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Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital.

Abstract According to the World Health Organization, China is one of 22 countries with serious tuberculosis (TB) infections and one of the 27 countries with serious multidrug-resistant TB strains. Despite the decline of tuberculosis in the overall population, healthcare workers (HCWs) are still at a high risk of infection. Compared with high-income countries, the TB prevalence among HCWs is higher in low- and middle-income countries. Low-dose computed tomography (LDCT) is becoming more popular due to its superior sensitivity and lower radiation dose. However, there have been no reports about active pulmonary tuberculosis (PTB) among HCWs as assessed with LDCT. The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers.
PMID
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Authors

Mayor MeshTerms
Keywords

Active tuberculosis

Computed tomography

Healthcare workers

Low-dose computed tomography

Pulmonary

Tuberculosis

Journal Title infectious diseases of poverty
Publication Year Start




PMID- 28335802
OWN - NLM
STAT- MEDLINE
DA  - 20170324
DCOM- 20170501
LR  - 20170501
IS  - 2049-9957 (Electronic)
IS  - 2049-9957 (Linking)
VI  - 6
IP  - 1
DP  - 2017 Mar 24
TI  - Use of low-dose computed tomography to assess pulmonary tuberculosis among
      healthcare workers in a tuberculosis hospital.
PG  - 68
LID - 10.1186/s40249-017-0274-6 [doi]
AB  - BACKGROUND: According to the World Health Organization, China is one of 22
      countries with serious tuberculosis (TB) infections and one of the 27 countries
      with serious multidrug-resistant TB strains. Despite the decline of tuberculosis 
      in the overall population, healthcare workers (HCWs) are still at a high risk of 
      infection. Compared with high-income countries, the TB prevalence among HCWs is
      higher in low- and middle-income countries. Low-dose computed tomography (LDCT)
      is becoming more popular due to its superior sensitivity and lower radiation
      dose. However, there have been no reports about active pulmonary tuberculosis
      (PTB) among HCWs as assessed with LDCT. The purposes of this study were to
      examine PTB statuses in HCWs in hospitals specializing in TB treatment and
      explore the significance of the application of LDCT to these workers. METHODS:
      This study retrospectively analysed the physical examination data of healthcare
      workers in the Beijing Chest Hospital from September 2012 to December 2015.
      Low-dose lung CT examinations were performed in all cases. The comparisons
      between active and inactive PTB according to the CT findings were made using the 
      Pearson chi-square test or the Fisher's exact test. Comparisons between the
      incidences of active PTB in high-risk areas and non-high-risk areas were
      performed using the Pearson chi-square test. Analyses of active PTB were
      performed according to different ages, numbers of years on the job, and the risks
      of the working areas. Active PTB as diagnosed by the LDCT examinations alone was 
      compared with the final comprehensive diagnoses, and the sensitivity and positive
      predictive value were calculated. RESULTS: A total of 1 012 participants were
      included in this study. During the 4-year period of medical examinations, active 
      PTB was found in 19 cases, and inactive PTB was found in 109 cases. The
      prevalence of active PTB in the participants was 1.24%, 0.67%, 0.81%, and 0.53%
      for years 2012 to 2015. The corresponding incidences of active PTB among the
      tuberculosis hospital participants were 0.86%, 0.41%, 0.54%, and 0.26%. Most HCWs
      with active TB (78.9%, 15/19) worked in the high-risk areas of the hospital.
      There was a significant difference in the incidences of active PTB between the
      HCWs who worked in the high-risk and non-high-risk areas (odds ratio [OR],
      14.415; 95% confidence interval (CI): 4.733 - 43.896). Comparisons of the CT
      signs between the active and inactive groups via chi-square tests revealed that
      the tree-in-bud, cavity, fibrous shadow, and calcification signs exhibited
      significant differences (P = 0.000, 0.021, 0.001, and 0.024, respectively).
      Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis, whereas
      fibrous shadow and calcification opacities are the main features of inactive
      pulmonary tuberculosis. Comparison with the final comprehensive diagnoses
      revealed that the sensitivity and positive predictive value of the diagnoses of
      active PTB based on LDCT alone were 100% and 86.4%, respectively. CONCLUSIONS:
      Healthcare workers in tuberculosis hospitals are a high-risk group for active
      PTB. Yearly LDCT examinations of such high-risk groups are feasible and
      necessary.
FAU - He, Wei
AU  - He W
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Chen, Bu-Dong
AU  - Chen BD
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China. [email protected]
FAU - Lv, Yan
AU  - Lv Y
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Zhou, Zhen
AU  - Zhou Z
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Xu, Jin-Ping
AU  - Xu JP
AD  - The school hospital, Beijing Science and Technology University, Beijing, 100083, 
      China.
FAU - Lv, Ping-Xin
AU  - Lv PX
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Zhou, Xin-Hua
AU  - Zhou XH
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Ning, Feng-Gang
AU  - Ning FG
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Li, Cheng-Hai
AU  - Li CH
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Wang, Dong-Po
AU  - Wang DP
AD  - Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou
      District, Beijing, 101149, China.
FAU - Zheng, Jie
AU  - Zheng J
AD  - Mallinckrodt Institute of Radiology, Washington University School of Medicine,
      4525 Scott Ave, Room 3114, Saint Louis, MO, 63110, USA. [email protected]
LA  - eng
PT  - Journal Article
DEP - 20170324
PL  - England
TA  - Infect Dis Poverty
JT  - Infectious diseases of poverty
JID - 101606645
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - China
MH  - Female
MH  - Health Personnel/statistics & numerical data
MH  - Hospitals, Chronic Disease/statistics & numerical data
MH  - Humans
MH  - Incidence
MH  - Infectious Disease Transmission, Patient-to-Professional/statistics & numerical
      data
MH  - Male
MH  - Middle Aged
MH  - Occupational Diseases/*diagnostic imaging/epidemiology/microbiology
MH  - Prevalence
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Tomography, X-Ray Computed/economics/methods
MH  - Tuberculosis, Pulmonary/*diagnostic imaging/epidemiology/transmission
MH  - Young Adult
PMC - PMC5364637
OTO - NOTNLM
OT  - Active tuberculosis
OT  - Computed tomography
OT  - Healthcare workers
OT  - Low-dose computed tomography
OT  - Pulmonary
OT  - Tuberculosis
EDAT- 2017/03/25 06:00
MHDA- 2017/05/02 06:00
CRDT- 2017/03/25 06:00
PHST- 2016/06/14 [received]
PHST- 2017/03/05 [accepted]
AID - 10.1186/s40249-017-0274-6 [doi]
AID - 10.1186/s40249-017-0274-6 [pii]
PST - epublish
SO  - Infect Dis Poverty. 2017 Mar 24;6(1):68. doi: 10.1186/s40249-017-0274-6.

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