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. 2016 Jun 3;11(6):e0157054.
doi: 10.1371/journal.pone.0157054. eCollection 2016.

Regular Sputum Check-Up for Early Diagnosis of Tuberculosis after Exposure in Healthcare Facilities

Wen-Cheng Chao  1   2 , Chieh-Liang Wu  3   4 , Po-Yu Liu  3 , Chi-Chang Shieh  2   5
Affiliations

Regular Sputum Check-Up for Early Diagnosis of Tuberculosis after Exposure in Healthcare Facilities

Wen-Cheng Chao et al. PLoS One. .

Abstract

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).

Conclusion: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of enrollment of participants.
Fig 2
Fig 2. Epidemic curve of the reported TB outbreak.
Fig 3
Fig 3
Kaplan-Meier analysis based on body mass index (A) and contact duration (B).
Fig 4
Fig 4. Using sputum check to early detect new tuberculosis cases based on CXR alone or combinational CCB score.
Receiver operator characteristic curve (A). Separate percentage (B) and diagnostic accuracy (C) by CCB score. CCB score: CXR, Contact-duration and BMI score.
See this image and copyright information in PMC

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