Use of low-dose computed tomography to assess pulmonary tuberculosis among healthcare workers in a tuberculosis hospital.
BACKGROUND
According to the World Health Organization, China is one of 22 countries with serious tuberculosis (TB) infections and one of the 27 countries with serious multidrug-resistant TB strains. Despite the decline of tuberculosis in the overall population, healthcare workers (HCWs) are still at a high risk of infection. Compared with high-income countries, the TB prevalence among HCWs is higher in low- and middle-income countries. Low-dose computed tomography (LDCT) is becoming more popular due to its superior sensitivity and lower radiation dose. However, there have been no reports about active pulmonary tuberculosis (PTB) among HCWs as assessed with LDCT. The purposes of this study were to examine PTB statuses in HCWs in hospitals specializing in TB treatment and explore the significance of the application of LDCT to these workers.


METHODS
This study retrospectively analysed the physical examination data of healthcare workers in the Beijing Chest Hospital from September 2012 to December 2015. Low-dose lung CT examinations were performed in all cases. The comparisons between active and inactive PTB according to the CT findings were made using the Pearson chi-square test or the Fisher's exact test. Comparisons between the incidences of active PTB in high-risk areas and non-high-risk areas were performed using the Pearson chi-square test. Analyses of active PTB were performed according to different ages, numbers of years on the job, and the risks of the working areas. Active PTB as diagnosed by the LDCT examinations alone was compared with the final comprehensive diagnoses, and the sensitivity and positive predictive value were calculated.


RESULTS
A total of 1 012 participants were included in this study. During the 4-year period of medical examinations, active PTB was found in 19 cases, and inactive PTB was found in 109 cases. The prevalence of active PTB in the participants was 1.24%, 0.67%, 0.81%, and 0.53% for years 2012 to 2015. The corresponding incidences of active PTB among the tuberculosis hospital participants were 0.86%, 0.41%, 0.54%, and 0.26%. Most HCWs with active TB (78.9%, 15/19) worked in the high-risk areas of the hospital. There was a significant difference in the incidences of active PTB between the HCWs who worked in the high-risk and non-high-risk areas (odds ratio [OR], 14.415; 95% confidence interval (CI): 4.733 - 43.896). Comparisons of the CT signs between the active and inactive groups via chi-square tests revealed that the tree-in-bud, cavity, fibrous shadow, and calcification signs exhibited significant differences (P = 0.000, 0.021, 0.001, and 0.024, respectively). Tree-in-bud and cavity opacities suggest active pulmonary tuberculosis, whereas fibrous shadow and calcification opacities are the main features of inactive pulmonary tuberculosis. Comparison with the final comprehensive diagnoses revealed that the sensitivity and positive predictive value of the diagnoses of active PTB based on LDCT alone were 100% and 86.4%, respectively.


CONCLUSIONS
Healthcare workers in tuberculosis hospitals are a high-risk group for active PTB. Yearly LDCT examinations of such high-risk groups are feasible and necessary.
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Wei
W
He
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China. budongchen@ccmu.edu.cn.
Bu-Dong
BD
Chen
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Yan
Y
Lv
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Zhen
Z
Zhou
The school hospital, Beijing Science and Technology University, Beijing, 100083, China.
Jin-Ping
JP
Xu
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Ping-Xin
PX
Lv
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Xin-Hua
XH
Zhou
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Feng-Gang
FG
Ning
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Cheng-Hai
CH
Li
Beijing Chest Hospital, Capital Medical University, No. 97 Beimachang, Tongzhou District, Beijing, 101149, China.
Dong-Po
DP
Wang
Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Room 3114, Saint Louis, MO, 63110, USA. zhengj@mir.wustl.edu.
Jie
J
Zheng
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D006763:Hospitals, Chronic Disease / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000635:transmission; D055815:Young Adult
Active tuberculosis; Computed tomography; Healthcare workers; Low-dose computed tomography; Pulmonary; Tuberculosis