DOI QR코드

DOI QR Code

Chest Radiographs and CT Findings during Healthcare Workers' Tuberculosis Screening Using Interferon- Gamma Release Assay: Retrospective Observational Study

인터페론-감마 분비 검사를 이용한 의료 종사자의 결핵 스크리닝에서 흉부 X선 사진 및 CT 소견: 후향적 관찰 연구

  • Ye Ra Choi (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Jung-Kyu Lee (Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Eun Young Heo (Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Deog Kyeom Kim (Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center) ;
  • Kwang Nam Jin (Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center)
  • 최예라 (서울특별시보라매병원 영상의학과 ) ;
  • 이정규 (서울특별시보라매병원 호흡기내과) ;
  • 허은영 (서울특별시보라매병원 호흡기내과) ;
  • 김덕겸 (서울특별시보라매병원 호흡기내과) ;
  • 진광남 (서울특별시보라매병원 영상의학과 )
  • Received : 2020.09.04
  • Accepted : 2021.03.03
  • Published : 2021.11.01

Abstract

Purpose To investigate the incidence of tuberculosis (TB) in healthcare workers (HCWs) with positive interferon-gamma release assay (IGRA) results based on chest X-ray (CXR) and CT findings and determine the role of imaging in the diagnosis of TB. Materials and Methods Among 1976 hospital personnel screened for TB using IGRA, IGRApositive subjects were retrospectively investigated. Clustered nodular and/or linear streaky opacities in the upper lung zone were considered positive on CXR. The CT findings were classified as active, indeterminate, inactive, or normal. The active or indeterminate class was considered CT-positive. Results IGRA was positive in 255 subjects (12.9%). CXR and CT were performed in 249 (99.2%) and 113 subjects (45.0%), respectively. CXR- and CT-positive findings were found in 7 of 249 (2.8%) and 9 of 113 (8.0%) patients, respectively. Among the nine CT-positive subjects, active and indeterminate TB findings were found in 6 (5.3%) and 3 (2.7%) patients, respectively. Microbiological tests, including acid-fast bacilli staining, culture, and polymerase chain reaction for TB, were negative in all nine CT-positive subjects. Empirical anti-TB medications were administered to 9 CT-positive subjects, and 3 of these nine subjects were CXR-negative for pulmonary TB.

목적 인터페론-감마 분비 검사(interferon-gamma release assay; 이하 IGRA) 결과가 양성인 의료종사자의 흉부 X선(chest X-ray; 이하 CXR) 및 CT 결과를 기반으로 결핵의 발생률을 조사하고, 결핵 진단에서 진단 영상의 추가적인 역할을 알아보고자 하였다. 대상과 방법 IGRA를 시행 받은 1976명의 의료 종사자 중에서 IGRA 양성자를 후향적으로 조사하였다. 상부 폐야의 군집 결절 또는 선형 음영을 흉부 X선 양성으로 간주하였고, CT 결핵소견은 활성, 활동성미정, 비활동성, 정상으로 분류하였다. 활성 또는 활동성미정을 CT 양성으로 정의하였다. 결과 IGRA 검사 결과 255명(12.9%)에서 양성이었다. CXR과 CT는 각각 249명(99.2%)과 113명(45.0%)에서 시행되었다. CXR 양성 소견은 249명 중 7명(2.8%), CT 양성 소견은 113명 중 9명(8.0%)에서 각각 나왔다. 9명의 CT 양성 대상자 중 활성 또는 활동성미정 결핵 소견은 각각 6명(5.3%)과 3명(2.7%)에서 발견되었다. Acid-fast bacilli 염색, 배양 및 결핵에 대한 polymerase chain reaction을 포함한 미생물적 검사는 9명의 CT 양성 피험자 모두에서 음성이었다. CT 양성 피험자 9명은 경험적 항결핵약물 치료를 받았고, 이 9명 중 3명은 CXR 음성 소견이었다. 결론 IGRA 양성 의료 종사자에서 CT 검사는 무증상 결핵을 진단하는 데 도움을 주었다.

Keywords

References

  1. Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med 2015;372:2127-2135 https://doi.org/10.1056/NEJMra1405427
  2. World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management (No. WHO/CDS/TB/2018.4). Geneva: World Health Organization 2018
  3. Lee SH. Diagnosis and treatment of latent tuberculosis infection: the updated 2017 Korean guidelines. Korean J Med 2018;93:509-517 https://doi.org/10.3904/kjm.2018.93.6.509
  4. Joint Committee for the Revision of Korean Guidelines for Tuberculosis Korea Centers for Disease Control and Prevention. Korean guidelines for tuberculosis. 4th ed. Cheongju: Korea Disease Control and Prevention Agency 2020
  5. He W, Chen BD, Lv Y, Zhou Z, Xu JP, Lv PX, et al. Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital. Infect Dis Poverty 2017;6:68
  6. Nachiappan AC, Rahbar K, Shi X, Guy ES, Mortani Barbosa EJ Jr, Shroff GS, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics 2017;37:52-72 https://doi.org/10.1148/rg.2017160032
  7. Ko Y, Lee HY, Park YB, Hong SJ, Shin JH, Choi SJ, et al. Correlation of microbiological yield with radiographic activity on chest computed tomography in cases of suspected pulmonary tuberculosis. PLoS One 2018;13:e0201748
  8. Im JG, Itoh H, Shim YS, Lee JH, Ahn J, Han MC, et al. Pulmonary tuberculosis: CT findings--early active disease and sequential change with antituberculous therapy. Radiology 1993;186:653-660 https://doi.org/10.1148/radiology.186.3.8430169
  9. Lyu J, Lee SG, Hwang S, Lee SO, Cho OH, Chae EJ, et al. Chest computed tomography is more likely to show latent tuberculosis foci than simple chest radiography in liver transplant candidates. Liver Transpl 2011;17:963-968 https://doi.org/10.1002/lt.22319
  10. Song DJ, Tong JL, Peng JC, Cai CW, Xu XT, Zhu MM, et al. Tuberculosis screening using IGRA and chest computed tomography in patients with inflammatory bowel disease: a retrospective study. J Dig Dis 2017;18:23-30 https://doi.org/10.1111/1751-2980.12437
  11. Hirama T, Hagiwara K, Kanazawa M. Tuberculosis screening programme using the QuantiFERON-TB Gold test and chest computed tomography for healthcare workers accidentally exposed to patients with tuberculosis. J Hosp Infect 2011;77:257-262 https://doi.org/10.1016/j.jhin.2010.11.012
  12. Lee SW, Jang YS, Park CM, Kang HY, Koh WJ, Yim JJ, et al. The role of chest CT scanning in TB outbreak investigation. Chest 2010;137:1057-1064 https://doi.org/10.1378/chest.09-1513
  13. Park SY, Lee E, Lee EJ, Kim TH, Kim YK. Screening and treatment of latent tuberculosis infection among healthcare workers at a referral hospital in Korea. Infect Chemother 2019;51:355-364 https://doi.org/10.3947/ic.2019.51.4.355
  14. Jo KW, Hong Y, Park JS, Bae IG, Eom JS, Lee SR, et al. Prevalence of latent tuberculosis infection among health care workers in South Korea: a multicenter study. Tuberc Respir Dis (Seoul) 2013;75:18-24 https://doi.org/10.4046/trd.2013.75.1.18
  15. Park JS. The prevalence and risk factors of latent tuberculosis infection among health care workers working in a tertiary hospital in South Korea. Tuberc Respir Dis (Seoul) 2018;81:274-280 https://doi.org/10.4046/trd.2018.0020
  16. Nishi K, Okazaki A. Combined use of interferon-gamma release assay and low-dose computed tomography for tuberculosis screening program of health care workers. Kekkaku 2015;90:683-687
  17. Chung SJ, Lee H, Koo GW, Min JH, Yeo Y, Park DW, et al. Adherence to nine-month isoniazid for latent tuberculosis infection in healthcare workers: a prospective study in a tertiary hospital. Sci Rep 2020;10:6462
  18. Han SS, Lee SJ, Yim JJ, Song JH, Lee EH, Kang YA. Evaluation and treatment of latent tuberculosis infection among healthcare workers in Korea: a multicentre cohort analysis. PLoS One 2019;14:e0222810
  19. World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment: annex 1: methods and expert panels (No. WHO/UCN/TB/2020.1). Geneva: World Health Organization 2020
  20. Nakanishi M, Demura Y, Ameshima S, Kosaka N, Chiba Y, Nishikawa S, et al. Utility of high-resolution computed tomography for predicting risk of sputum smear-negative pulmonary tuberculosis. Eur J Radiol 2010;73:545-550 https://doi.org/10.1016/j.ejrad.2008.12.009
  21. Fujikawa A, Fujii T, Mimura S, Takahashi R, Sakai M, Suzuki S, et al. Tuberculosis contact investigation using interferon-gamma release assay with chest X-ray and computed tomography. PLoS One 2014;9:e85612
  22. Kim CH, Lim JK, Lee SY, Won DI, Cha SI, Park JY, et al. Predictive factors for tuberculosis in patients with a TB-PCR-negative bronchial aspirate. Infection 2013;41:187-194 https://doi.org/10.1007/s15010-012-0394-7