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ABSTRACT: BACKGROUND AND OBJECTIVES: Our objetive is to compare the tuberculin skin test (TST) and the QuantiFERON-TB(®) Gold In-Tube (QFT) in the diagnosis of latent tuberculosis infection (LTI) in a population of contacts of patients with pulmonary tuberculosis, and to analyze the influence of different variables in the discordance. PATIENTS AND METHOD: From March 2008 to September 2010, among a population of 300,000 inhabitants of the Basque Country, we analyzed all contacts of patients with pulmonary tuberculosis. All patients underwent the TST and the value of QFT was measured. Sociodemographic variables and vaccination were examined and we analyzed the discordance between the 2 tests. RESULTS: Seven hundred and four were included in the study, with a mean age of 27 years. Of these, 397 were vaccinated, with similar proportion between native and foreign. Increasing the age to 59 years (odds ratio [OR] 10.53, P<.001), being foreign (OR 2.71, P=.02) and vaccination (OR 4.22, P<.001) were predictors of the discordance between a positive TST and negative QFT. CONCLUSIONS: It seems that the QFT, alone or combined with the TST, is a safe method for the diagnosis of LTI and its use would contribute to a more specific selection of individuals who would need preventive treatment.
Medicina Clínica 01/2013; · 1.38 Impact Factor
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ABSTRACT: In this note we present the increased prevalence of silicosis found in a marble factory after exposure to a new presentation of silica. A prospective, observational study was conducted on 11 workers who were exposed to different presentations of quartz surfaces since 1995. The jobs were divided into two groups: 4 subjects worked in the cutting workshop; the rest of the workers worked in assembly. Up to that date they had not used any specific respiratory protection apparatus. Six cases of silicosis have been diagnosed, which assumes a disease prevalence in this environment of 54.5%. Of the 6 affected, 5 (83.3% are assemblers. We highlight the high risk of developing silicosis in the handling of different products which make up the range of quartz surfaces.
Archivos de Bronconeumología 01/2011; 47(1):50-1. · 2.17 Impact Factor
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ABSTRACT: Isoniazid (I) is the drug of choice for treating latent tuberculous infection (LTI). Duration of treatment with I and its liver toxicity represent a serious drawback for a correct enforceability. In several clinical guides, a 3-month course with rifampicin (Rif) and I is recommended as an acceptable alternative to the 6-9 month course with I. Here we present our experience with this new regimen.
From 2001, the 3-month regimen with Rif and I was offered to patients older than 14 years, who were recruited in the contacts study. A good adherence was considered when the patient manifested so and he/she went to the scheduled monthly controls. We performed baseline liver analyses in those patients at risk of hepatotoxicity and in all patients older than 35 years. In all cases, a liver laboratory control was done at the first month of treatment and whenever patients had symptoms suggestive of intolerance. Databases of tuberculosis controls and contacts were crossed to evaluate the number of individuals who developed tuberculosis.
Between 2000 and 2008, treatment for LTI was indicated in 547 contacts (7.8% refused treatment, 34.1% with the 6-month I course, 63.5% with the 3-month Rif and I course and 2.3% with other regimens). A total of 84.97% (147/173) patients with the 6-month I regimen and 92.55% (302/322) with the 3-month Rif and I course fulfilled the treatment (p=0.024). 2.37% (4/169) and 1.6% (5/313) patients with the 6-month I course and 3-month Rif and I course, respectively, withdrew because of hepatotoxicity (p=0.33). There were no patients among those who fulfilled the treatment in any of the 2 study arms.
There was a higher adherence (statistically significant) and lower hepatotoxicity with the 3-month Rif and I regimen. Both regimens showed a full effectivity.
Medicina Clínica 09/2010; 135(7):293-9. · 1.38 Impact Factor
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ABSTRACT: To investigate the incidence of tuberculosis (TB) in a cohort of contacts and to analyze the variables associated with the disease.
A prospective analysis was undertaken of all the contact investigations carried out in a health district in the Basque Country in northern Spain between January 1, 1995 and December 31, 2004. The dependent variable was the number of cases of TB detected among the contacts. Independent variables were age, sex, tuberculin skin test result, and the degree of contact. In index cases, additional variables were the site of the disease and smear test result.
Analysis of 5444 contacts of 596 patients with TB yielded 66 secondary cases of TB (40 at the time of the contact investigation and 26 at a later stage); the majority (73%) developed the disease within 12 months. Multivariate analysis revealed a significant relationship between the detection of secondary cases and the following variables: close contact (odds ratio [OR], 3.05; 95% confidence interval [CI], 1.75-5.31), positive smear test (OR, 8.54; 95% CI, 2.06-35.43), induration of 10 mm or larger (OR, 10.18; 95% CI, 4.27-24.26), and age under 30 years (OR, 3.35; 95% CI, 1.88-5.98). The final predictive model constructed on the basis of these 3 variables had a sensitivity of 77.4%, a specificity of 80.3%, and an area under the curve of 0.83 (95% CI, 0.78-0.88).
The contact investigation is a valid strategy for the detection of new cases of TB. Prophylactic treatment should be implemented at an early stage and priority should be given to young contacts of smear positive patients using an induration size of 10 mm or more as a reference.
Archivos de Bronconeumología 07/2007; 43(6):317-23. · 2.17 Impact Factor
