Abstract
IntroductionHealthcare workers (HCWs) are exposed to Mycobacterium tuberculosis (MTB) and therefore are screened for tuberculosis (TB). Results of TB screenings with the Interferon-γ Release Assay (IGRA) in a French psychiatric hospital without a TB ward are described.MethodsAt the Sainte-Anne Hospital, a referral centre for psychiatric patients throughout the municipal region of Paris, IGRA screening is performed during pre-employment and general health examination or after potential contact to MTB. The QuantiFERON Gold in tube (QFT) is used and data on TB history are assessed in a standardized manner.ResultsBetween August 2008 und August 2013 in total 1.192 HCWs were tested and the QFT was positive in 265 (22.2%). Probability of a positive QFT increased with age. A second QFT was performed in 144 HCWs with a positive QFT and 53 (36.8%) HCWs had a reversion. With a positive QFT close to the cut-off (e.g. 0.35-0.7 IU/ml) the odds ratio for a reversion was 4.6 compared to an INF-γ concentration of ≥3.0 IU/ml. Probability of reversion was not influenced by preventive chemotherapy, which was completed by 28 (19.4%) HCWs with a positive QFT. No active TB was detected.ConclusionPrevalence of positive IGRA is high in French HCWs as is the number of reversions in IGRA. Reversion rate is particularly high around the cut-off of the IGRA. A borderline zone will therefore reduce the influence of test variability.
Highlights
Healthcare workers (HCWs) are exposed to Mycobacterium tuberculosis (MTB) and are screened for tuberculosis (TB)
A second interferon-gamma release assays (IGRA) was performed in 144 HCWs with a positive IGRA (55.5%) and a negative second IGRA was observed in 53 HCWs (36.8%)
It was assumed that all HCWs were vaccinated, no data on BCG vaccination was considered in this analysis
Summary
Healthcare workers (HCWs) are exposed to Mycobacterium tuberculosis (MTB) and are screened for tuberculosis (TB). Around the cut-off the reversion rate is high and the clinical importance of this observation is not jet well understood. Do they reflect transient infection, good control of the infection with no further stimulation of the immune system or just variability by chance [5]? We do not have the answer to this question It is questionable whether HCWs with a positive but low result in the IGRA should receive preventive treatment or whether they should be retested before a decision is made [15,17]
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