestimates the actual risk.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
- LungClinic Großhansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Albert Nienhaus
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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2
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Cinquetti S, Dalmanzio M, Ros E, Gentili D, Ramigni M, Grossi A, Andrianou XD, La Torre LE, Rigoli R, Scotton PG, Taraschi A, Baldo V, Napoletano G, Russo F, Pezzotti P, Rezza G, Filia A. High rate of transmission in a pulmonary tuberculosis outbreak in a primary school, north-eastern Italy, 2019. Euro Surveill 2019; 24:1900332. [PMID: 31213222 PMCID: PMC6582512 DOI: 10.2807/1560-7917.es.2019.24.24.1900332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Italy is a low-incidence country for tuberculosis (TB). We describe a TB outbreak in a primary school in north-eastern Italy, involving 10 cases of active pulmonary disease and 42 cases of latent infection. The index case was detected in March 2019, while the primary case, an Italian-born schoolteacher, was likely infectious since January 2018. Administration of a pre-employment health questionnaire to school staff with sustained contact with children should be considered in low-incidence countries.
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Affiliation(s)
- Sandro Cinquetti
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Maria Dalmanzio
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Elisa Ros
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Davide Gentili
- Public Health Office , Local Health Unit 2 Marca Trevigiana, Treviso, Italy,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Mauro Ramigni
- Epidemiology Office, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Adriano Grossi
- University Cattolica del Sacro Cuore, Rome, Italy,Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
| | - Xanthi D Andrianou
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Roberto Rigoli
- Department of Microbiology, Treviso Hospital, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Pier Giorgio Scotton
- Department of Infectious Diseases, Treviso Hospital, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Angela Taraschi
- Department of Pediatrics, Oderzo Hospital, Local Health Unit 2 Marca Trevigiana, Treviso, Italy
| | - Vincenzo Baldo
- Hygiene and Public Health Unit, University of Padua, Padua, Italy
| | | | - Francesca Russo
- Prevention Department, Veneto Regional Health Authority, Venice, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
| | - Giovanni Rezza
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Health Institute (Istituto Superiore di Sanità), Rome, Italy
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3
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Meier NR, Volken T, Geiger M, Heininger U, Tebruegge M, Ritz N. Risk Factors for Indeterminate Interferon-Gamma Release Assay for the Diagnosis of Tuberculosis in Children-A Systematic Review and Meta-Analysis. Front Pediatr 2019; 7:208. [PMID: 31192175 PMCID: PMC6548884 DOI: 10.3389/fped.2019.00208] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/08/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Interferon-gamma release assays (IGRA) are well-established immunodiagnostic tests for tuberculosis (TB) in adults. In children these tests are associated with higher rates of false-negative and indeterminate results. Age is presumed to be one factor influencing cytokine release and therefore test performance. The aim of this study was to systematically review factors associated with indeterminate IGRA results in pediatric patients. Methods: Systematic literature review guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) searching PubMed, EMBASE, and Web of Science. Studies reporting results of at least one commercially available IGRA (QuantiFERON-TB, T-SPOT.TB) in pediatric patient groups were included. Random effects meta-analysis was used to assess proportions of indeterminate IGRA results. Heterogeneity was assessed using the I2 value. Risk differences were calculated for studies comparing QuantiFERON-TB and T-SPOT.TB in the same study. Meta-regression was used to further explore the influence of study level variables on heterogeneity. Results: Of 1,293 articles screened, 133 studies were included in the final analysis. These assessed QuantiFERON-TB only in 77.4% (103/133), QuantiFERON-TB and T-SPOT.TB in 15.8% (21/133), and T-SPOT.TB only in 6.8% (9/133) resulting in 155 datasets including 107,418 participants. Overall 4% of IGRA results were indeterminate, and T-SPOT.TB (0.03, 95% CI 0.02-0.05) and QuantiFERON-TB assays (0.05, 95% CI 0.04-0.06) showed similar proportions of indeterminate results; pooled risk difference was-0.01 (95% CI -0.03 to 0.00). Significant differences with lower proportions of indeterminate assays with T-SPOT.TB compared to QuantiFERON-TB were only seen in subgroup analyses of studies performed in Africa and in non-HIV-infected immunocompromised patients. Meta-regression confirmed lower proportions of indeterminate results for T-SPOT.TB compared to QuantiFERON-TB only among studies that reported results from non-HIV-infected immunocompromised patients (p < 0.001). Conclusion: On average indeterminate IGRA results occur in 1 in 25 tests performed. Overall, there was no difference in the proportion of indeterminate results between both commercial assays. However, our findings suggest that in patients in Africa and/or patients with immunocompromising conditions other than HIV infection the T-SPOT.TB assay appears to produce fewer indeterminate results.
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Affiliation(s)
- Noëmi R Meier
- Mycobacterial Research Laboratory, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thomas Volken
- School of Health Professions, Zürich University of Applied Sciences, Winterthur, Switzerland
| | - Marc Geiger
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Ulrich Heininger
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland
| | - Marc Tebruegge
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.,Royal Children's Hospital Melbourne, Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Nicole Ritz
- Mycobacterial Research Laboratory, University of Basel Children's Hospital, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland.,Paediatric Infectious Diseases and Vaccinology Unit, University of Basel Children's Hospital, Basel, Switzerland.,Royal Children's Hospital Melbourne, Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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4
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Luzzati R, Migliori GB, Zignol M, Cirillo DM, Maschio M, Tominz R, Ventura G, Patussi V, D'Ambrosio L, Centis R, Michieletto F, Trovato A, Salton F, Busetti M, Di Santolo M, Raviglione M, Confalonieri M. Children under 5 years are at risk for tuberculosis after occasional contact with highly contagious patients: outbreak from a smear-positive healthcare worker. Eur Respir J 2017; 50:50/5/1701414. [PMID: 29097434 DOI: 10.1183/13993003.01414-2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/16/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Roberto Luzzati
- Unit of Infectious Diseases, Dept of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.,These authors contributed equally
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy.,These authors contributed equally
| | - Matteo Zignol
- Global TB Programme, World Health Organization, Geneva, Switzerland.,These authors contributed equally
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology and Infectious Diseases, San Raffaele Scientific Institute, HSR, Milan, Italy.,These authors contributed equally
| | - Massimo Maschio
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Riccardo Tominz
- Dept of Prevention, Local Health Authority and University of Trieste, Trieste, Italy
| | - Giovanna Ventura
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Valentino Patussi
- Dept of Prevention, Local Health Authority and University of Trieste, Trieste, Italy
| | - Lia D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy.,Public Health Consulting Group, Lugano, Switzerland
| | - Rosella Centis
- WHO Collaborating Centre for TB and Lung Diseases, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - Franco Michieletto
- Dept of Prevention, Local Health Authority and University of Trieste, Trieste, Italy
| | - Alberto Trovato
- Emerging Bacterial Pathogens Unit, Division of Immunology and Infectious Diseases, San Raffaele Scientific Institute, HSR, Milan, Italy
| | - Francesco Salton
- Pulmonology Unit, University Hospital of Cattinara, Trieste, Italy
| | - Marina Busetti
- Microbiology Unit, University Hospital ASUITS, Trieste, Italy
| | | | - Mario Raviglione
- Global TB Programme, World Health Organization, Geneva, Switzerland.,These authors contributed equally
| | - Marco Confalonieri
- Pulmonology Unit, University Hospital of Cattinara, Trieste, Italy .,These authors contributed equally
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5
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Laurenti P, Raponi M, de Waure C, Marino M, Ricciardi W, Damiani G. Performance of interferon-γ release assays in the diagnosis of confirmed active tuberculosis in immunocompetent children: a new systematic review and meta-analysis. BMC Infect Dis 2016; 16:131. [PMID: 26993789 PMCID: PMC4797356 DOI: 10.1186/s12879-016-1461-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background Tuberculosis (TB) is a global public health problem, causing morbidity and mortality in adults and children. The most reliable diagnostic tools currently available are the in vivo Tuberculin Skin Test (TST) and the ex vivo Interferon-γ release assays (IGRAs). Several clinical, radiological, and bacteriological features make the detection of active (overt disease) TB in children difficult. Although recently developed immunological assays such as QuantiFERON-TB Gold In-Tube (QFT-IT) and T-SPOT®.TB are commonly used to identify active TB in adults, different evidence is required for diagnosis in children. The purpose of this study was to reassess the sensitivity and specificity of IGRAs in detecting microbiologically confirmed active TB in immunocompetent children. Methods A systematic review and meta-analysis of studies reporting on the diagnostic accuracy of tests for TB in immunocompetent children aged 0–18 years, with confirmation by positive M. tuberculosis cultures, were undertaken. Electronic databases were searched up to September 2015 and study quality assessment was performed using QUADAS-2. Results Fifteen studies were included in our meta-analysis. Results showed that there were no significant differences in sensitivity between TST (88.2 %, 95 % confidence interval [CI] 79.4–94.2 %), QFT-IT (89.6 %, 95 % CI 79.7–95.7 %) and T SPOT (88.5 %, 95 % CI 80.4–94.1 %). However, both QFT-IT (95.4 %, 95 % CI 93.8–96.6 %) and T-SPOT (96.8 %, 95 % CI 94.2–98.5 %) have significantly higher specificity than TST (86.3 %, 95 % CI 83.9–88.6 %). Conclusions QFT-IT and T-SPOT have higher specificity than TST for detecting active TB cases in immunocompetent children.
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Affiliation(s)
- Patrizia Laurenti
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Matteo Raponi
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy.
| | - Chiara de Waure
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Marta Marino
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Walter Ricciardi
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
| | - Gianfranco Damiani
- Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy
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6
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Baquero-Artigao F, Mellado Peña M, del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez M. Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (I): Epidemiology and diagnosis. Congenital tuberculosis. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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7
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Sanderson JM, Proops DC, Trieu L, Santos E, Polsky B, Ahuja SD. Increasing the efficiency and yield of a tuberculosis contact investigation through electronic data systems matching. J Am Med Inform Assoc 2015; 22:1089-93. [PMID: 25888587 DOI: 10.1093/jamia/ocv029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/08/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Electronic health data may improve the timeliness and accuracy of resource-intense contact investigations (CIs) in healthcare settings. METHODS In September 2013, we initiated a CI around a healthcare worker (HCW) with infectious tuberculosis (TB) who worked in a maternity ward. Two sources of electronic health data were employed: hospital-based electronic medical records (EMRs), to identify patients exposed to the HCW, and an electronic immunization registry, to obtain contact information for exposed infants and their providers at two points during follow-up. RESULTS Among 954 patients cared for in the maternity ward during the HCW's infectious period, the review of EMRs identified 285 patients (30%) who interacted with the HCW and were, thus, exposed to TB. Matching infants to the immunization registry offered new provider information for 52% and 30% of the infants in the first and second matches. Providers reported evaluation results for the majority of patients (66%). CONCLUSION Data matching improved the efficiency and yield of this CI, thereby demonstrating the usefulness of enhancing CIs with electronic health data.
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Affiliation(s)
- Jennifer M Sanderson
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
| | - Douglas C Proops
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
| | - Lisa Trieu
- CDC/CSTE Applied Epidemiology Fellowship Program, Atlanta, GA, USA
| | - Eloisa Santos
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA
| | - Bruce Polsky
- Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, Long Island City, NY, USA Mount Sinai Roosevelt, New York, NY, USA
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8
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Schepisi MS, Sotgiu G, Contini S, Puro V, Ippolito G, Girardi E. Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis. PLoS One 2015; 10:e0121639. [PMID: 25835507 PMCID: PMC4383623 DOI: 10.1371/journal.pone.0121639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/11/2015] [Indexed: 11/18/2022] Open
Abstract
Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04-0.21) for infants, 0.38% (95% CI 0.01-1.60) for children, 0.09% (95% CI 0.02-0.22) for adults and 0.00% (95% CI 0.00-0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 - 2.02) for infants, 0.9% (95% CI 0.40-1.60) for children, 4.32% (95% CI 1.43-8.67) for adults and 2.62% (95% CI 1.05-4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.
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Affiliation(s)
- Monica Sañé Schepisi
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
- * E-mail:
| | - Giovanni Sotgiu
- Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy
| | - Silvia Contini
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Vincenzo Puro
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Giuseppe Ippolito
- Office of the Scientific Director, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
| | - Enrico Girardi
- Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy
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9
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Baquero-Artigao F, Mellado Peña MJ, Del Rosal Rabes T, Noguera Julián A, Goncé Mellgren A, de la Calle Fernández-Miranda M, Navarro Gómez ML. [Spanish Society for Pediatric Infectious Diseases guidelines on tuberculosis in pregnant women and neonates (i): Epidemiology and diagnosis. Congenital tuberculosis]. An Pediatr (Barc) 2015; 83:285.e1-8. [PMID: 25754313 DOI: 10.1016/j.anpedi.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/13/2015] [Accepted: 01/15/2015] [Indexed: 12/18/2022] Open
Abstract
Tuberculosis (TB) screening in pregnancy using tuberculin skin test (TST) is recommended in case of symptoms of TB disease, close contact with a patient with infectious TB, or high risk of developing active disease. The new interferon gamma release assay (IGRA) tests are recommended in BCG-vaccinated pregnant women with positive TST and no known risk factors for TB, and in those immunocompromised, with clinical suspicion of TB but negative TST. TB diagnosis is difficult due to the non-specific symptoms, the increased frequency of extrapulmonary disease, the delay in radiological examinations, and the high rate of tuberculin anergy. Neonatal TB can be acquired in utero (congenital TB), or through airborne transmission after delivery (postnatal TB). Congenital TB is extremely rare and does not cause fetal malformations. It may be evident at birth, although it usually presents after the second week of life. In newborns with no family history of TB, the disease should be considered in cases of miliary pneumonia, hepatosplenomegaly with focal lesions, or lymphocytic meningitis with hypoglycorrhachia, especially in those born to immigrants from high TB-burden countries. TST is usually negative, and IGRAs have lower sensitivity than in older children. However, the yield of acid-fast smear and culture is higher, mostly in congenital TB. Molecular diagnosis techniques enable early diagnosis and detection of drug resistance mutations. There is a substantial risk of disseminated disease and death.
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Affiliation(s)
- F Baquero-Artigao
- Grupo de Infección Congénita y Perinatal de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España.
| | - M J Mellado Peña
- Grupo de Tuberculosis de la SEIP, Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España
| | - T Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital Infantil La Paz, Madrid, España
| | - A Noguera Julián
- Unidad de Infecciones, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - A Goncé Mellgren
- Servicio de Medicina Maternofetal, Institut Clínic de Ginecología, Obstetricia i Neonatologia, Hospital Clínic, Barcelona, España
| | | | - M L Navarro Gómez
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Gregorio Marañón, Madrid, España
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10
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Durando P, Alicino C, Orsi A, Barberis I, Paganino C, Dini G, Mazzarello G, Del Bono V, Viscoli C, Copello F, Sossai D, Orengo G, Sticchi L, Ansaldi F, Icardi G. Latent tuberculosis infection among a large cohort of medical students at a teaching hospital in Italy. Biomed Res Int 2015; 2015:746895. [PMID: 25705685 PMCID: PMC4331323 DOI: 10.1155/2015/746895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Abstract
The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis. A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9-160.2; P value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0-265.1; P value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medical students, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Cristiano Alicino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Ilaria Barberis
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Chiara Paganino
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Guglielmo Dini
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Valerio Del Bono
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa and Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Francesco Copello
- Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Dimitri Sossai
- Health Safety and Prevention Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giovanni Orengo
- Quality and Risk Management Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa and Hygiene and Infection Control Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
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11
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Fisher KE, Guaran R, Stack J, Simpson S, Krause W, For KD, Ryan E, Conaty S, Hope K, Isaacs D, Chay P, Eastwood J, Marks GB. Nosocomial Pulmonary Tuberculosis Contact Investigation in a Neonatal Intensive Care Unit. Infect Control Hosp Epidemiol 2015; 34:754-6. [DOI: 10.1086/670995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The diagnosis of smear-positive pulmonary tuberculosis in a medical officer working in a metropolitan Australian neonatal intensive care unit led to a contact investigation involving 125 neonates, 165 relatives, and 122 healthcare workers with varying degrees of exposure. There was no evidence of nosocomial tuberculosis transmission from the index case.
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12
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Esposito S, Giannini A, Biondetti P, Bonelli N, Nosotti M, Bosis S, Calderini E, Principi N. Subcutaneous emphysema as the first relevant clinical sign of complicated tubercular lymph node disease in a child. BMC Infect Dis 2013; 13:461. [PMID: 24094042 PMCID: PMC3851260 DOI: 10.1186/1471-2334-13-461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children make up a significant proportion of the global tuberculosis (TB) caseload, and experience considerable TB-related morbidity and mortality. Unfortunately, it is not easy to diagnose TB in the first years of life because of the diversity of its clinical presentation and the non-specific nature of most of its symptoms. CASE PRESENTATION A 26-month-old male child was admitted to hospital because of the sudden onset of rapidly increasing swelling of the neck, face and upper trunk a few hours before. Upon admission, his temperature was 36.5°C, pulse rate 120/min, respiratory rate 36/min, and O2 saturation 97% in air. Palpation revealed subcutaneous emphysema (SE) over the swollen skin areas, and an examination of the respiratory system revealed crepitations in the left part of the chest without any significant suggestion of mediastinal shift. Chest radiography showed enlargement of the left lung hilum with pneumomediastinum and diffuse SE. Bronchoscopy was carried out because of the suspicion that the SE may have been due to the inhalation of a peanut. This excluded the presence of a foreign body but showed that the left main bronchus was partially obstructed with caseous material and showed significant signs of granulomatous inflammation on the wall. Contrast-enhanced computed tomography of the lungs confirmed the SE and pneumomediastinum, and revealed bilateral hilum lymph node disease with infiltration of the adjacent anatomical structure and a considerable breach in the left primary bronchus wall conditioning the passage of air in the mediastinum and subcutaneous tissue. As a tuberculin skin test and polymerase chain reaction for Mycobacterium tuberculosis on bronchial material and gastric aspirate were positive, a diagnosis of TB was made and oral anti-TB therapy was started, which led to the elimination of M. tuberculosis and a positive clinical outcome. CONCLUSIONS This is the first case in which SE was the first relevant clinical manifestation of TB and arose from infiltration of the bronchial wall secondary to caseous necrosis of the hilum lymph nodes. Physicians should be aware of the fact that SE is one of the possible initial signs and symptoms of early TB infection, and act accordingly.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
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13
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Durando P, Sotgiu G, Spigno F, Piccinini M, Mazzarello G, Viscoli C, Copello F, Poli A, Ansaldi F, Icardi G. Latent tuberculosis infection and associated risk factors among undergraduate healthcare students in Italy: a cross-sectional study. BMC Infect Dis 2013; 13:443. [PMID: 24059355 PMCID: PMC3848912 DOI: 10.1186/1471-2334-13-443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/18/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The screening of both healthcare workers and students attending teaching hospitals for latent tuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including Italy, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the prevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian students. METHODS In a cross-sectional study, performed between January and May 2012, 881 undergraduate students attending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST). All the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. A standardized questionnaire was collected for risk-assessment analysis. RESULTS Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives was 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the prevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595) students. No statistically significant association between TST positivity and age, gender, and BCG vaccination was observed. The main independent variable associated with TST positivity was to be born in a country with a high TB incidence (i.e., ≥20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001). CONCLUSIONS The prevalence of LTBI among healthcare students resulted very low. The only significant association between TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low incidence of TB, the screening programs of healthcare students before clinical training can be useful for the early identification and treatment of the sporadic cases of LTBI.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Associate Professor of Medical Statistics, Research, Medical Education and Professional Development Unit, AOU Sassari, University of Sassari, Via Padre Manzella 4, 07100, Sassari, Italy
| | - Fabio Spigno
- Department of Health Sciences, Associate Professor of Occupational Health, Chief of the Occupational Health Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Mauro Piccinini
- Prevention and Protection Service of the University of Genoa, Via Balbi 5, 16126, Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, Full Professor of Infectious Diseases, Chief of the Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Francesco Copello
- Occupational and Preventive Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Alessandro Poli
- Occupational and Preventive Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, Full Professor of Hygiene, Preventive Medicine and Public Health, Chief of the Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
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14
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Fisher KE, Cook NF, Marks GB. Costs of a contact screening activity in a neonatal intensive care unit. N S W Public Health Bull 2013; 24:29-31. [PMID: 23849026 DOI: 10.1071/nb12108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Kate E Fisher
- Department of Community Paediatrics, South Western Sydney Local Health District
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15
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Cassone A, Cauda R, De Maria A. High rate of Quantiferon positive and tuberculin negative tests in infants born at a large Italian university hospital in 2011: a cautionary hypothesis. Pathog Glob Health 2012; 106:8-11. [PMID: 22595269 DOI: 10.1179/2047773212y.0000000006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
In the summer of 2011, an outbreak of Mycobacterium tuberculosis infection was suspected, and widely publicized, to have occurred in a maternity ward of an Italian University Hospital based on a case of tuberculosis in a nurse and another case in a newborn. More than 1300 newborns in the Hospital were surveyed for the occurrence of latent TB by the use of interferon-gamma released assays, which was positive in 118 newborns, all negative at the tuberculin skin test. We present here several theoretical arguments and literature data suggesting caution in interpreting the interferon-gamma released assays positivity alone as indication of latent TB infection in newborns.
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Affiliation(s)
- Antonio Cassone
- Molecular Parasitology Course, Imperial College, London, UK.
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