Resumen de Enfermedad tuberculosa entre trabajadores de salud

Roberto Alfonso Accinelli Tanaka, Julio Noda Milla, Erika Bravo Padilla, Maribel Galloso Benites, Lidia López Oropeza, João Da Silva Caballero, Yeny Aurea Bravo Pajuelo, Juan Agapito Panta, Amador Carcelén Bustamante, Augusto Yi Chu, Javier Díaz Urteaga, Rosa Mayhua Pérez, William Chávez Frías, Danilo Salazar Oré, Henry Martínez Garibay

• español

  Introducción: la transmisión de Mycobacterium tuberculosis es un riesgo reconocido en las instituciones de salud. El riesgo varía según el tipo de instalación, la prevalencia de tuberculosis (TB) en la comunidad, el grupo ocupacional de los trabajadores, el área de la instalación en que trabajan y la efectividad del control. Objetivo: describir las características de la enfermedad tuberculosa y los resultados del tratamiento entre los trabajadores de salud atendidos en el Programa de Control de la Tuberculosis del Hospital Nacional Cayetano Heredia. Material y método: estudio descriptivo observacional de casos entre trabajadores de salud (TS) y pacientes (controles) entre que ingresaron al Programa de Control de la Tuberculosis (PCT) del Hospital Nacional Cayetano Heredia (HNCH) entre 1994 al 2007. Resultados: de enero 1994 a diciembre 2007 se atendieron 957 enfermos de tuberculosis de los cuales 159 (16,6%) fueron TS, con edad promedio de 31,05 ±8,79, siendo 84 (52,8%) mujeres y 122 (76,7%) con enfermedad pulmonar. De estos 36,5% fueron profesionales y 34,6% estudiantes de ciencias de la salud. Entre los profesionales de la salud hubo 41 médicos (71%) y de ellos los residentes fueron mayoría (63%). Entre los estudiantes de ciencias de la salud el grupo mayoritario fue el de los estudiantes de medicina (87%), y dentro de ellos la mayoría (75%) externos e internos. De 20 cepas con sensibilidad realizada 11 (55%) fueron resistentes al menos a un fármaco, 5 (25%) multidrogoresistentes, 8 (40%) resistentes a isoniacida, 6 (30%) a rifampicina, 6 (30%) a estreptomicina y 4 (20%) a etambutol. Setenta y cuatro (60,7%) de los 122 TS con TB pulmonar ingresaron con BK negativo, y sólo 41 (33,6%) controles (p<0,001). Los TS recibieron el mismo tipo y tiempo de tratamiento (7,2 ± 3,1 meses) que sus controles (6,8 ± 3,6 meses), (p=0,3) pero mayor número de dosis de la primera fase diaria del tratamiento (73,2 ± 65,6 vs 59,01 ± 44,5 dosis) p= 0,001. El 5,03% de los TS y el 13,21% de los controles tuvo algún contacto al que se le diagnosticó tuberculosis durante el control de los mismos. (p<0,001) Conclusiones: los TS con TB en su mayoría fueron profesionales o estudiantes de ciencias de la salud, con elevado porcentaje de cepas MDR, no habiendo fallecido ninguno por TB, predominando entre los pulmonares las formas negativas. Comparado con los otros pacientes con TB estos curaron más, en igual tiempo de tratamiento, pero con más número de dosis diarias.

• English

  Introduction: Tuberculosis (TB) transmission is a well-recognized risk in healthcare facilities. This risk is variable considering to the nature of such facilities (primary, secondary, or tertiary care), the prevalence of TB in the community, occupational groups of healthcare workers (HCW), the particular area in which they work, and the effectiveness of control programs. Objectives: To describe the features of TB and results of therapy for this disease in HCW seen in the TB Control Program in Cayetano Heredia National Hospital in Lima, Peru. Material and methods: A descriptive observational study was performed, including cases (HCWs) and controls (patients) admitted in the TB Control Program in Cayetano Heredia National Hospital in Lima, Peru, between 1994 and 2007. Results: 957 TB cases were seen in the TB Control Program in Cayetano Heredia Hospital from January 1994 to December 2007. One hundred and fifty nine (16,6%) were HCW, their average age was 31,05 ±8,79 years, 84 (52,8%) were female, and 122 (76,7%) developed pulmonary disease. Of these latter cases, 36,5% were healthcare professionals and 34,6% were medicine, nursing, or health technology students. Amongst healthcare professionals that developed TB, 41 (71%) were physicians, and most of them (63%) were residents in-training. Amongst students, medicine students accounted for most TB cases (87%), and 75% of them were senior medical students (interns and 6th year). Twenty isolated of M. tuberculosis had susceptibility tests performed, 11 (55%) were resistant to at least one antituberculous drug, 5 (25%) were multidrug resistant M. tuberculosis isolates, 8 (40%) were isoniazid-resistant, 6 (30%), were rifampin-resistant, 6 (30%) were streptomycin-resistant, and 4 (20%) were ethambutol-resistant. Seventy four (60,7%) of 122 HCWs with pulmonary TB entered the Program with sputum smears negative for acid-fast bacilli (AFB), and only 41 (33%) controls had negative sputum smears (p<0.001). HCWs received the same antituberculous therapy and for the same time compared to controls (7,2 ±3,1 months and 6,8 ±3,6 months, p= 0,3), but they received a higher number of doses during the first phase of antituberculous therapy (73,2 ±65,6 vs. 59,01 ±44,5 doses, p= 0.001). Five per cent of HCWs and 13,21% controls had a contact diagnosed with TB during the control period (p<0.001). Conclusions: Most healthcare workers with TB were professionals or students, with a high frequency of MDR strains, there were no deaths in the population studied, and smear-negative forms were most frequent amongst pulmonary TB cases. Compared with controls, TB cases in HCWs had better curation rates with the same time of therapy, but using more daily doses.