Value of the Tuberculin Skin Test in Screening for Tuberculosis in Dialysis Patients

اختصاصی از اینو دیدی Value of the Tuberculin Skin Test in Screening for Tuberculosis in Dialysis Patients دانلود با لینک مستقیم و پر سرعت .

M.A. Habesoglu, D. Torun, Y.Z. Demiroglu, M. Karataslı, N. Sen, H. Ermis, Nurhan Ozdemir,
and F.O. Eyuboglu
ABSTRACT
Background. Hemodialysis patients are at high risk for tuberculosis, and a tuberculin
skin test (TST) is not usually helpful in detecting tuberculosis infection because of anergic
reactions. Prophylactic therapy against tuberculosis in dialysis patients is important to
enhance transplantation success. Herein we evaluated the value of TST in screening for
tuberculosis and analyzed any compounding factors that might affect the results of the test
in hemodialysis patients in an endemic area of Turkey.
Methods. A total of 187 (96 female, 91 male) patients were screened using a 2-step TST.
Test results were compared with clinical, radiologic, and laboratory data.
Results. None of the patients had active tuberculosis during the study and 55% had been
vaccinated against tuberculosis. After the first purified protein derivative (PPD) test,
55.1% of the patients showed a positive reaction, ultimately reaching a total of 68.4%
following the second test. Cumulative positive TST results were significantly correlated
with male gender (P .001, r .352), previous tuberculosis history (P .013, r .183)
positively, whereas with the ferritin level (P .001, r .233) negatively; but there were
no significant relationships between TST results and other data.
Conclusions. Impairment of delayed-type hypersensitivity reaction is frequent in dialysis
patients, but we observed high rates of positivity with the two-step TST which could be
attributed to tuberculosis being endemic in Turkey. Further comparative studies with more
specific diagnostic methods will be helpful to evalute the importance of TST positivity in
identifying tuberculosis-infected HD patients.

Is screening for tuberculosis acceptable to immigrants? A qualitative study

اختصاصی از اینو دیدی Is screening for tuberculosis acceptable to immigrants? A qualitative study دانلود با لینک مستقیم و پر سرعت .

P. Brewin1, A. Jones2, M. Kelly3, M. McDonald4, E. Beasley4, P. Sturdy5, G. Bothamley1,
C. Griffiths5Background Screening of immigrants has been a widespread response to the global resurgence of tuberculosis but has been criticized as discriminatory
and stigmatising. Acceptability is an essential but neglected ethical prerequisite of screening programmes, particularly those targeting vulnerable
groups such as refugees. No data exist concerning acceptability of tuberculosis screening. We therefore examined the responses of
immigrants to screening for tuberculosis in a range of settings.
Methods We carried out a qualitative interview study of a maximum diversity sample of 53 immigrants offered screening for tuberculosis in east
London. We recruited people screened in three settings: a social service centre for asylum seekers, a hospital clinic for new entrants and primary
care. We confirmed validity of our findings at a focus group of asylum seekers.
Results The opportunity to be screened for tuberculosis was valued highly by recipients. Moreover, many saw being screened as a socially
responsible activity. Of the minority raising concerns, few mentioned the possibility of discrimination. Acceptability was high irrespective of setting,
with respondents expressing preference for their chosen place of screening.
Conclusion Screening for tuberculosis was highly acceptable to recipients in these settings. Screening should be offered in a range of settings.
Keywords public health, screening, tuberculosis

Contact tracing and population screening for tuberculosis – who should be assessed?

اختصاصی از اینو دیدی Contact tracing and population screening for tuberculosis – who should be assessed? دانلود با لینک مستقیم و پر سرعت .

Abstract

Benjamin R. Underwood, Veronica L. C. White, Tim Baker, Malcolm Law
and John C. Moore-Gillon

Background The aim of the study was to investigate the
relative effectiveness of four strategies in detecting and preventing
tuberculosis: contact tracing of smear-positive pulmonary
disease, of smear-negative pulmonary disease and
of non-pulmonary disease, and screening new entrants.
Methods An analysis of patient records and a TB database
was carried out for an NHS Trust-based tuberculosis service
in a socio-economically deprived area. Subjects were contacts
of all patients treated for TB between 1997 and 1999.
New entrants were screened in 1999. Outcomes measured
were numbers of cases of active tuberculosis detected and
numbers of those screened given chemoprophylaxis.
Results A total of 643 contacts of 227 cases of active TB were
seen, and 322 new entrants to the United Kingdom. The highest
proportion of contacts requiring full treatment or chemoprophylaxis
were contacts of smear-positive index cases (33
out of 263 contacts; 12.5 per cent). Tracing contacts of those
with smear-negative pulmonary tuberculosis (12 out of 156;
7.7 per cent) and non-pulmonary disease (14 out of 277;
6.2 per cent) was significantly more effective in identifying
individuals requiring intervention (full treatment or chemoprophylaxis)
than routine screening of new entrants (10 out
of 322; 3.1 per cent).
Conclusions Screening for TB of new entrants to the United
Kingdom is part of the national programme for control and
prevention of TB, whereas tracing contacts of those with
smear-negative and non-pulmonary disease is not. This study
demonstrates that, in our population, the contact-tracing
strategy is more effective than new entrant screening. It is not
likely that the contacts have caught their disease from the
index case, but rather that in high-incidence areas such as
ours such tracing selects extended families or communities at
particularly high risk.
Keywords: tuberculosis, contact tracing, immigrants, cost
effectiveness