Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-23T08:22:46.229Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors Associated With Diagnostic Evaluation for Tuberculosis Among Adults Hospitalized for Clinical Pneumonia in Thailand

Published online by Cambridge University Press:  02 January 2015

Ann M. Weber ,
Peera Areerat ,
Julie E. Fischer ,
Somsak Thamthitiwat ,
Sonja J. Olsen  and
Jay K. Varma
Ann M. Weber
Affiliation:
University of California at Berkeley School of Public Health, Berkeley, Thailand
Peera Areerat
Affiliation:
Sa Kaeo Provincial Public Health Office, Sa Kaeo, Thailand
Julie E. Fischer
Affiliation:
Thailand Ministry of Public Health–US Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
Somsak Thamthitiwat
Affiliation:
Thailand Ministry of Public Health–US Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand
Sonja J. Olsen
Affiliation:
CDC, Atlanta, Georgia
Jay K. Varma*
Affiliation:
Thailand Ministry of Public Health–US Centers for Disease Control and Prevention (CDC) Collaboration, Nonthaburi, Thailand CDC, Atlanta, Georgia
*
CDC/HIV, Box 68 American Embassy APO, AP 96546
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Thailand is one of 22 countries designated by the World Health Organization as “high burden” with regard to tuberculosis. Preventing nosocomial tuberculosis transmission remains an important, unmet need. We investigated the adequacy of current practices to evaluate hospitalized patients for tuberculosis, which is critical in preventing delayed diagnosis and nosocomial tuberculosis transmission.

Methods.

Thailand conducts active, population-based surveillance for pneumonia in 2 rural provinces. Case report forms are completed for all persons who are hospitalized and meet a case definition of having clinical pneumonia. We analyzed how frequently patients had an adequate diagnostic evaluation for infectious pulmonary tuberculosis, in accordance with national guidelines. We conducted multivariate analyses to determine patient and health-system factors associated with an inadequate diagnostic evaluation for tuberculosis and with tuberculosis disease.

Results.

Of 8,853 cases of clinical pneumonia between September 2003 and March 2006,73% were in patients not adequately evaluated for tuberculosis. Acid-fast bacilli (AFB)–positive tuberculosis was diagnosed in 188 cases, which was 2% of all pneumonia cases and 12% of pneumonia cases in patients adequately evaluated for tuberculosis. Diagnostic evaluations for tuberculosis were less commonly performed among those who were younger than 25 years of age, were female, and lacked cough, sputum production, hemoptysis, and dyspnea. Among patients adequately evaluated, a clinical syndrome of no cough, no hemoptysis, and normal chest radiography findings had a 95% negative predictive value.

Conclusions.

The prevalence of AFB-positive, pulmonary tuberculosis was high among adults hospitalized with clinical pneumonia in Thailand. Most patients were not adequately evaluated for tuberculosis. Efforts are needed to improve identification and diagnosis of infectious tuberculosis cases in hospitalized patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 7 , July 2008 , pp. 648 - 657
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.World Health Organization (WHO). Global tuberculosis control: surveillance, planning, financing. WHO report 2007. Geneva: WHO; 2007. Available at: http://www.who.int/tb/publications/global_report/2007/download_centre/en/index.html. Accessed September 3, 2007.Google Scholar
2.Harries, AD, Maher, D, Nunn, P. Practical and affordable measures for the protection of health care workers from tuberculosis in low income countries. Bull World Health Organ 1997;75:477–489.Google Scholar
3.Granich, R, Binkin, N, Jarvis, W, et al. Guidelines for the prevention of Tuberculosis in health care facilities in resource-limited settings. Geneva: World Health Organization; 1999.Google Scholar
4.World Health Organization (WHO). Summary by WHO region: South-East Asia. 2006 Global Report. Geneva: World Health Organization; 2006. Available at: http://www.who.int/tb/publications/global_report/2006/pdf/sear.pdf. Accessed February 8, 2007.Google Scholar
5.Rojpibulstit, M, Kanjanakiritamrong, J, Chongsuvivatwong, V. Patient and health system delays in the diagnosis of tuberculosis in Southern Thailand after health care reform. Int J Tuberc Lung Dis 2006;10:422–428.Google Scholar
6.Yanai, H, Limpakarnjanarat, K, Uthaivoravit, W, Mastro, TD, Mori, T, Tappero, JW. Risk of Mycobacterium tuberculosis infection and disease among health care workers, Chiang Rai, Thailand. Int J Tuberc Lung Dis 2003;7:36–45.Google ScholarPubMed
7.Menzies, D, Fanning, A, Yuan, L, Fitzgerald, M. Tuberculosis among health care workers. N Engl J Med 1995;332:92–98.CrossRefGoogle ScholarPubMed
8.Centers for Disease Control. Epidemiologic Notes and Reports: nosocomial transmission of multidrug-resistant tuberculosis among HIV-infected persons—Florida and New York, 1988–1991. MMWR Morb Mortal Wkly Rep 1991;40:585–591.Google Scholar
9.Gandhi, NR, Moll, A, Sturm, AW, et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006;368:1575–1580.Google Scholar
10.Rozovsky-Weinberger, J, Parada, JP, Phan, L, et al. Delays in suspicion and isolation among hospitalized persons with pulmonary tuberculosis at public and private IS hospitals during 1996 to 1999. Chest 2005;127:205–212.CrossRefGoogle ScholarPubMed
11.Thailand Ministry of Public Health (MOPH). Health service systems in Thailand. Thailand Health Profile, 1999–2000. Available at: http://www.moph.go.th/ops/thealth_44/index_eng.htm. Accessed February 8, 2007.Google Scholar
12.Olsen, SJ, Laosiritaworn, Y, Siasiriwattana, S, Chunsuttiwat, S, Dowell, SF. The incidence of pneumonia in rural Thailand. Int J Inf Dis 2006;10:439–445.Google Scholar
13.World Health Organization (WHO). TB manual: National Tuberculosis Programme guidelines. Geneva: World Health Organization; 2001. Available at: http://www.euro.who.int/document/e75464.pdf. Accessed May 17, 2007.Google Scholar
14.Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep 1997;46(RR-10):1–55.Google Scholar
15.Mathers, CD, Lopez, AD, Murray, CJL. The burden of disease and mortality by condition: data, methods, and results for 2001. In: Lopez, AD, Mathers, CD, Ezzati, M, Jamison, DT, Murray, CJL, eds. Global burden of disease and risk factors. New York: Oxford University Press;2006:228–229.Google ScholarPubMed
16.Rieder, HL. Epidemiologic basis of TB control. Paris: International Union against TB and Lung Diseases (IUATLD); 1999.Google Scholar
17.International Union Against Tuberculosis and Lung Diseases (IUATLD). Technical guide for sputum examination for tuberculosis by direct smear microscopy. 3rd ed. Paris: IUATLD; 1978.Google Scholar
18.Siddiqi, K, Lambert, ML, Walley, JClinical diagnosis of AFB-negative pulmonary tuberculosis in low-income countries: the current evidence. lancet 2003;3:288–296.Google Scholar
19.Meya, DB, McAdam, KP. The TB pandemic: an old problem seeking new solutions. J Intern Med 2007;261:309–329.Google Scholar
20.Center for Disease Control and Prevention (CDC), the World Health Organization (WHO). Tuberculosis infection control in the era of expanding HIV care and treatment. Addendum to WHO guidelines for the prevention of tuberculosis in health care facilities in resource-limited settings, 1999. Geneva: World Health Organization; 1999. Available at: http://whqlibdoc.who.int/hq/1999/WHO_TB_99.269_ADD_eng.pdf. Accessed February 8, 2007.Google Scholar
21.Ruxrungtham, K, Brown, T, Phanuphak, P. HIV/AIDS in Asia. Lancet 2004;364:69–82.Google Scholar