Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand.
Int J Tuberc Lung Dis. 2011 Jan;15(1):14-23.
The tuberculin skin test (TST) is an important tool for the detection of latent tuberculosis (TB) and the identification of health care workers (HCWs) who require chemoprophylaxis. Although TST is inexpensive, easily available and the preferred test in most TB-prevalent settings, it has recognised limitations, including subjective interpretation, false positivity, cross reactivity with non-tuberculous mycobacteria, administration errors and the requirement for two visits. Given these limitations and the unavailability of better screening tests in resource-limited settings, the acceptance rate for chemoprophylaxis among HCWs has remained low. Furthermore, chemoprophylaxis in these settings is complicated by the high rate of drug-resistant TB, potential adverse reactions, prescription of chemoprophylaxis in undiagnosed active TB patients and the unavailability of follow-up systems provided by occupational health programmes. In the present article, we provide our viewpoint and a practical approach along with existing evidence supporting or discouraging the use of TST and isoniazid chemoprophylaxis for TB screening and management among HCWs in TB-prevalent settings.
结核菌素皮肤试验（TST）是检测潜伏性结核（TB）和确定需要化学预防的卫生保健工作者（HCWs）的重要工具。尽管 TST 价格低廉、易于获得，并且是大多数 TB 流行地区首选的检测方法，但它存在一些公认的局限性，包括主观解释、假阳性、与非结核分枝杆菌的交叉反应、给药错误以及需要两次就诊。鉴于这些局限性以及在资源有限的环境中缺乏更好的筛选检测方法，HCWs 对化学预防的接受率仍然较低。此外，在这些环境中进行化学预防还存在一些问题，例如耐药性结核的发生率高、潜在的不良反应、在未确诊的活动性 TB 患者中开具化学预防药物以及缺乏职业健康计划提供的随访系统。在本文中，我们提供了我们的观点和实用方法，以及现有的支持或不支持 TST 和异烟肼化学预防用于 TB 流行地区 HCWs 的 TB 筛查和管理的证据。
