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Annali Di Igiene : Medicina Preventiva... 2018The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent...
BACKGROUND
The World Health Organization's Action Framework for tuberculosis elimination in low-tuberculosis incidence countries includes the screening for active and latent tuberculosis in selected high-risk groups, including health care workers. In this context, medical and health profession students, exposed to nosocomial tuberculosis transmission during training and clinical rotations, are target populations for tuberculosis screening. No updated data are available on tuberculosis screening practice and knowledge of medical and health profession students in Italy.
METHODS
Within the activities Italian Study Group on Hospital Hygiene of the Italian Society of Hygiene, Preventive Medicine and Public Health, we carried out a multicentre cross-sectional study to assess knowledge, attitude and practices on tuberculosis prevention and control among Medical, Dentistry, Nursing and other health professions' students. Students were enrolled in the study on a voluntary basis and were administered a previously piloted structured questionnaire. Logistic regression models were applied to explore knowledge on tuberculosis prevention by selected socio-demographic variables and University-based tuberculosis prevention practice.
RESULTS
Students of seventeen Universities across Italy participated in the study, and 58.2% of them received compulsory tuberculin skin test either at enrollment or while attending clinical practice. A total of 5,209 students filled the questionnaire. 37.7% were medicine and dentistry students (Group 1), 44.9% were nursing students (Group 2) and 17.4% were other health professions' students (Group 3). Age and gender had different distributions by groups, as well as knowledge and practice on tuberculin skin test. 84.4% of the study population (95% CI = 83.3-85.3) was aware of the existence of the tuberculin skin test, 74.4% (95% CI = 73.2-75.6) knew what is the first-level screening test for latent tuberculosis and only 22.5% (95% CI = 21.4-23.6) knew how to proceed after a positive tuberculin skin test result. Overall, knowledge on tuberculosis prevention was higher in Group 2 and lower Group 3, as compared to Group 1.
CONCLUSION
In Italy, the knowledge on tuberculosis screening among University students is generally good. To reduce some of the criticalities found among the different study courses, it would be appropriate to harmonize both the regulations on tuberculosis screening practices for admission to University courses, and the educational activities on the topic of tuberculosis, to be extended to all workers involved in health care setting.
Topics: Adolescent; Adult; Attitude of Health Personnel; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Italy; Latent Tuberculosis; Logistic Models; Male; Middle Aged; Statistics, Nonparametric; Students, Health Occupations; Surveys and Questionnaires; Tuberculin Test; Tuberculosis, Pulmonary; Young Adult
PubMed: 30374514
DOI: 10.7416/ai.2018.2253 -
Rheumatology Advances in Practice 2021Patients with immune-mediated inflammatory disease (IMID) present an increased risk of infection. Here, we present the concept of a preventive consultation called...
OBJECTIVES
Patients with immune-mediated inflammatory disease (IMID) present an increased risk of infection. Here, we present the concept of a preventive consultation called ImmunoStart and the first results of its implementation in the care pathway of patients with IMID.
METHODS
Relevant information about vaccination history, tuberculosis exposure and other infectious risks were collected through blood sampling, complete anamnesis, chest X-ray and Mantoux test. During the ImmunoStart consultation, vaccination schedules, specific treatments and risk considerations were discussed.
RESULTS
Between October 2016 and February 2020, 437 patients were seen at an ImmunoStart consultation, mainly referred by rheumatologists (56%), dermatologists (25%) and gastroenterologists (18%). A total of 421 (96%) patients needed at least one vaccine (a mean of 3.3 vaccines per patient). Live attenuated vaccine was indicated for 45 patients (10%), requiring them to reduce or interrupt their immunosuppressive drug(s). Ninety-two patients (21%) were treated for latent tuberculosis infection.
CONCLUSION
This preventive consultation provides a centralized and systematic setting for the direct management of patients with IMID in need of vaccination, treatment of latent disease and specific advice regarding their immunomodulating treatments.
PubMed: 34909567
DOI: 10.1093/rap/rkab092 -
Urology Journal Oct 2019To evaluate on a large group of patients whether Mantoux tuberculin skin test (TST) result is associated with BCG immunotherapy effectiveness and whether it can predict...
PURPOSE
To evaluate on a large group of patients whether Mantoux tuberculin skin test (TST) result is associated with BCG immunotherapy effectiveness and whether it can predict occurrence of moderate to severe toxicity.
MATERIALS AND METHODS
We analysed group of 823 patients with intermediate and high risk NMIBCs who were treated with BCG. The study included 412 patients with the history TST and 411 without TST. A standard dose of Statens Serum Institute tuberculin RT23 was used. The reaction was read 48-72 hours later by evaluating the diameter of palpable induration. The size of the induration was considered positive when the measurement was greater than or equal to 6 mm and excessively positive when bigger than 26 mm. Whole BCG immunotherapy schedule consisted of 27 instillations.
RESULTS
The patients were followed for median 61 months. The 5-year recurrence and progression free survival (RFS, PFS) did not differ between the groups in both total study population and in tumour subgroup analysis. TST result in both total study population and in subgroups was not statistically associated with RFS, PFS and cancer specific survival.The moderate-to-severe toxicity was observed in 181(44%) TST patients, and in 196(47%) patients without TST. Incidence of toxicity was not statistically different and also not statistically associated with TST result in any of the tumour subgroups of TST group.
CONCLUSION
This study shows, that TST does not have value in prediction of bladder cancer recurrence, progres-sion nor cancer specific survival. Also it doesn't have a value in predicting therapy toxicity.
Topics: Adjuvants, Immunologic; Adult; Aged; Aged, 80 and over; BCG Vaccine; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Severity of Illness Index; Treatment Outcome; Tuberculin Test; Urinary Bladder Neoplasms
PubMed: 30471076
DOI: 10.22037/uj.v0i0.4542 -
Journal of Infection in Developing... Aug 2018Mantoux test aids in the diagnosis of tuberculosis (TB), however its application and interpretation are dependent on multiple factors. (Observational Study)
Observational Study
INTRODUCTION
Mantoux test aids in the diagnosis of tuberculosis (TB), however its application and interpretation are dependent on multiple factors.
METHODOLOGY
A prospective study enrolling 400 children (aged 2-12) suspected to have tuberculosis. All participants received Mantoux test with two different strengths (1 TU and 5 TU) of Purified Protein Derivative (PPD) on different forearms. The test was read by two readers after 48 ± 2 and 72 ± 2 hours. Primary outcome was difference in the size of induration when read by two readers (interobserver variability). Secondary outcomes were difference in the size of induration at different intervals, with different strengths of PPD and percentage positivity of Mantoux test in TB patients.
RESULTS
Statistically significant difference was seen in the size of induration when read by two different readers, with fair to moderate agreement when read at 48 and 72 hours (1 TU: p = 0.002, k = 0.52 and p = 0.1, k = 0.73 respectively, 5 TU: p = 0.001, k = 0.39 and p = 0.0009, k = 0.33 respectively). Tendency of under-reading occurred when size of induration was close to significant level (10-14 mm). Size of induration was similar when read at 48 or 72 hours (1 TU: p = 0.9, 5 TU: p = 1.0). Mantoux positivity rate in patients with TB was more with 5 TU as compared to 1 TU (61.2% vs. 16.3%).
CONCLUSIONS
There is significant interobserver variability with a tendency to under-read around the cutoff point. The use of 5 TU PPD at 48 hours by a trained physician can aid in early and more reliable diagnosis of TB.
Topics: BCG Vaccine; Child; Child, Preschool; Female; Humans; Male; Observer Variation; Prospective Studies; Tuberculin Test; Tuberculosis; Tuberculosis, Meningeal; Tuberculosis, Pulmonary
PubMed: 31958324
DOI: 10.3855/jidc.9601 -
Anales de Pediatria (Barcelona, Spain :... Mar 2007To study the clinical features, epidemiology and outcome of nontuberculous mycobacterial lymphadenitis (NTML).
OBJECTIVE
To study the clinical features, epidemiology and outcome of nontuberculous mycobacterial lymphadenitis (NTML).
METHODS
A retrospective study was performed on 54 patients under 14 years old diagnosed with atypical mycobacterial lymphadenitis between 1987 and 2004. Inclusion criteria were: (i) positive polymerase chain reaction (PCR) test or culture; (ii) positive sensitin skin test 6 mm above Mantoux; (iii) histopathologic features compatible with mycobacterial infection and/or positive direct smear for acid-fast bacilli, Mantoux reaction less than 15 mm, a normal chest radiograph, absence of exposure to an adult with tuberculosis, negative Mantoux test reactions in family members, and exclusion of other causes of granulomatous adenitis.
RESULTS
Fifty-four patients were included in the study. The number of NTML cases increased notably from 1996, coinciding with a decrease in cases of tuberculous adenitis. The mean age was 35 months (range: 14 months-6 years). Submandibular nodes were involved in 22 of 63 cases of adenitis (34.9%) and cervical nodes were involved in 21 (33.3%). In 8/42 patients (19%) the tuberculin skin test was larger than 10 mm. Cultures were positive in 52.9% of the cases (18/34) and PCR in 53.3% (8/15). The most frequently isolated mycobacteria was Mycobacterium avium (61%). Therapy failed in 8/21 patients receiving antibiotics (38%), in 10/13 patients with drainage alone (77%) and in none of the patients who underwent surgery (8/8).
CONCLUSIONS
Nontuberculous mycobacterial adenitis has become more frequent in our hospital since 1996. Cultures do not always allow isolation of mycobacteria and the Mantoux test frequently yields false positive results, thus hampering diagnosis. The most effective treatment was surgical excision. Nevertheless, when the surgical approach is difficult or there is postoperative recurrence, pharmacological treatment can be useful.
Topics: Child; Child, Preschool; Female; Humans; Infant; Lymphadenitis; Male; Mycobacterium Infections; Mycobacterium avium; Retrospective Studies
PubMed: 17349251
DOI: 10.1157/13099687 -
Anales de Pediatria (Barcelona, Spain :... Mar 2003Takayasu's arteritis is a rare vasculitis in the pediatric population that affects the aorta and its branches. There are few studies with an appropriate number of...
BACKGROUND
Takayasu's arteritis is a rare vasculitis in the pediatric population that affects the aorta and its branches. There are few studies with an appropriate number of patients and follow-up.
OBJECTIVE
To describe the clinical manifestations, laboratory alterations, radiological findings, and treatment in eight children and adolescents with Takayasu's arteritis.
METHODS
A retrospective analysis of patients' records from 1990 to 2001 was performed.
RESULTS
There were six girls and two boys. The mean age at disease onset was five years and five months. The most common clinical manifestations were systemic findings and cardiovascular, dermatological and neurological abnormalities. In all patients inflammatory activity was high and in three patients the Mantoux test was strongly positive. The most common radiological findings were type IV and V. Treatment included steroids, methotrexate, cyclophosphamide, intravenous gamma globulin, and vascular surgery. Three patients presented sequelae.
CONCLUSIONS
Takayasu's arteritis produces considerable morbidity and mortality. To make an early diagnosis, pediatricians should be aware of inflammatory systemic manifestations and cardiovascular abnormalities. To gain further knowledge of this entity prospective and ideally multicenter studies are required.
Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Retrospective Studies; Takayasu Arteritis
PubMed: 12628090
DOI: No ID Found -
American Journal of Physiology. Lung... Mar 2022Tuberculosis has been present in the world's population for as long as there has been written language. It is a disease known to the ancient Egyptians, Greeks, Romans,... (Review)
Review
Tuberculosis has been present in the world's population for as long as there has been written language. It is a disease known to the ancient Egyptians, Greeks, Romans, and Hebrews, but its etiology eluded the world for thousands of years. Even after the germ theory was accepted and early scientists hypothesized a pathogen as the cause, the identity of the sleeping killer in society remained a mystery. That is until Robert Koch was able to grow and visualize . Koch introduced his Old Tuberculin solution as a diagnostic therapy of tuberculosis (TB), with the intent to reduce the number of infected persons and stop its spread. Old Tuberculin's ability to treat TB proved minimal, but its diagnostic potential paved the way for more effective tests from von Pirquet, Calmette, Wolff-Eisner, and Mantoux. Florence Seibert set out to identify and purify the active principle in Koch's Old Tuberculin and ended up creating purified protein derivative (PPD) tuberculin which is still used as the standard for the tuberculin skin test (TST). Interferon-γ release assays (IGRAs) are a more modern diagnostic tool for detecting latent TB infection that offer some benefits (and some disadvantages) to TST. TSTs and IGRAs can determine if an individual has been infected with but are equally unable to predict progression to active tuberculosis, the diagnosis of which relies on assessment of clinical symptoms, radiographic imaging, and sample culture.
Topics: Humans; Interferon-gamma Release Tests; Latent Tuberculosis; Mycobacterium tuberculosis; Sensitivity and Specificity; Tuberculin; Tuberculosis
PubMed: 35170334
DOI: 10.1152/ajplung.00217.2021 -
The Pan African Medical Journal 2024
Topics: Humans; Antitubercular Agents; Tuberculosis, Cutaneous; Tuberculosis, Lymph Node
PubMed: 38708138
DOI: 10.11604/pamj.2024.47.78.42404 -
Case Reports in Ophthalmological... 2021To report a case of high-altitude retinopathy with vitreous hemorrhage.
PURPOSE
To report a case of high-altitude retinopathy with vitreous hemorrhage.
METHODS
An apparently healthy 29-year-old boy presented with a history of floater and slight diminution of vision in the left eye after climbing the mountain 4760 meters high.
RESULTS
The visual acuity at presentation was 20/20 in the right eye and 20/30 in the left eye. Anterior segment findings of both eyes were unremarkable. Fundus evaluation revealed bilaterally dilated major retinal veins. The right eye revealed clear, quiet vitreous, healthy macula, and pink and smooth optic disc. There was fresh vitreous hemorrhage confined just one disc diameter away at the superior and inferior part of the optic nerve in the left eye. The macula and optic nerve head of this eye grossly looked normal. Complete blood count, haemoglobin, ESR, CRP, sugar, renal function test, lipid panel, and serology for HIV, HCV, VDRL, and HBsAg were normal. The Mantoux test and chest X-ray also revealed normal findings. Physician consultation did not reveal other abnormalities. On the 3 week of follow-up, his vision was 20/20 in both eyes. Fundus examination revealed clear vitreous in both eyes though some venous dilation and tortuosities were still evident in the left eye. A macular OCT scan showed almost normal-appearing fundus.
CONCLUSIONS
Vitreous hemorrhage following climbing high altitude can be one of the manifestations of high-altitude retinopathy.
PubMed: 34422422
DOI: 10.1155/2021/7076190 -
Canadian Family Physician Medecin de... Jun 1995Interpreting and acting upon results of the tuberculin skin test (Mantoux test) can be confusing because the test is inherently ambiguous and published recommendations... (Review)
Review
Interpreting and acting upon results of the tuberculin skin test (Mantoux test) can be confusing because the test is inherently ambiguous and published recommendations for investigation and prevention of tuberculosis are complex. This article presents a step-by-step guide to enable family physicians to make effective use of the Mantoux test.
Topics: Clinical Protocols; Family Practice; Humans; Isoniazid; Tuberculin Test; Tuberculosis, Pulmonary
PubMed: 7780314
DOI: No ID Found