Exposure to Mycobacterium tuberculosis during Flexible Bronchoscopy in Patients with Unexpected Pulmonary Tuberculosis

• Published in: PloS one 2016-05, Vol.11 (5), p.e0156385-e0156385
• Main Authors: Na, Hae Jung, Eom, Jung Seop, Lee, Geewon, Mok, Jeong Ha, Kim, Mi Hyun, Lee, Kwangha, Kim, Ki Uk, Lee, Min Ki
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alveoli; Atelectasis; Biology and Life Sciences; Bronchiectasis; Bronchoscopy; Bronchus; Computed tomography; Confidence intervals; Diagnosis; Disease; Exposure; Female; Fluids; Health care; Hospitals; Humans; Incidence; Infectious Disease Transmission, Patient-to-Professional; Internal medicine; Lavage; Lungs; Male; Medical diagnosis; Medical imaging; Medical personnel; Medical screening; Medicine; Medicine and Health Sciences; Middle Aged; Mycobacterium tuberculosis; Occupational exposure; Occupational Exposure - adverse effects; Occupational health; Particulates; Patients; Personnel; Physicians; Practice; Pulmonary tuberculosis; Research and Analysis Methods; Respiratory diseases; Retrospective Studies; Sputum; Tuberculosis; Tuberculosis, Pulmonary - transmission
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0156385

Recent guidelines recommend the use by healthcare personnel of a fit-tested N95 particulate respirator or higher-grade respiratory precaution in a patient undergoing bronchoscopy when pulmonary tuberculosis (PTB) is suspected. However, PTB may be unexpectedly diagnosed in this setting and therefore not evaluated, resulting in the unexpected exposure to Mycobacterium tuberculosis (MTB) of healthcare workers in the bronchoscopy suite. Here, we examined the incidence of unexpected exposure to MTB during flexible bronchoscopy and determined the exposure-related factors. Between 2011 and 2013, a retrospective study was conducted to evaluate unexpected diagnoses of PTB in the bronchoscopy suite. During the study period, 1650 consecutive patients for whom previous CT scans were available and who underwent bronchoscopy for respiratory disease other than PTB were included. The results of bronchial washing, bronchoalveolar lavage, and post-bronchoscopic sputum were reviewed. PTB was unexpectedly diagnosed in 76 patients (4.6%). The presence of anthracofibrosis [odds ratio (OR), 3.878; 95% confidence interval (CI), 1.291-11.650; P = 0.016), bronchiectasis (OR, 1.974; 95% CI, 1.095-3.557; P = 0.024), or atelectasis (OR, 1.740; 95% CI, 1.010-2.903; P = 0.046) as seen on chest CT scan was independently associated with unexpected PTB. Patients with both anthracofibrosis and atelectasis were at much higher risk of unexpected PTB (OR, 4.606; 95% CI, 1.383-15.342; P = 0.013). The risk of MTB exposure by healthcare personnel in the bronchoscopy suite due to patients with undiagnosed PTB has been underestimated. Therefore, in geographic regions with an intermediate PTB prevalence, such as South Korea (97/100,000 persons per year), higher-grade respiratory precaution, such as a fit-tested N95 particulate respirator, should be considered to prevent occupational exposure to MTB during routine bronchoscopy, especially in patients with CT-confirmed anthracofibrosis, bronchiectasis, or atelectasis.