Audit of tuberculosis contact tracing procedures in south gwent
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Keywords:
Contact tracing
Index case
Chest radiograph
Chemoprophylaxis
Mantoux test
QuantiFERON
Objetives
The control of tuberculosis (TB) transmission and prevention of outbreaks requires appropriate studies for the contacts. We’re going to present an outbreak of tuberculosis in a daycare centre.Methods
A case of pulmonary TB were reported in a 3 years old boy from a daycare, admitted with pneumonia without response to conventional antibiotic therapy, tuberculin test (PPD):5 mm, positive quantiferon. Study of family contacts was negative. After that pulmonary TB was confirmed in a caregiver from the daycare, she was considered baciliferus and also the index case.Results
Contact study was performed in 90 persons exposed. 85%(77/90) contacts from the daycare (67 children under 3 years and 10 adults).15 people had positive tuberculin, 8 contacts from the daycare (7 children and 1 caregiver). 5 patients of the group mentioned before were considered latent tuberculosis infection, receiving secondary chemoprophylaxis and 3 were diagnosed with tuberculosis disease, being treated with satisfactory outcome in all cases. The index case had over a month off work so that children with negative tuberculin was repeated at 5 weeks being negative in all cases.Conclusions
TB in children can be confused with other typical lung infections, however, must be ruled out if it has a subacute respiratory symptoms and poor response to conventional treatment. It’s really important the rapid detection of contacts incase of adults with TB disease, especially if those work with susceptible people like children. The PPD is still an easy and simple tool for unvaccinated contacts diagnostic.Index case
Chemoprophylaxis
Contact tracing
QuantiFERON
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The following report describes the contact investigation of a pediatrician with tuberculosis (TB). The pediatrician's disease was discovered in late February 1993 after tuberculin skin testing (TST) of his 15-month-old son was positive (13-mm induration). Further investigation to identify the source of the child's infection revealed a positive (15-mm induration) TST in the pediatrician. The pediatrician had been symptomatic with a cough since September 1992. The pediatrician had a chest radiograph that revealed numerous cavitary lesions and a sputum smear that was positive for acid-fast bacilli. An investigation was initiated to assess whether the transmission of Mycobacterium tuberculosis had occurred in the pediatrician's office to patients, families, or other visitors. The investigation was later extended to include the hospitals and the day care center where the pediatrician worked. Methods. A letter was mailed to parents of children served by the practice, explaining the potential exposure to TB and requesting that all persons who visited the office after September 1, 1992 complete an interview and Mantoux TST. Mass interviewing, testing, and test interpretation within the practice took place seven times during March and April 1993. Results. At the completion of screening, 181 (87%) of 208 children who had close contact with the index case were reliably skin-tested and returned for interpretation. Three (1.7%) of the 181 children were TST-positive (≥5 mm). Thirty-seven (13%) of the 286 adults tested and returning for interpretations were TST-positive (≥10 mm). Thirty-two (86%) of the 37 adults who tested positive were foreign-born. Conclusion. This investigation highlighted the need for identifying childhood TB infection as a sentinel event for adult disease. It also demonstrated the difficulty associated with deciding the extent of contact investigation of a health care worker with TB. Finally, the investigation emphasized the importance of maintaining regularly scheduled and appropriate testing for TB infection in health care workers and the need for health care workers to be cognizant of their own risk and be able to identify, especially in themselves, signs and symptoms of potential TB disease.
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Contact tracing
Index case
Chemoprophylaxis
Medical microbiology
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National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease.We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results.During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis."Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.
Contact tracing
Chest radiograph
Active tuberculosis
Case finding
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Contact screening in tuberculosis: can we identify those with higher risk?To the Editor:Contact screening, as a strategy to identify recently infected individuals, is part of the tuberculosis (TB) elimination strategy.It follows risk stratification concerning the infectiousness of the index patient, the duration and proximity of exposure, and the susceptibility of the contact [1, 2].For its optimisation it is important to know which risk factors are associated with Mycobacterium tuberculosis transmission in order to not over screen or lose at-risk contacts.In view of that, this study aims to identify potential risk factors for M. tuberculosis transmission among contacts of pulmonary TB patients, in a Portuguese TB reference centre.From January to December of 2011, all contacts of confirmed pulmonary TB patients, screened in the TB centre, were questioned about their exposure to the index patient through a questionnaire completed during the medical appointment.Both household and casual contacts were screened, independent of their cumulative exposure.Contacts excluded: those with exposure outdoors (e.g. in the street); those with incomplete characterisation of exposure (e.g.index patients for whom we did not know the symptomatic period); those non-compliant with screening (e.g.contacts who failed tuberculin skin test (TST) reading); and those with a past history of M. tuberculosis infection or TB disease (e.g.contacts verbal report of previous TB disease, contact with a pulmonary TB patient or treatment for latent tuberculosis infection (LTBI)).
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Present study has revealed low diagnostic value of Mantoux test with 2 TE in detection of tuberculosis in MBT-infected children, thus requiring implementation of novel methods. Detectable activity of tuberculosis infection among observed children with low tuberculin sensitivity was found in 23.8% of cases, as revealed by Diaskin test, as compared to 42.7% cases in a group with moderate sensitivity to tuberculin. As shown by radiological data it was accompanied by enlargement of intrathoracic lymphatic nodes in 14.3% and 53.0% cases, respectively. The data obtained with Diaskin probe were confirmed by a reference QuantiFERON testing in 95% cases. Parameters of diagnostic value for Diaskin test are two-fold higher than for Mantoux test with 2 TE. Positivity for Diaskin test reflects activity of tuberculosis infection which is accompanied by clear clinical signs in 67.3% cases, and, in 80% cases, it ischaracterized by enlargement of intrathoracic lymphatic nodes as based on radiologic data, thus arranging a risk group for tuberculosis morbidity in children. Appropriate recommendations for these patients include a fullscale phthisiatric assessment and administration of well justified and adequate therapy.
Mantoux test
QuantiFERON
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To determine the optimum cut-off level of a newly developed method for diagnosing tuberculosis infection based on whole-blood interferon-gamma measurement, and to study the basic characteristics of the method.1) A total of 220 young, healthy individuals having no apparent exposure to tuberculosis infection, most of whom have had a vaccination with BCG vaccine. 2) One hundred eighteen tuberculosis patients who were diagnosed by positive Mycobacterium tuberculosis on culture. 3) A group of 75 youngsters exposed to an infectious tuberculosis patient and who showed a strong tuberculin reaction (with erythema diameter of 30 mm or more).Whole-blood specimens of donors were stimulated with antigens, i.e., ESAT-6 and CFP-10, and then cultured. Plasma concentrations of interferon-gamma discharged were then determined with QuantiFERON-CMI. Correlation between interferon-gamma concentrations in response to ESAT-6 and CFP-10, and their correlation with Mantoux test results were analyzed for various categories of donors. The Receiver Operating Characteristics analysis was performed considering the loss due to misclassification. [The optimum cut-off level was determined as 0.35 IU/ml for both ESAT-6 and CFP-10. This gave the test a sensitivity of 89.0% and specificity of 98.1% in detecting tuberculosis infection. The correlation of interferon-gamma response with tuberculin tests among BCG-vaccinated individuals was low, which suggested that the test was not influenced by previous BCG vaccination. The low correlation between ESAT-6 and CFP-10 tests suggested that the simultaneous use of the two tests was beneficial. As in the case of clinical tests in general, the cut-off should be set at a lower level when the test is applied to high prevalence situation and vice versa.
QuantiFERON
ESAT-6
Mantoux test
Langhans giant cell
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