Screening of latent tuberculosis infection among health care workers working in Hajj pilgrimage area in Saudi Arabia, using interferon gamma release assay and tuberculin skin test.

BACKGROUND: Interferon gamma release assays (IGRA) is highly specific for Mycobacterium tuberculosis and is the preferred test in BCG-vaccinated individuals. The few studies that have screened health care workers (HCWs) in Saudi Arabia for latent tuberculosis infection (LTBI) using IGRA have varied in agreement with the traditional tuberculin skin test (TST). OBJECTIVE: Assess the prevalence of LTBI among HCWs working in the Hajj pilgrimage using IGRA and TST and measuring their agreement. DESIGN: Cross-sectional prospective. SETTING: Multiple non-tertiary care hospitals. PATIENTS AND METHODS: HCWs who worked during the Hajj pilgrimage in Saudi Arabia in December 2015. Data was collected by standarized questionnaire. Samples were drawn and analyzed by standard methods. MAIN OUTCOME MEASURES: The prevalence of LTBI among HCW and the agreement by kappa statistic between QFT-GIT and TST. SAMPLE SIZE: 520 subjects. RESULTS: Nurses accounted for 30.7% of the sample and physicians, 19.2%. The majority were BCG vaccinated (98.5%). There were a total of 56 positive by QFT-GIT and the LTBI rate was 10.8%. In 50 QFT positive/476 TST negative the LTBI rate was 10.5% in discordant tests, and in 6 QFT positive/44 TST positive it was 13.6% in concordant tests. The overall agreement between both tests was poor-83% and kappa was 0.02. LTBI prevalence was associated with longer employment (13.1 [9.2] years). The QFT-GIT positive test was significantly higher in physicians (P=.02) and in HCWs working in chest hospitals 16/76 (21.05%) (P=.001). CONCLUSION: Agreement between the tests was poor. QFT-GIT detected LTBI when TST was negative in HCWs who had a history of close contact with TB patients. LIMITATIONS: A second step TST was not feasible within 2-3 weeks. CONFLICT OF INTEREST: None.

Tuberculosis treatment outcome in a tertiary care setting.

BACKGROUND: The outcome of chemotherapy for pulmonary, extrapulmonary, and disseminated tuberculosis is not well documented, especially in developing countries. This study assessed tuberculosis treatment outcome, cure-to-treatment ratio and mortality among all types of tuberculosis patients in a tertiary care setting in Saudi Arabia. METHODS: All cases diagnosed and treated for active Mycobacterium tuberculosis infection between 1991 and 2000 were included retrospectively. Data collected included type of tuberculosis involvement, treatment outcome, relapse, and colmorbidities. RESULTS: Over a ten-year period, 535 cases of tuberculosis were diagnosed and treated. Isolated pulmonary tuberculosis was identified in 141 cases (26.4%), extrapulmonary tuberculosis in 339 cases (63.3%), and combined pulmonary and extrapulmonary disseminated involvements in 55 cases (10.3%). Colmorbidities were noted in 277 (52%) patients. Immunosuppression was found in 181 (34%) patients. The cure rate was 82%. The cure-to-treatment ratio was 86% in extrapulmonary tuberculosis and 78% in pulmonary tuberculosis, and 65% in disseminated tuberculosis. Overall mortality was 18%. Disseminated tuberculosis had the highest mortality (34.9%), followed by pulmonary (21.8%), then extrapulmonary tuberculosis (13.6%). Forty-seven percent of all mortalities were directly related to tuberculosis. Relapse was documented in 14 out of 349 patients (4%) who had 24 months of follow up. CONCLUSION: Despite tertiary care support, complicated tuberculosis carries a high mortality. Earlier diagnosis and complete appropriate chemotherapy are essential for improved outcome.

Extrapulmonary tuberculosis, clinical presentation and outcome.

OBJECTIVE: To identify patterns, features, and outcome of extrapulmonary tuberculosis in a tertiary care setting. METHODS: A retrospective case-series was carried out of all cases diagnosed and treated as extrapulmonary tuberculosis during 1991 through to 2000 at King Faisal Specialist Hospital and Research Centre (KFSH and RC), Riyadh, Kingdom of Saudi Arabia. Demographic, clinical, laboratory, and outcome data were abstracted from medical records. RESULTS: Over a 10-year period, 394 cases of extrapulmonary tuberculosis were diagnosed and treated at KFSH and RC. Isolated extrapulmonary tuberculosis was identified in 339 (86%) patients, 55 cases (14%) had both pulmonary and extrapulmonary tuberculosis. Mean age was 45-years, and 188 patients (47%) had co-morbidities, most commonly diabetes mellitus in 14.2% of patients. Laboratory confirmation of extrapulmonary tuberculosis was available on 386 patients. The most frequent site involvement was lymphadenopathy in 41% of the time. Chest x-ray was normal in 75% of patients. Among 298 patients with follow up data, 10 (3.4%) had documented relapse and 50 (16%) died. Death was related to tuberculosis in 24 (48%) patients. CONCLUSION: A high level of clinical suspicion is essential for early diagnosis and treatment of extrapulmonary tuberculosis to reduce the significant morbidity and mortality.