Geringe Prävalenz von Prädiktoren für eine latente Tuberkulose bei ägyptischem medizinischem Personal auf Intensivtherapie- und Bronchoskopieeinheiten

Aim: Latent tuberculosis infections (LTBI) contain a significant reservoir for future epidemics. Screening of health care workers (HCWs) in a high-risk tuberculosis (TB) environment is an important strategy in TB control. The study aimed to assess the prevalence of LTBI among high risk Egyptian HCWs and to assess infection associated risk factors.Methods: Fifty-two HCWs who work at intensive care unit (ICU), bronchoscopy unit, and chest diseases department were tested for LTBI using both tuberculin skin test (TST) and Quantiferon TB Gold in-tube test (QFT). Risk factors for infection, knowledge of HCWs towards different aspects of TB infection and agreement between TST and QFT were also evaluated.Results: Prevalence of LTBI in this study was 13.5% by QFT and TST. It was 13.6% by TST alone and 10.3% by QFT alone. There was good concordance between both tests (Kappa=0.713). There was a statistically significant association between prevalence of LTBI and age of staff >=30 yr (p=0.002), period of working experience (p=0.006) and working at the Bronchoscopy Unit (p=0.001). The total knowledge of HCWs towards different aspects of TB infection was generally good. Conclusion: Although the participants in the current study were among high risk HCWs, the prevalence of LTBI was low. Bacille Calmette-Guerin (BCG) vaccination, young age, short employment duration, good knowledge and a good infection control were the predictors of low risk of contracting TB at our hospitals. The risk of TB infection in resource-limited countries can be reduced with simple continuous educational and administrative infection control programmes.Zielsetzung: Eine latente Tuberkuloseinfektion (LTBI) ist ein Reservoir für Epidemien. Daher ist das Screening von medizinischem Personal (HCWs) in einem Hochrisikobereich eine wichtige Strategie zur Kontrolle der Tuberkulose (TB). In der Untersuchung sollten die Prävalenz von LTBI bei ägyptischem medizinischem Personal und mit der Infektion assoziierte Risikofaktoren bestimmt werden.Methode: 52 HCWs, die auf einer Intensivtherapieeinheit (ITS), einer Bronchoskopieeinheit und einer Abteilung für Thoraxerkrankungen tätig waren, wurden auf das Vorkommen einer LTBI mittels Tuberkulin-Hauttest (THT) und QuantiFERON-TB Gold (QFT) untersucht. Ferner wurden Risikofaktoren für eine Infektion, Kenntnisse der HCWs zu verschiedenen Aspekten der TB-Infektion und die Übereinstimmung zwischen THT und QFT evaluiert.Ergebnisse: Die Prävalenz von LTBI betrug 13,5% mittels QFT und TST (13,6% mittels TST allein und 10,3% mittels QFT allein). Damit war eine gute Konkordanz zwischen beiden Tests gegeben (Kappa=0.713). Es war eine statistisch signifikante Assoziation zwischen der Prävalenz von LTBI und Alter der HCWs >=30 Jahre (p=0.002), Zeitdauer der Tätigkeit (p=0.006) und Tätigkeit in der Bronchoskopieeinheit (p=0.001) nachweisbar. Die Kenntnisse der HCWs zu verschiedenen Aspekten der TB-Infektion waren im Allgemeinen gut.Schlussfolgerung: Obwohl die Teilnehmer der Studie in Hochrisikobereichen tätig waren, war die Prävalenz der LTBI niedrig. Bacillus Calmette-Guérin (BCG)-Impfung, junges Alter, kurze Zeitdauer der Berufstätigkeit, gute Kenntnisse und eine gute Infektionskontrolle erwiesen sich als Prädiktoren für ein geringes Risiko zum Erwerb einer LTBI. Das Risiko einer TB-Infektion kann in Ländern mit begrenzten Ressourcen durch einfache kontinuierliche Erziehung und Infektionskontrollprogramme reduziert werden

Clinicopathological profile of gastrointestinal tuberculosis: a multinational ID-IRI study.

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery

Managing adult patients with infectious diseases in emergency departments: international ID-IRI study.

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 ± 0.74. Sepsis (qSOFA ≥ 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 ± 0.963) compared to upper-middle (0.17 ± 0.482) and high-income (0.36 ± 0.714) countries (P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required