Ali N S, Hussain S F, Azam S I
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Int J Tuberc Lung Dis. 2002 Nov;6(11):1012-6.
Pre-employment screening of health care workers (HCWs) is practiced widely. Research needs to be carried out to evaluate the screening procedure in developing countries.
To evaluate the efficacy of Mantoux test and erythrocyte sedimentation rate (ESR) for the diagnosis of active tuberculosis (TB), in pre-employment screening of HCWs, in a high prevalence country.
Pre-employment screening of all new employees was reviewed from June to September 2000. The screening consisted of history, physical examination, blood and urine tests, Mantoux test and a chest radiograph. Patients with clinical, laboratory or radiological features suggestive of active TB were referred to a specialist.
Out of 207 employees, a Mantoux reaction of > or = 10 mm and ESR of > or = 25 mm/first hour was noted in 90 (43.5%) and 21 (10.1%), respectively. One person had symptoms suggestive of TB and was already on anti-tuberculosis therapy at the time of screening. All other employees were asymptomatic. Based on radiographic findings, four (2%) cases were referred and one was given anti-tuberculosis therapy. An additional 48 (23.1%) employees were referred on the basis of positive Mantoux or elevated ESR; none were found to have active TB.
In high prevalence countries use of Mantoux test and ESR in pre-employment screening of HCWs is not recommended for detection of active TB.
医护人员的入职前筛查广泛开展。在发展中国家需要开展研究以评估该筛查程序。
在结核病高流行国家，评估结核菌素试验和红细胞沉降率（ESR）在医护人员入职前筛查中诊断活动性结核病（TB）的效能。
回顾2000年6月至9月所有新员工的入职前筛查情况。筛查包括病史、体格检查、血液和尿液检查、结核菌素试验及胸部X线片。有临床、实验室或影像学特征提示活动性TB的患者被转诊至专科医生处。
207名员工中，结核菌素试验反应≥10mm和ESR≥25mm/第1小时的分别有90名（43.5%）和21名（10.1%）。1人有TB相关症状且在筛查时已接受抗结核治疗。所有其他员工均无症状。基于影像学检查结果，4例（2%）被转诊，1例接受抗结核治疗。另外48名（23.1%）员工因结核菌素试验阳性或ESR升高被转诊；均未发现活动性TB。
在结核病高流行国家，不推荐在医护人员入职前筛查中使用结核菌素试验和ESR来检测活动性TB。
