The diagnosis and treatment of Latent Tuberculosis Infection (LTBI) are priority elements of control programs of Tuberculosis (TB). It is believed that it will not be possible to eradicate TB within 2050 unless the overall population with LTBI is found. Healthcare Workers (HCWs) are an important group of people which has a high risk of becoming infected by LTBI or that is already infected. Despite that, the health surveillance for this issue is not homogeneously articulated on national territory within the three steps of (i) preventive screening, (ii) periodical screening and (iii) investigation of cases of unprotected exposures. The diagnosis of LTBI is made possible by two immunologic tests, a cutaneous test (Tuberculin Skin Test by Mantoux, TST) and a hematic test (Interferon Gamma Release Assay, IGRA), while at the same time excluding the active TB by means of a chest radiography. While TST has been successfully used since one century, the current increasing usage of IGRAs raises the issue of its proper indication as an integrative, alternative or substitutional exam compared to TST. The aim of this work is to design easily accessible specific algorithms which are not included within up to date scientific literature and which could facilitate Italian doctors in handling TB cases in their clinical practice, without substituting available official guidelines. With that aim we have made an analysis of the advantages and limits of TST and IGRAs (with a special focus on issues related to the usage of IGRAs among HCWs) and of the two main diagnostic procedures recommended within the different national and international guidelines. Algorithms have been structured according to a sequential strategy in order to take advantage of the most favourable cost-benefit ratio and to avoid diagnostic and therapeutic errors, thus compensating better than the other strategies to the lack of a gold standard diagnostic test for LTBI. The proposed algorithms could be used within the health surveillance of HCWs. A structured, synergic and timely action among the healthcare manager, the occupational physician and the pulmonologist could lead to a more effective Health Surveillance and to a more accurate diagnosis of LTBI in HCWs, that ultimately would help in the prevention of active TB, thus making more doctors aware of an issue which would otherwise keep being latent... just as the infection!.

Latent tuberculosis infection in healthcare workers. Strategies and proposal of specific algorithms

CASTELLANA, GIORGIO;Resta O.
2014-01-01

Abstract

The diagnosis and treatment of Latent Tuberculosis Infection (LTBI) are priority elements of control programs of Tuberculosis (TB). It is believed that it will not be possible to eradicate TB within 2050 unless the overall population with LTBI is found. Healthcare Workers (HCWs) are an important group of people which has a high risk of becoming infected by LTBI or that is already infected. Despite that, the health surveillance for this issue is not homogeneously articulated on national territory within the three steps of (i) preventive screening, (ii) periodical screening and (iii) investigation of cases of unprotected exposures. The diagnosis of LTBI is made possible by two immunologic tests, a cutaneous test (Tuberculin Skin Test by Mantoux, TST) and a hematic test (Interferon Gamma Release Assay, IGRA), while at the same time excluding the active TB by means of a chest radiography. While TST has been successfully used since one century, the current increasing usage of IGRAs raises the issue of its proper indication as an integrative, alternative or substitutional exam compared to TST. The aim of this work is to design easily accessible specific algorithms which are not included within up to date scientific literature and which could facilitate Italian doctors in handling TB cases in their clinical practice, without substituting available official guidelines. With that aim we have made an analysis of the advantages and limits of TST and IGRAs (with a special focus on issues related to the usage of IGRAs among HCWs) and of the two main diagnostic procedures recommended within the different national and international guidelines. Algorithms have been structured according to a sequential strategy in order to take advantage of the most favourable cost-benefit ratio and to avoid diagnostic and therapeutic errors, thus compensating better than the other strategies to the lack of a gold standard diagnostic test for LTBI. The proposed algorithms could be used within the health surveillance of HCWs. A structured, synergic and timely action among the healthcare manager, the occupational physician and the pulmonologist could lead to a more effective Health Surveillance and to a more accurate diagnosis of LTBI in HCWs, that ultimately would help in the prevention of active TB, thus making more doctors aware of an issue which would otherwise keep being latent... just as the infection!.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11586/239615
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