Incomplete contact investigation and risk of developing TB among healthcare professionals.

BACKGROUND: Data on the impact of incomplete contact investigation on TB incidence among healthcare professionals (HCPs) after TB exposure are limited.METHODS: This was a prospective cohort study with 2-year follow-up among Thai HCPs exposed to TB to determine TB incidences and factors associated with TB development.RESULTS: Of the 398 HCPs with TB exposure, 367 (92%) participated in the study; 342 HCPs were included in the final analysis; 311 participated in contact investigations; 303 underwent chest X-ray; 252 completed baseline TB and latent TB infection screening using tuberculin skin test (TST); 210 had negative baseline TST; and 45 completed follow-up tests at 3 months. Altogether, 20 HCPs developed TB (2.92/100 person-years). TB incidences in HCPs not participating in or not completing the investigation at any step were higher than in those who completed the evaluation (11.29 and 2.90, respectively, vs. 0/100 person-years; P < 0.05). No participation in contact investigation and no baseline chest X-ray were independent factors associated with TB development (adjusted odds ratio [aOR] 6.7; P < 0.001 and aOR 8.9; P = 0.01, respectively).CONCLUSION: Study findings indicate increased risks of TB development among HCPs not undergoing or not completing contact investigations and underscore the need for interventions to improve contact investigation participation and completeness.

Quality of life assessment among patients living with HIV/AIDS at a tertiary care hospital in Thailand.

HIV/AIDS remains one of the most serious public health problems in Thailand. This study aimed to assess the health-related quality of life (HRQOL) and its related factors among people living with HIV/AIDS (PLWHA) in Thailand. A cross-sectional study was conducted with 259 patients at a tertiary care hospital. HRQOL was assessed using the Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. Socio-demographics and clinical status were measured using a self-administered questionnaire. Multiple linear regression models were used to explore associations between socio-demographic status, clinical status, and HRQL. Multiple linear regression analyses showed that employment status was strongly related to better overall physical and mental health summary scores (PHS, MHS). In addition, patients with disclosure of HIV status, aged over 50 years, and having at least a rating of good health in the nurses' opinion were the independent positive predictive factors for overall PHS. While being on antiretroviral therapy (ART) and good compliance with ART were positive predictive factors for overall MHS. Improving and strengthening quality of life among PLWHAs are important goals for HIV/AIDS services. Regular assessment of HRQL can provide potential information for intervention to improve quality of life.

Post-flood measurement of fungal bio-aerosol in a resource-limited hospital: can the settle plate method be used?

The performance of the settle plate method (SPM) compared with the microbiological air sampler method (MAS) for post-flood fungal bio-aerosol (FB) measurement was evaluated in a Thai hospital. Compared with closed-ventilation units, open-ventilation units had significantly higher median FB level by SPM on days 3 and 5 of incubation (270 vs 90 colony-forming units (cfu)/m(3) and 420 vs 180 cfu/m(3), respectively). Strong correlations between SPM and MAS results on day 3 (r = 1.60, P < 0.001) and day 5 (r = 1.49, P = 0.002) of incubation suggested the utility of SPM for post-flood FB measurement in open-ventilation units in resource-limited situations.

Isoniazid preventive therapy and 4-year incidence of pulmonary tuberculosis among HIV-infected Thai patients.

SETTING: Human immunodeficiency virus (HIV) clinics at two Thai tertiary care medical centres. OBJECTIVES: To evaluate the efficacy of tuberculin skin test (TST) guided isoniazid preventive therapy (IPT) in combination with antiretroviral therapy (ART) in the prevention of tuberculosis (TB). DESIGN: A 4-year prospective comparative study of patients at two HIV clinics: one performed TST at enrolment and, if positive, prescribed IPT (IPT group), while the other did not perform TST (non-IPT group). RESULTS: There were 200 patients included in each group. Baseline characteristics and drop-out rates were similar in both groups. The incidence of pulmonary TB over 4 years was not significantly different between the IPT and non-IPT groups (0.80 cases vs. 1.76 per 100 person-years [py], P = 0.13). However, the incidence of pulmonary TB in the non-IPT group was significantly higher during the first 6 months (8.60 vs. 0 cases/100 py, P = 0.01) and among patients with initial CD4 < 200 cells/l (9.41 vs. 0 cases/100 py, P = 0.02). The survival analyses demonstrated a protective effect of IPT (x(2) = 3.66, P = 0.04) for early TB. CONCLUSIONS: Benefit of IPT plus ART was evident only in the first 6 months of care. These findings suggest that TST-guided IPT should be routinely provided for HIV-infected patients after initial entry into medical care.

Tuberculin skin test and isoniazid prophylaxis among health care workers in high tuberculosis prevalence areas.

The tuberculin skin test (TST) is an important tool for the detection of latent tuberculosis (TB) and the identification of health care workers (HCWs) who require chemoprophylaxis. Although TST is inexpensive, easily available and the preferred test in most TB-prevalent settings, it has recognised limitations, including subjective interpretation, false positivity, cross reactivity with non-tuberculous mycobacteria, administration errors and the requirement for two visits. Given these limitations and the unavailability of better screening tests in resource-limited settings, the acceptance rate for chemoprophylaxis among HCWs has remained low. Furthermore, chemoprophylaxis in these settings is complicated by the high rate of drug-resistant TB, potential adverse reactions, prescription of chemoprophylaxis in undiagnosed active TB patients and the unavailability of follow-up systems provided by occupational health programmes. In the present article, we provide our viewpoint and a practical approach along with existing evidence supporting or discouraging the use of TST and isoniazid chemoprophylaxis for TB screening and management among HCWs in TB-prevalent settings.

Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review.

Treatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7-1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection.

Assessment of risk for pulmonary tuberculosis after non-reactive tuberculin skin testing among patients with HIV infection in a resource-limited setting.

SUMMARY: A cross-sectional study of 350 patients with HIV-1 infection was conducted to identify risks for pulmonary Mycobacterium tuberculosis (TB) after non-reactive two-step tuberculin skin tests (TST). Among 219 patients (62.6%) with non-reactive TST, independent risks for active pulmonary TB were prior known TB exposure (adjusted odds ratio [aOR] = 16.00, 95% confidence interval [CI] = 2.00-26.36, P = 0.008), CD4 <100 cells/microL (aOR = 2.50, 95% CI = 1.30-6.50, P = 0.04) and less than secondary-school education (aOR = 2.60, 95% CI = 1.50-6.90, P = 0.02). Our findings suggest that further diagnostic work-up for pulmonary TB is warranted among patients with HIV infection, non-reactive TSTs and either prior known TB exposure, CD4 counts <100 cells/microL or limited formal education.

Non-neoformans cryptococcal infections: a systematic review.

Non-neoformans cryptococci have been generally regarded as saprophytes and rarely reported as human pathogens. However, the incidence of infection due to these organisms has increased over the past 40 years, with Cryptococcus laurentii and Cryptococcus albidus, together, responsible for 80% of reported cases. Conditions associated with impaired cell-mediated immunity are important risks for non-neoformans cryptococcal infections and prior azole prophylaxis has been associated with antifungal resistance. The presence of invasive devices was a significant risk factor for Cryptococcus laurentii infection (adjusted OR = 8.7; 95% CI = 1.48-82.9; p = 0.003), while predictors for mortality included age > or =45 years (aOR = 8.4; 95% CI = 1.18-78.82; p = 0.004) and meningeal presentation (aOR = 7.0; 95% CI = 1.85-60.5; p= 0.04). Because clinical manifestations of non-neoformans cryptococcal infections are most often indistinguishable from Cryptococcus neoformans, a high index of suspicion remains important to facilitate early diagnosis and prompt treatment for such infections.