Regular Sputum Check-Up for Early Diagnosis of Tuberculosis after Exposure in Healthcare Facilities.
BACKGROUND
The early diagnosis of patients with TB disease is critical after an outbreak of tuberculosis (TB) infection in healthcare facilities. In this study, we report a catastrophic TB outbreak in a psychiatric healthcare facility and analyze the role of regular sputum check-ups and other diagnostic tools to facilitate an early diagnosis.


METHODS
Every exposed participant received regular sputum check-ups and chest X-rays (CXR) as part of the outbreak management protocol. We retrospectively analyzed data from the contact participants to identify risk factors for eventual TB development and investigated the diagnostic efficacy of regular sputum check-ups.


RESULTS
Among 133 contact participants, 16 (12.0%) developed TB during the 4-year follow-up period. Low body-mass-index (BMI) (<21) (adjusted hazard ratio (aHR) 3.16, 95% confidence interval (CI) 1.11-8.98) and long duration of contact (>3 months) (aHR 8.70, 95% CI, 1.14-63.34) independently predicted the development of TB. Even though regular sputum check-ups required significant resources, they did facilitate the early identification of new TB cases among the contact participants. Regular sputum check-ups for high-risk patients based on BMI, contact duration and CXR findings may be a practical approach when compared with universal sputum follow-up, with a slightly decreased sensitivity but high positive likelihood ratio (88%, [95% CI, 62-98%] and 5.12, [95%CI, 3.30-7.95], respectively).


CONCLUSIONS
While regular sputum check-ups for all contact participants facilitated the early identification of cases after the outbreak of TB in the healthcare facility, regular sputum check-ups for high-risk patients might be an effective alternative in resource-limited settings.
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
Wen-Cheng
WC
Chao
Department of Internal Medicine, Taichung Veteran General Hospital, Taichung, Taiwan.|Center for Quality Management, Taichung Veterans General Hospital, Taichung, Taiwan.
Chieh-Liang
CL
Wu
Department of Internal Medicine, Taichung Veteran General Hospital, Taichung, Taiwan.
Po-Yu
PY
Liu
Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.|Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan.
Chi-Chang
CC
Shieh
D000328:Adult; D004196:Disease Outbreaks; D042241:Early Diagnosis; D005260:Female; D005838:Genotype; D006268:Health Facilities / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000175:diagnosis* / Q000382:microbiology; D014965:X-Rays