Tuberculosis is an occupational risk hazard among healthcare workers, including residents. Not too much studies have been done specifically for this population. An study in resident doctors in 2004 (Int J Tuberc Lung Dis. 2004 Nov;8(11):1392-4.) found an incidence of 11.2 cases per 1000 person-years of exposure.

In residents you should consider, as risk factors, number of TB patients examined, job characteristics and place of work, delay in diagnostic suspicion, patients with multidrug resistant strains, limited access to appropriate ventilation systems, non-compliance with aerosol dissemination precautions, immune suppressed and/or malnourished resident. Also is important to keep in mind that not every TB case among HCW is related to occupational exposure. The tuberculin skin test (TST) is an important tool for the detection of latent tuberculosis (TB) and the identification of residents who require chemoprophylaxis. Also interferon-gamma testing should be considered.

"I have recently noted an upsurge in the incidence of tuberculosis (both pulmonary and extrapulmonary) in medical Residents"

Does this refer to: the clinical disease; active, latent or previous infection; presence of antibodies; evidence for part(s) of the organism in the human body, etc? And which country does this apply to?

I have done an Immunoepidemiological study on Healthy blood donors at a reputed center in South India. This study was done at three different points after two yrs.break and at each time it is noticed that about 5% of the donors were positive foe anti-mycobacterial antibodies by ELISA. It is not clear whether these individuals turn out to be carriers of laternt infection or just incidental

Thanks Dear Anthony,

I refer to the clinical disease in North Indian tertiary care centres

Regards

As a non-clinican, should I be worried about all this? Are doctors going to be intermediate hosts for an unstoppable epidemic of drug-resistant TB?

I do not know myself of studies specifically focused on medical residents, but I have found some published data on healthcare workers (in general):

Menzies D, Joshi R, Pai M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis. 2007 Jun;11(6):593-605.

http://www.ncbi.nlm.nih.gov/pubmed/17519089

This one is Open access: Baussano I1, Nunn P, Williams B, Pivetta E, Bugiani M, Scano F. Tuberculosis among health care workers. Emerg Infect Dis. 2011 Mar;17(3):488-94. doi: 10.3201/eid1703.100947.

I hope this is of any help

Best wishes

Thanks Dear Miguel for your contribution

Regards

For health care workers who work in high TB prevalence setting and develop latent TB infection (detected by TST or quantiferon), how do these patients get monitored for re-infection after chemoprophylaxis? Are there any studies looking at the rate of TB re-infection among non-HIV patients who have received chemoprophylaxis?

We found this study was done in an hospital in Perú.

http://wwwnc.cdc.gov/eid/article/8/7/pdfs/01-0506.pdf

Definitvely, the risk of our students or residents is higher than the general population in the settings in wich they working now.

yes. Its really a problem in countries like Sri Lank where I am working as a physician. It is said residents who skip meals and working hard in mefical wards are at risk. And those who are taking steroids and pregnant.

In previous days, we had patients with open TB like TB bronchiectasis. Many residents fall prey to this disease during their residency years because of irregular eating or skipped meals as well as inadequate sleep. Also,they are under considerable stress and hardly venture out of hospital- thus having poor Vit. D status. All these factors together contribute to activity of TB disease in residents where self immunity plays a major role in keeping the infection in check.

• latent TB in HCW's is posing serious threat in health care industry. survey done in  a developed country  has revealed a very poor knowledge among medical students about tuberculosis. nursing students and nurses are at highest risk for LTBI. Lack of awarenes, overcrowding and overtime working due to poor manpower keeps them at increased risk. eastern russia has high LTBI IN   Med ical  students  . In Asia it is 2-4%. as there is no DATA from medical institutions, the incidencewill be only a  speculation.

I believe that latent TB, is frequent, by the expositión to M. tuberculosis or atypical Mycobacteria.  Honestly, there is not conscience against to public health problem.

I think it is better to work in the area of TBIC and look into the administrative, personal and environmental TB control strategies that are being implemented at facilities.

Strick adherence to respiratory isolation precautions; and periodic evaluation of TB infection either by yearly PPD placement or other methods of early identification of infected health care workers. In my hospital, as health care workers, we get yearly PPD.

Its all about your awareness while patient and body fluid contact. .always be conscious. 

The investigation of the epidemics of multi-drug resistant and pan-susceptible tuberculosis alike in United States hospital staff in the 1990s were very instructive and sobering. Use of the Xpert instrument for a point-of-care rapid diagnosis of tuberculosis even in AFB smear-negative sputum and ruling out multi-drug resistance is critical for prompt initiation of effective treatment. It is critical to perform PPD on healthcare workers at initiation of work and periodically afterwards, with prompt evaluation of skin test conversions for preventive treatment (to the worker) and identification of flaws in institutional control measures. The key, necessary and sufficient measures to prevent occupational infection remain: 1) timely, effective SOURCE CONTROL, identifying, masking (not with respirators; just surgical masks) persons at high risk of tuberculosis and initiation of 4-drug treatment; 2) ISOLATION of patients in negative-pressure rooms which can be done with fans and 3) least effective, useless without 1 and 2 are PROTECTIVE RESPIRATORS for staff. Active tuberculosis in a healthcare provider is a SENTINEL EVENT, almost entirely preventable, life threatening indicator of multiple departures in control measures. Autopsy procedures that produce aerosols can result in transmission of M. tuberculosis infection even from patients who were not suspected to have antemortem active tuberculosis. Please, investigate what went wrong in those cases. See attachments. Also check out Wenger PN, Otten J, Breeden A, Orfas D, Beck-Sague CM, Jarvis WR.Control of nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis among healthcare workers and HIV-infected patients. Lancet. 1995 Jan 28;345(8944):235-40.THERE IS NO "ACCEPTABLE" OR "ENDEMIC RATE" OF OCCUPATIONAL TUBERCULOSIS IN HEALTHCARE PROVIDERS. These are sentinel events. Good luck!  

I fully agree that the measures of TB infection control should be in place at health care facilities. They usually are in place at TB departments. It is considered that health care providers working at triage are more exposed to TB. In 2013, a cross-sectional study from Japan involved HCWs from a hospital without TB-specific wards. The screening for latent tuberculosis infection (LTBI) has been performed by interferon gamma release assay (Quantiferon TB Gold in tube). LTBI prevalence rate was 11% and questionnaire revealed previous close contact of the staff with TB patients. Please find attached the paper.