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Health (SSH) regulations in Germany. Results: There is an increased risk of infection not only in phenomenology and laboratories with regular contact with tuberculosis patients or infectious materials. Epidemiological studies have also verified an increased risk of infection from activities that involve close contact with patients’ breath (e. G. Bronchus’s, intubations) or close contact with patients in need of care in geriatric medicine or geriatric nursing. In occupational disease claim proceedings on account of tuberculosis, the burden of proof can be eased for insured persons who work in these or other memorable fields.
Forgoing evidence of an index person as a source of infection has led to a doubling of the rate of cases of tuberculosis recognized as an occupational disease and has halved the duration of occupational disease claim proceedings in Germany. For several years now, it has been possible to use the new interferon-y release assays (Cigars) to diagnose a latent tuberculosis infection (LILT) with significantly greater validity than with the traditional tuberculin skin test (TTS). However, variability of the Cigars around the cut-off poses problems especially in serial testing of Haws.
At round 10%, L TUB prevalence in German healthcare workers is lower than had been assumed. It can make sense to treat a recent L TUB in a young healthcare worker so as to prevent progression into active tuberculosis. If the L TUB is occupational in origin, the provider of statutory accident insurance can cover the costs of preventive treatment. However, little is known about disease progression in Haws with positive IGRP sofas. Conclusion: TUB screening in Haws will remain an important issue in the near future even in low Incidence, high income countries, as active TUB in Haws is often due to workplace exposure.
The Cigars facilitate these screenings. However, variability of IGRP results in serial testing of Haws need further investigations. Keywords: Tuberculosis, Provision, Occupational disease, Assessment, Healthcare, Prevention Introduction Tuberculosis (TUB) is the second most frequent workplace infectious disease among German healthcare workers (HOC) Understanding the dynamics of infection risks for Haws and developing an adequate Occupational Safety and Health (SSH) system is crucial * Correspondence: a. nienhaus@uke. De Institute for Health Service Research in Dermatology and Nursing (VIVID),
Center of Excellence for Epidemiology and Health Service Research for Healthcare Professionals (Caver), University Medical Center Hamburg- Offender, Martinis;e 52, Hamburg 20246, Germany 2 Principles of Prevention and Rehabilitation Department (GAP), Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BAG), Hamburg, Germany Full list of author information is available at the end of the article to protect HOC from TUB and to limit the spread of infections from Haws to patients.
In this narrative review we describe the German perspective and experience with TUB in Haws. As Germany has an elaborate system for occupational disease prevention and rehabilitation, telling the story from a German perspective might encourage other countries with less developed SSH systems [2] to improve infection control in Haws. Epidemiology of tuberculosis in Germany According to information provided by the Robert Koch Institute (IRK), in 2011 a total of 4,317 cases of tuberculosis were registered in Germany (previous year: 4,388), 0 2014 Ingenious et al. Licensee Boomed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creationism’s. Org/licenses/by/2. O), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons public Domain Dedication waiver (http://creationism’s. Org/publication/zero/l . 01) applies to the data made available in this article, unless otherwise stated. Http://www. Occupy-med-corn/content/9/1/9 equivalent to an incidence of 5. 3 (previous year: 5. ) new cases per 100,000 inhabitants The clear downward trend observed in Germany in recent years thus almost ground to a halt (Figure 1). The lung was the organ most recently affected by TUB, accounting 79. 6% (3,346) of cases. Around one third (33. 9%) of lung tuberculosis were of the infectious, microscopically positive type. The success of treatment in higher age groups declined continuously to just 63. 3% in patients aged 70 and over. The incidence of TUB among citizens with a migration background is approximately four times higher than among German nationals (5. 3 versus 21. 5/100,000).
Transmission paths and clinical picture of TUB Bacteria of the Mycobacterium tuberculosis (MET B) complex are transmitted from person to person by droplet infection and rarely via smear infections on kin and mucous membranes, via contaminated dust particles or cuts and stab wounds involving contaminated canella or scalpels [4]. Environmental factors, hygiene conditions, the amount of germs discharged and the virulence of the pathogens determine the degree of infection risk. Personal factors such as nutritional condition, age, immune status and commonality determine susceptibility of infection and the progression of the disease.
Primary tuberculosis or latent TUB infection (LILT) The risk of infection increases with the duration and closeness of contact with the source of infection. However, brief occasional contacts -?? even a single conversational contact -?? can also lead to infection After an incubation period of five to six weeks on average (maximum 8 weeks), an inflammatory reaction occurs in the lung (primary focus) and possibly in the regional lymph Page 2 of 12 nodes (primary complex). In most cases, this process heals without significant clinical symptoms.
Sometimes calcification takes place, so that the primary focus and possibly also the associated lymph nodes remain radiological identifiable at a later date (Goon foci). However, it is also possible that active tuberculosis ill develop immediately, with a progressive, infiltrative and captivating process and/or with bronchial, homogeneous or lymphocyte’s spread, leading to further organ manifestations. In the primary complex, which often cannot be rendered visible, viable mycobacterium capable of replication and proliferation may remain for years or decades.
This leads to assassination of monocot’s circulating in the peripheral blood. The presence of these sensitizes monocot’s can be measured by means of a tuberculin skin test (T SST) or with the interferon-y release assays (Cigars) that have recently become available. Both tests are based on the calumniated immune response to M. Tuberculosis antigens. However, the IGRP is considerably more specific than the TTS, since it works with only two or three M. Tuberculosis antigens instead of approximately 200 antigens as in the tuberculin for the TTS [6,7].