Pulmonary Tuberculosis in Healthcare Workers at a University Hospital: A Significant Burden of Subclinical Disease
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Abstract
OBJECTIVES: This research intends to determine the incidence of subclinical and active pulmonary tuberculosis (TB) among healthcare workers at a university hospital in Bangkok, Thailand.
MATERIALS AND METHODS: A retrospective cohort study included data from full-time employees aged 18 and over from January 1st, 2018, to December 31st, 2022. Data from the hospital’s employee database and extracted cases of subclinical and active pulmonary TB were collected to calculate their annual incidences. The study also compared jobs with different levels of patient exposure risk and sputum culture positivity rates between both groups.
RESULTS: During the five-year period, 65 cases of pulmonary TB were diagnosed. Of these, 45 (69.2%) were subclinical, and 20 (30.8%) were active pulmonary TB. The annual incidence of subclinical pulmonary TB per 100,000 persons was 98.12, 47.85, 46.93, 53.70, and 23.24 between 2018 and 2022, respectively. Meanwhile, the incidence of active pulmonary TB for the same period was 18.40, 29.90, 35.20, 23.87, and 11.62 per 100,000 persons, respectively. Compared to Thailand’s overall TB incidence of 155 per 100,000 persons in 2022, our lower incidence was likely due to early detection and treatment of TB among healthcare workers, raising concerns about the transmissibility of subclinical pulmonary TB. Notably, a significant proportion of healthcare workers with pulmonary TB were nurses (41.5%), and 22.2% of subclinical pulmonary TB cases were culture-positive.
CONCLUSION: The study revealed that subclinical pulmonary TB constitutes a considerable proportion of pulmonary TB among healthcare workers. It also highlights the contagious potential of subclinical pulmonary TB, contributing to the TB burden in both healthcare workers and society. Given the asymptomatic nature of subclinical pulmonary TB, which complicates detection through passive case finding, implementing active case finding using routine chest radiographs is essential for preventing TB transmission.
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