Napoli Christian, Ferretti Filippo, Di Ninno Filippo, Orioli Riccardo, Marani Alessandra, Sarlo Maria Giuditta, Prestigiacomo Claudio, De Luca Assunta, Orsi Giovanni Battista
Department of Medical Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Via di Grottarossa 1035/1039, 00189 Rome, Italy; Health Direction, University Hospital Sant'Andrea, Via di Grottarossa 1035/1039, 00189 Rome, Italy.
Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
Biomed Res Int. 2017;2017:7538037. doi: 10.1155/2017/7538037. Epub 2017 Feb 27.
Health care workers (HCW) are particularly at risk of acquiring tuberculosis (TB), even in countries with low TB incidence. Therefore, TB screening in HCW is a useful prevention strategy in countries with both low and high TB incidence. Tuberculin skin test (TST) is widely used although it suffers of low specificity; on the contrary, the in vitro enzyme immunoassay tests (IGRA) show superior specificity and sensitivity but are more expensive. The present study reports the results of a three-year TB surveillance among HCW in a large teaching hospital in Rome, using TST (by standard Mantoux technique) and IGRA (by QuantiFERON-TB) as first- and second-level screening tests, respectively. Out of 2290 HCW enrolled, 141 (6.1%) had a positive TST; among them, 99 (70.2%) underwent the IGRA and 16 tested positive (16.1%). The frequency of HCW tested positive for TB seems not far from other experiences in low incidence countries. Our results confirm the higher specificity of IGRA, but, due to its higher cost, TST can be considered a good first level screening test, whose positive results should be further confirmed by IGRA before the patients undergo X-ray diagnosis and/or chemotherapy.
医护人员（HCW）尤其有感染结核病（TB）的风险，即使在结核病发病率较低的国家也是如此。因此，在结核病发病率低和高的国家，对医护人员进行结核病筛查都是一种有用的预防策略。结核菌素皮肤试验（TST）虽特异性低但仍被广泛使用；相反，体外酶免疫测定试验（IGRA）显示出更高的特异性和敏感性，但成本更高。本研究报告了罗马一家大型教学医院对医护人员进行的为期三年的结核病监测结果，分别使用TST（采用标准曼托试验技术）和IGRA（采用结核感染T细胞检测）作为一级和二级筛查试验。在纳入的2290名医护人员中，141人（6.1%）TST呈阳性；其中，99人（70.2%）接受了IGRA检测，16人检测呈阳性（16.1%）。医护人员结核病检测呈阳性的频率似乎与低发病率国家的其他情况相差不远。我们的结果证实了IGRA具有更高的特异性，但由于其成本较高，TST可被视为一种良好的一级筛查试验，其阳性结果在患者接受X线诊断和/或化疗之前应由IGRA进一步确认。
