Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
    • WoS Reviewer Recognition Service
  • Alerts
  • Subscriptions

Who misses the second step of evaluation in tuberculosis contact screening?

F. Soares Pires, C. Pinto, R. Duarte
European Respiratory Journal 2011 38: 474-476; DOI: 10.1183/09031936.00200910
F. Soares Pires
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: filipasp@gmail.com
C. Pinto
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
R. Duarte
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

To the Editors:

Assessment of people likely to have been recently infected with Mycobacterium tuberculosis is important because of the risk to these people of progressing to active tuberculosis (TB) within 1–2 yrs [1]. In Portugal, contact investigation is an integral part of the TB control programme, enabling the identification and treatment of individuals with latent TB infection (LTBI), thus preventing active TB.

National guidelines require a two-step evaluation of pulmonary TB contacts, with the first step being performed at the moment the index case is diagnosed and the second performed 10–12 weeks later if the first evaluation was negative. We have analysed the results of re-evaluating TB contacts and have identified risk factors associated with missing re-evaluation.

Our study was a retrospective cohort study of pulmonary TB contacts screened between January 1 and June 30, 2009, at the Chest Disease Centre of Vila Nova de Gaia, Porto, Portugal, an outpatient TB clinic. All individuals were administered a symptom questionnaire and underwent a tuberculin skin test (TST)/interferon-γ release assay (IGRA) and chest radiograph. The first TST was performed upon identification of the index case, with individuals testing negative being offered a second TST 12 weeks later. Individuals testing positive were offered an IGRA test (QuantiFERON®-TB Gold; Cellestis Ltd, Melbourne, Victoria, Australia). Individuals positive on both TST and IGRA were offered preventive treatment, after exclusion of risk factors for hepatotoxicity. Individuals with symptoms or chest radiograph abnormalities were assessed for active TB.

Active TB was defined as positivity for M. tuberculosis in biological samples, either by culture or nuclei-amplification tests. LTBI was defined, in patients not having active TB, as TST ≥10 mm with positive IGRA.

Demographic, social and clinical data were collected and the results of the first and second screenings were reviewed.

Statistical analyses were performed using Epi Info (version 3.5.1; Centre for Diesease Control and Prevention (www.cdc.gov)). Chi-squared, Kruskal-Wallis, ANOVA and Fisher's exact tests were performed for univariate analysis, with logistic regression performed for multivariate analysis. A p-value <0.05 was considered statistically significant.

Screening of TB contacts was offered as part of the National Tuberculosis Program guidelines [2]. We evaluated 226 TB contacts, 150 females (66.4%) and 76 males (33.6%), of mean age 44.6±17.2 yrs.

The results of the first evaluation of the TB contacts are presented in figure 1. Of the 226 contacts, two (0.9%) were diagnosed with active TB, and 40 (17.7%) were diagnosed with LTBI. The remaining 161 TB contacts tested negative and were therefore eligible for the second evaluation. Of these 161 individuals, 56 (34.8%) missed the second evaluation.

Figure 1–
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1–

Results of the first evaluation of 226 tuberculosis (TB) contacts. LTBI: latent TB infection.

Of the 105 re-evaluated individuals, none had active TB, whereas nine (8.6%) were diagnosed with LTBI. Thus re-evaluation led to the diagnosis of LTBI in 18.4% of all individuals diagnosed with LTBI.

Male sex and period of re-evaluation during the summer months (July, August and September) were associated with missing re-evaluation (table 1).

View this table:
  • View inline
  • View popup
Table 1– Factors associated with missing the second evaluation, as shown by univariate and multivariate analyses

LTBI screening 10–12 weeks after exposure has been shown to be important, with 13.2–22.9% of all individuals with LTBI diagnosed at second evaluation. A negative result before this window period is considered unreliable for excluding infection [1]. We found that re-evaluation led to a diagnosis of LTBI in 8.6% of patients screened, suggesting that some individuals who were not re-evaluated were positive for LTBI.

This two-step evaluation can confound a booster phenomenon with a true conversion. Searching for boosting may not be useful because of the small number of patients identified in this way, and because this distinction is also difficult in two-step TST. Although a single evaluation performed ≥8 weeks after exposure may also be diagnostic, the first evaluation has been shown to be important in diagnosing active TB [1].

Compliance with re-evaluation was 65.2%, slightly higher than previously described (53–63%) [3]. Although no studies have determined factors associated with noncompliance with re-evaluation, male sex and seasonality have been associated with noncompliance in other clinical situations. For example, male sex has been associated with noncompliance during diagnosis in individuals suspected of TB [4] and in treatment for TB [5], and seasonality has been found to be associated with noncompliance for appointments at outpatient clinics [6].

The main limitation of our study was its retrospective design, which did not allow us to test the effectiveness of strategies to improve adherence. Future prospective studies should test different strategies, including oral and written information about the importance of TB screening and particularly of the second evaluation, using reminder telephone calls and other reminder strategies to encourage attendance.

Acknowledgments

The authors' respective contributions are as follows: F. Soares Pires: collection of data, performance of statistical analyses and writing of the article; C. Pinto: collection of data; and R. Duarte: design and supervision of the study, and critical revision of the article.

Footnotes

  • Statement of Interest

    None declared.

  • ©ERS 2011

REFERENCES

  1. ↵
    1. Erkens CG,
    2. Kamphorst M,
    3. Abubakar I,
    4. et al
    . Tuberculosis contact investigation in low prevalence countries: a European consensus. Eur Respir J 2010; 36: 925–949.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    Direcçáo Geral de Saúde. Programa Nacional de Luta Coutra a Tuberculose. Diário da República. II Série. www.dre.pt Date last updated: September 20: 1995.
  3. ↵
    1. Trueba F,
    2. Haus-Cheymol R,
    3. Koeck JL,
    4. et al
    . Contact tracing in a case of tuberculosis in a health care worker. Rev Mal Respir 2006; 23: 339–342.
    OpenUrlPubMedWeb of Science
  4. ↵
    1. Khan MS,
    2. Khan S,
    3. Godfrey-Faussett P
    . Default during TB diagnosis: quantifying the problem. Trop Med Int Health 2009; 14: 1437–1441.
    OpenUrlCrossRefPubMedWeb of Science
  5. ↵
    1. Rakotonirina el-CJ,
    2. Ravaoarisoa L,
    3. Randriatsarafara FM,
    4. et al
    . Factors associated with tuberculosis treatment non-compliance in Antananarivo city, Madagascar. Sante Publique 2009; 21: 139–146.
    OpenUrlCrossRefPubMedWeb of Science
  6. ↵
    1. Rodríguez Pacheco R,
    2. Negro Alvarez JM,
    3. Campuzano López FJ,
    4. et al
    . Noncompliance with appointments amongst patients attending an allergology clinic, after implementation of an improvement plan. Allergol Immunopathol (Madr) 2007; 35: 136–144.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
View this article with LENS
Vol 38 Issue 2 Table of Contents
European Respiratory Journal: 38 (2)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Who misses the second step of evaluation in tuberculosis contact screening?
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Who misses the second step of evaluation in tuberculosis contact screening?
F. Soares Pires, C. Pinto, R. Duarte
European Respiratory Journal Aug 2011, 38 (2) 474-476; DOI: 10.1183/09031936.00200910

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Who misses the second step of evaluation in tuberculosis contact screening?
F. Soares Pires, C. Pinto, R. Duarte
European Respiratory Journal Aug 2011, 38 (2) 474-476; DOI: 10.1183/09031936.00200910
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Acknowledgments
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • Respiratory infections and tuberculosis
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

  • Predictors of treatment outcome in MDR-TB in Portugal
  • Drug concentration in lung tissue in MDR-TB
  • Obesity in COPD: the effect of water-based exercise
Show more Letters

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2023 by the European Respiratory Society