scholarly journals 798. Incomplete Contact Investigation and Risk of Developing Tuberculosis Among Healthcare Professionals After Tuberculosis Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S494-S494
Author(s):  
Thana Khawcharoenporn ◽  
Kongporn Noisang
Keyword(s):  
Healthcare Professionals ◽  
Latent Tuberculosis ◽  
Index Patient ◽  
Factors Associated ◽  
Ltbi Screening ◽  
Contact Investigation ◽  
Contact Investigations ◽  
Complete Contact ◽  
Negative Sputum

Abstract Background Tuberculosis (TB) contact investigation is recommended for healthcare professionals (HCPs) after TB exposure. However, association between no participation in or incomplete contact investigation and subsequent TB development has not been well-described. This study aims to determine TB incidences and factors associated with TB development among HCPs requiring contact investigations. Methods We conducted a prospective cohort study among Thai HCPs with TB exposure from January 2013 to December 2017. Contact investigations, including baseline TB and latent tuberculosis infection (LTBI) screening and follow-up at 3 months after TB exposure, were recommended to all HCPs. The two-step tuberculin skin test (TST) was used for LTBI testing. All HCPs were followed for 2 years for TB development. Results Of the 342 HCPs with TB exposure included in the study, 311 (91%) participated in the contact investigations and 252 (74%) completed baseline TB and LTBI screening. Among the 210 HCPs with negative baseline TST, 45 (21%) completed the follow-up tests. The overall incidence of TB was 2.92/100 person-years. HCPs who did not complete follow-up TST had significantly higher TB incidence than those completed baseline and follow-up TST (3.55 vs. 0/100 person-years; P=0.01). No participation in the contact investigation and no chest radiograph performed at baseline were the independent factors associated with TB development among the HCPs [adjusted odds ratio (aOR) 6.69; P< 0.001 and aOR 8.85; P=0.01, respectively]. Contact with an index patient with concomitant TB at extrapulmonary sites (aOR 49.76, 10.03-246.99; P< 0.001) and with negative sputum AFB but positive sputum GeneXpert MTB/RIF (aOR 3.18, 1.35-7.50; P=0.008) were independently associated with no participation in the contact investigation. Conclusion The findings indicate the risk of TB development among the HCPs who did not undergo or complete contact investigations and underscore the need for interventions to improve contact investigation participation and completeness. Disclosures All Authors: No reported disclosures

scholarly journals POS1157 CONCORDANCE BETWEEN THE QUANTIFERON-TB GOLD IN-TUBE AND TUBERCULIN TEST FOR THE DIAGNOSIS OF LATENT TUBERCULOSIS INFECTION IN PATIENTS WITH RHEUMATIC DISEASES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 857.1-857
Author(s):  
C. Pávez Perales ◽  
A. Quiles Roger ◽  
E. Grau García ◽  
M. De la Rubia Navarro ◽  
S. Leal Rodriguez ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Infection ◽  
Categorical Variables ◽  
Ltbi Screening ◽  
Kappa Test ◽  
Receive Treatment

Background:Patients with rheumatic diseases (RD) are at higher risk of latent tuberculosis infection (LTBI) reactivation. To detect and treat it before starting treatment, especially with biological therapies, decrease the reactivation risk. Diagnosis is carried out by the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs), IGRAs might be more specific and sensitive.Objectives:We aim to analyze the concordance between QuantiFERON-TB Gold In-Tube (QTF) and TST for the diagnosis of LTBI in patients with rheumatic diseases.Methods:A retrospective observational study was conducted including patients diagnosed with RD screened for LTBI with both TST and QTF (2014-2018). Demographical and clinical variables at screening and at follow-up were collected. The concordance between both tests has been estimated as categorical variables using Cohen´s Kappa test, considering “poor” if it is ≤ 0,20; “low” if 0,20 < k ≤ 0,40, “moderate” if 0,40 < k ≤ 0,60, “substantial” if 0,60 < k ≤ 0,80 and “optimal” if k > 0,80.Results:167 patients were included (57% women) with a mean age of 52±16 years. 42% of them had systemic autoimmune diseases, 22% spondyloarthropathies and 36% other RD. 2 had history of past active tuberculosis (TB). At the time of screening, 46.11% were treated with GC.LTBI was diagnosed in 35 patients: 15 had both QTF and TST positive, 16 only QTF positive and 4 only TST positive. 12 from 31 QTF positive patients were treated with GC at the time of screening. 3 from 19 TST positive patients were treated with GC at the time of screening.After LTBI screening 62 patients received biological treatment, 4 of them had both test positive, 6 only QTF positive and 2 only TST positive. 11 received LTBI treatment according to the hospital protocol (isoniazid for 6 to 9 months). 10 completed treatment, 1 did not because of intolerance and did not receive other treatment. 1 patient with only TST positive was considered a false positive and did not receive treatment. During follow-up no TB reactivation was reported.23 patients with LBTI received treatment other than biological therapy during follow-up, of them 8 received LBTI treatment. There was no TB reactivation during follow up.The Kappa concordance between QTF and TST was estimated: moderated in the whole sample, poor in the patients treated with GC at screening, and substantial when the patients treated with GC at screening were excluded. Results are shown in Table 1.Table 1.Kappa concordance between QTF and TST.Conclusion:QTF seems to be the most appropriate LTBI screening test in patients with RD treated with GC. Screening and treatment of LTBI in patients with RD treated with or without biological agents was effective in reducing TB reactivation.Disclosure of Interests:None declared.

scholarly journals Pharmacovigilance of suspected or confirmed therapeutic ineffectiveness of artemisinin-based combination therapies: extent, associated factors, challenges and solutions to reporting

2020 ◽  
Author(s):  
Ronald Kiguba ◽  
Helen Byomire Ndagije ◽  
Victoria Nambasa ◽  
Leonard Manirakiza ◽  
Elijah Kirabira ◽  
...  
Keyword(s):  
Associated Factors ◽  
Healthcare Professionals ◽  
Pharmacovigilance Centre ◽  
Combination Therapies ◽  
Public And Private ◽  
Factors Associated ◽  
Adr Reporting ◽  
National Pharmacovigilance Centre ◽  
Reporting Procedures

Abstract Background: This study aimed to determine the extent and associated factors of past 6-month reporting of artemisinin-based combination therapy (ACT)-failure by healthcare professionals (HCPs); and difficulties and solutions to the pharmacovigilance (PV) of ACT therapeutic ineffectiveness.Methods: Survey of 685 HCPs from June to July 2018 in purposively selected public and private health facilities in Uganda.Results: One in five [20%, 137/685; 95% confidence intervals (CI) 17% to 23%] HCPs reported ACT-failure to any authority in the previous 6-months. HCPs commonly reported ACT-failure to immediate supervisors (72%, 106/147), mostly verbally only (80%, 109/137); none had ever reported a written ACT-failure to Uganda’s National Pharmacovigilance Centre. Common difficulties to reporting ACT-failure were; unavailability of reporting procedures (31%, 129/421), poor follow-up of treated patients (22%, 93/421) and absence of reporting tools (16%, 68/421). Factors associated with reporting ACT-failure in past 6-months were: hospital-status (vs other; OR = 2.4, 95% CI, 1.41 to 4.21), HCPs aged under 25 years (OR = 2.2, 95% CI, 1.29 to 3.76), suspicion of ACT-failure in past 4-weeks (OR = 2.3, 95% CI, 1.29 to 3.92), receipt of patient-complaint(s) of ACT-failure in past 4-weeks (OR = 2.9, 95% CI, 1.62 to 5.12) and HCPs from northern (vs central; OR = 0.5, 95% CI, 0.28 to 0.93) and western (vs central; OR = 0.4, 95% CI, 0.17 to 0.77) parts of Uganda.Conclusion: One in five HCPs reported ACT-failure, mostly verbally to supervisors. The existing ADR-reporting infrastructure should be leveraged to promote the PV of ACT therapeutic ineffectiveness.

scholarly journals Risk factors for tuberculosis in contact investigations in Rotterdam, the Netherlands

2012 ◽  
Vol 4 (2) ◽  
pp. 26 ◽  
Author(s):  
Jesse Eduard Verdier ◽  
Sake Jan De Vlas ◽  
Inge D. Kidgell-Koppelaar ◽  
Jan Hendrik Richardus
Keyword(s):  
Risk Factors ◽  
The Netherlands ◽  
Old Age ◽  
Latent Tuberculosis ◽  
Index Patient ◽  
Active Tuberculosis ◽  
Tuberculosis Case ◽  
Tuberculosis Patients ◽  
The Public ◽  
Contact Investigations

Contact investigations around tuberculosis patients enable early detection of infection and disease, and prevention of secondary tuberculosis cases. We aim to identify risk factors for <em>M. tuberculosis </em>transmission to contacts of tuberculosis patients, based on unique data from routine contact investigations by the Public Health Service in Rotterdam, the Netherlands, collected between 2001 and 2006. Through logistic regression analysis, we determined the effect of various risk factors on the chance of finding a latent tuberculosis (TB) infection or overt tuberculosis case among contacts. A total of 1165 index patients with active tuberculosis were registered and at least one contact was investigated in 731, resulting in 21,540 contacts overall. Altogether, the contact investigations led to 91 cases of active tuberculosis. Of the 12,698 contacts eligible for screening by tuberculin skin test, 1091 (9%) were diagnosed with latent tuberculosis infections. Risk factors were old age of the contact, old age of the index patient, and the relationship to the index. A larger fraction of infected close contacts was strongly associated with infections among more distant contacts. Our findings emphasize the importance of including these personal and interpersonal risk factors in decision making in contact investigations.

scholarly journals 1376. Physician Practice Patterns for Screening and Treatment of Latent Tuberculosis Infection in the South Asian Population in Central New Jersey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S499-S500
Author(s):  
Nupur Gulati ◽  
Sri Ram Pentakota ◽  
Kristina N Feja ◽  
Bishakha Ghoshal ◽  
Rajita Bhavaraju ◽  
...  
Keyword(s):  
New Jersey ◽  
South Asian ◽  
Outcome Measure ◽  
Latent Tuberculosis Infection ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Medical Graduate ◽  
Chi Square ◽  
Ltbi Screening

Abstract Background New Jersey (NJ) has a significant burden of tuberculosis (TB) cases (ranked 8th in the United States) and 22% of the cases are among foreign-born (FB) individuals. We have approximately 33% FB residents in our targeted counties in Central NJ of whom 43% are originally from high TB burden areas of South Asia. Central NJ is home to the county with the second highest TB case rate in NJ. Latent tuberculosis infection (LTBI) treatment remains a key component of the World Health Organization TB elimination strategy. We sought to survey community physicians about their LTBI screening and treatment practices in South Asian (SA) patients. Methods An IRB-approved anonymous survey was distributed online to practicing staff physicians at local hospitals over a 2-month period. The primary outcome measure was whether physicians appropriately screen for LTBI. A secondary outcome measure was whether follow-up after medication initiation was provided. Predictors measured included: age, gender, self -identification of physician as SA, years in practice, and if they were a foreign medical graduate (FMG). Descriptive statistics were provided using counts and proportions. Chi-square tests were used for bivariate analyses to look for factors associated with LTBI screening and treatment. Results A total of 218 physicians responded to the survey; of whom, 137 identified themselves as primary care physicians (i.e., pediatrics (62%), internal medicine (30%), or family medicine (8%)). About half of them were FMG and 40% identify themselves as SA. Three out of four of these physicians (n = 101) indicated they routinely screen their patients for LTBI. Bivariate analyses using chi-square did not find any statistically significant associations with LTBI screening. A quarter of the physicians screened with an IGRA and 60% reported always offering treatment for LTBI. Isoniazid was the most common medication prescribed. A majority of respondents did not report prescribing Rifampin or Rifapentine. Follow-up after initiation of treatment was provided at least every other month by 52.7% of physicians. Conclusion There is wide variability in LTBI screening, treatment, and follow-up among our physician sample. Physicians have not yet adopted newer treatment regimens suggesting the need for an educational intervention. Disclosures All authors: No reported disclosures.

scholarly journals Latent tuberculosis screening before kidney transplantation in the South of Brazil

2021 ◽  
Author(s):  
Gisele Meinerz ◽  
Cynthia Keitel da Silva ◽  
Damaris Mikaela Balin Dorsdt ◽  
Julia Bertoni Adames ◽  
Julio Pasquali Andrade ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Latent Tuberculosis ◽  
Tuberculin Test ◽  
Tuberculosis Screening ◽  
Post Transplant ◽  
Ltbi Screening ◽  
Interferon Gamma Release Assays ◽  
High Incidence ◽  
South Of Brazil

Abstract Background: Tuberculosis (TB) is a prevalent infection after kidney transplantation (KT) in high-burden countries. Latent tuberculosis infection (LTBI) screening includes previous TB history, chest radiograph findings, and tuberculin test (TST) and/or interferon-gamma release assays (IGRAs) results. We aimed to compare our routine LTBI screening of KT candidates and living donors (LD) with their IGRA results, and evaluate if this would improve isoniazid (INH) treatment referral. Methods: We evaluated adult KT candidates and LD with complete routine LTBI screening and QuantiFERON-TB® Gold In-Tube (QFT) testing. Blood samples were collected from April 4th, 2014 to October 31st, 2018, with follow-up until October 31st, 2019. Results: There were 116 KT recipients, with 30% QFT-positive results. Positive QFT was associated with past TB history (p=0.007), positive TST (p<0.0001), residual radiographic lesions (p=0.003), and diabetes (p=0.035). There were 25 LD, 40% had positive QFT. Positive QFT was associated with a positive TST (p=0.002). Positive QFT results increased INH referral in 80%. Post-transplant TB incidence was 2.6% in a median follow-up of 2 (1-33) months. No variables were associated with post-transplant TB. TB patients had inferior, although non-significant, 5-year graft survival (66.7% vs. 76.5%) (p = 0.402). Conclusion: In the present study, the association of QFT to our routine LTBI screening incremented INH treatment referral, but there was still a high incidence of post-transplant TB, possibly related to other forms of infection, such as new exposure and donor transmission.

The effectiveness of contact investigation among contacts of tuberculosis patients: a systematic review and meta-analysis

2021 ◽  
pp. 2100266
Author(s):  
Kavindhran Velen ◽  
Rashmi Vijay Shingde ◽  
Jennifer Ho ◽  
Greg James Fox
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Meta Analysis ◽  
Latent Tuberculosis ◽  
Index Patient ◽  
Case Detection ◽  
Randomised Trials ◽  
Contact Investigation ◽  
Pooled Prevalence ◽  
Passive Case Detection

BackgroundWe aimed to evaluate the effectiveness of contact investigation in comparison to passive case-detection alone and estimated the yield of co-prevalent and incident tuberculosis (TB), and latent tuberculosis infection (LTBI) among contacts of patients with TB.MethodsA systematic search was undertaken of studies published between January 1, 2011 and October 1, 2019 in the English language. The proportion of contacts diagnosed with co-prevalent TB, incident TB and/or LTBI was estimated. Evaluation of the effectiveness of contact investigation included randomised trials, while the yield of contact investigation (co-prevalent and incident TB and LTBI) was assessed in non-randomised studies.ResultsData were extracted from 244 studies, of which 187 studies measured the proportion of contacts diagnosed with TB disease and 135 studies measured LTBI prevalence. Individual randomised trials demonstrated that contact investigation increased TB case notification (RR 2.5 [95% CI: 2.0–3.2]), TB case detection (OR 1.34 [95% CI: 0.43–4.24]) and decreased mortality (RR 0.6 [95% CI: 0.4–0.8]) and population TB prevalence (risk ratio 0.82 [95% CI: 0.64–1.04]).The overall pooled prevalence of TB was 3.6% (95% CI: 3.3–4.0%; I2=98.9%, 181 studies). The pooled prevalence of microbiologically-confirmed TB was 3.2% (95% CI: 2.6–3.7%; I2=99.5%, 106 studies). The pooled incidence of TB was highest in the first year after exposure to index patients (2.0%, 95% CI: 1.1–3.3%; I2=96.2%, 14 studies) and substantially lower five years after exposure to index patient (0.5%, 95% CI: 0.3–0.9%; 1 study). The pooled prevalence of LTBI among contacts was 42.4% (95% CI: 38.5–46.4%; I2=99.8%, 135 studies).Conclusions and RelevanceThis systematic review and meta-analysis found that contact investigation was effective in high-burden settings. The higher pooled prevalence estimates of microbiologically-confirmed TB compared to previous reviews suggests newer rapid molecular diagnostics contribute to increased case detection.

scholarly journals National roll-out of latent tuberculosis testing and treatment for new migrants in England: a retrospective evaluation in a high-incidence area

2018 ◽  
Vol 51 (1) ◽  
pp. 1701226 ◽  
Author(s):  
Miranda G. Loutet ◽  
Matthew Burman ◽  
Nivenka Jayasekera ◽  
Duncan Trathen ◽  
Susan Dart ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
Country Of Birth ◽  
Factors Associated ◽  
Ltbi Screening ◽  
Treatment Uptake ◽  
High Incidence ◽  
Testing Uptake ◽  
Low Incidence ◽  
Ltbi Testing ◽  
High Incidence Area

Latent tuberculosis infection (LTBI) screening is an important intervention for tuberculosis (TB) elimination in low-incidence countries and is, therefore, a key component of England's TB control strategy. This study describes outcomes from a LTBI screening programme in a high-incidence area to inform national LTBI screening in England and other low-incidence countries.We conducted a retrospective cohort study of LTBI screening among eligible migrants (from high-incidence countries and entered the UK within the last 5 years), who were identified at primary-care clinics in Newham, London between August 2014 and August 2015. Multivariable logistic regression was used to identify factors associated with LTBI testing uptake, interferon-γ release assay (IGRA) positivity and treatment uptake.40% of individuals offered LTBI screening received an IGRA test. The majority of individuals tested were 16–35 years old, male and born in India, Bangladesh or Pakistan. Country of birth, smoking status and co-morbidities were associated with LTBI testing uptake. IGRA positivity was 32% among those tested and was significantly associated with country of birth, age, sex and co-morbidities.This study identifies factors associated with screening uptake, IGRA positivity and treatment uptake, and improves understanding of groups that should be supported to increase acceptability of LTBI testing and treatment in the community.

Population-based contact investigation of a cluster of tuberculosis cases in a small village

2009 ◽  
Vol 137 (10) ◽  
pp. 1426-1435 ◽  
Author(s):  
J. CASTILLA ◽  
R. PALMERA ◽  
A. NAVASCUÉS ◽  
M. ABETI ◽  
A. GUILLERMO ◽  
...  
Keyword(s):  
Latent Tuberculosis ◽  
Population Based ◽  
Restriction Pattern ◽  
Contact Tracing ◽  
Chromosomal Dna ◽  
Resident Population ◽  
Contact Investigation ◽  
Dna Restriction ◽  
Contact Investigations ◽  
Close Contacts

SUMMARYA cluster of five cases of tuberculosis (TB) in persons aged 19–23 years who were not close contacts was detected in a small village in Spain in 2006. All culture isolates had the same chromosomal-DNA restriction pattern. Contact investigations of family members, friends, workmates and schoolmates were complemented with tuberculin screening offered to the resident population born between 1976 and 1995. Expanded contact tracing detected two new cases of TB, 27 tuberculin conversions and an excess of latent tuberculosis infections (LTI) in persons born between 1978 and 1990. The contacts of two cases had a significantly elevated prevalence of LTI. Two secondary cases of TB, 33·3% of those diagnosed with LTI and 47·8% of the converters were unaware of any contact with the TB cases, but had frequented some of the same bars. This study suggests that a considerable percentage of the episodes of TB transmission in young people may escape detection in conventional contact studies.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

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