Demkow U, Broniarek-Samson B, Filewska M, Lewandowska K, Maciejewski J, Zycinska K, Zwolska Z, Kus J
Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.
J Physiol Pharmacol. 2008 Dec;59 Suppl 6:209-17.
Health care workers (HCWs) are at risk for developing active tuberculosis (TB). The prevalence of latent tuberculosis infection (LTBI) in this group is unknown in Poland, due largely to the problems associated with the interpretation of the tuberculin skin test (TST) in BCG immunized population. The goal of the present study was to assess the prevalence of LTBI in both clinical and non-clinical 155 HCWs (120 females and 35 males) and to compare the groups at different levels of risk. All participants were interviewed using a questionnaire and underwent interferon-gamma whole blood assay (Quantiferon-Tb-Gold) (QTF) and TST. The questionnaire provided information on possible risk factors for LTBI, including demographic and socioeconomic details, the presence of BCG scars, and the degree of occupational exposure. We found that the prevalence of LTBI among HCWs was, on average, 27.1%. A higher risk of acquiring LTBI was associated with certain work locations (TB lab workers--prevalence 50%, TB ward clinicians--34%, nurses--30%). The prevalence in analytical lab technicians was 20%, in administration staff was 15%. The HCWs with positive QTF test results were older and worked longer than those who had negative results. There was a significant correlation between the level of IFN-gamma and both age (P<0.001) and length of employment (P<0.01). The correlation between the diameter of skin test induration and the magnitude of the INF-gamma response also was significant (P<0.001). We conclude that HCWs are at increased risk of infection, suggesting that appropriate preventive strategies should be undertaken. IFN-gamma test is a useful tool in detecting LTBI cases in a country where BCG vaccination is a national policy.
医护人员有感染活动性肺结核（TB）的风险。在波兰，这一群体中潜伏性结核感染（LTBI）的患病率尚不清楚，这主要是由于在卡介苗（BCG）免疫人群中结核菌素皮肤试验（TST）结果解读存在问题。本研究的目的是评估155名临床和非临床医护人员（120名女性和35名男性）中LTBI的患病率，并比较不同风险水平的组。所有参与者均通过问卷调查进行访谈，并接受干扰素-γ全血检测（QuantiFERON-TB-Gold）（QTF）和TST。问卷提供了关于LTBI可能的风险因素的信息，包括人口统计学和社会经济细节、卡介苗疤痕的存在情况以及职业暴露程度。我们发现，医护人员中LTBI的平均患病率为27.1%。感染LTBI的较高风险与某些工作地点相关（结核病实验室工作人员——患病率50%，结核病病房临床医生——34%，护士——30%）。分析实验室技术人员的患病率为20%，行政人员为15%。QTF检测结果呈阳性的医护人员比结果呈阴性的医护人员年龄更大，工作年限更长。干扰素-γ水平与年龄（P<0.001）和工作年限（P<0.01）之间存在显著相关性。皮肤试验硬结直径与INF-γ反应强度之间的相关性也很显著（P<0.001）。我们得出结论，医护人员感染风险增加，这表明应采取适当的预防策略。在一个将卡介苗接种作为国家政策的国家，干扰素-γ检测是检测LTBI病例的有用工具。
