• 한국산업보건학회지
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• 제29권3호
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• pp.289-297
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• 2019

Objectives: To identify the positive rate of and the risk factors associated with latent tuberculosis infection(LTBI) in mine workers, the objectives of the present study evaluated those among former mine workers. Methods: Between January 2015 and May 2017, former male mine workers who had been subjects for epidemiology research for work-related chronic obstructive pulmonary disease(COPD) and had received QuantiFERON-$TB^{(R)}$ Gold In-Tube(QFT-GIT) from the Institute of Occupation and Environment(IOE) under Korea Workers' Compensation and Welfare Service(KCOMWEL) were selected as the study subjects. To identify significant variables for increased risk of LTBI, logistic regression analysis was performed. Results: A total of 736 male former mine workers were selected as study subjects. The positive rate of LTBI among subjects was 69.2%(509/736). The current smoking[odds ratio(OR), 2.3; 95% confidence interval(CI), 1.1-4.9], COPD(OR, 1.4; 95% CI, 0.9-2.3), department loading(OR, 1.8; 95% CI, 0.9-3.4) and mining(OR, 1.5; 95% CI, 0.9-2.5), and working duration of over 20(OR, 1.6; 95% CI, 0.9-3.1) and over 30 years(OR, 2.2; 95% CI, 0.9-4.9) were associated with increased risk of LTBI. The interferon-gamma(IFN-${\gamma}$) level after stimulation with Mycobacterium tuberculosis(MTB)-specific antigens showed a significantly negative correlation with age(r=-0.126). Conclusions: The present study determined that the high positive rate of LTBI among mine workers was associated with not only the host factors but also the occupational exposure to mine dust.

• Journal of Korean Medical Science
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• 제33권47호
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• pp.292.1-292.10
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• 2018

Background: We investigated the incidence of active tuberculosis among patients with inflammatory bowel disease (IBD) treated with tumor necrosis factor (TNF) inhibitors, with or without latent tuberculosis infection (LTBI). Methods: The study was performed at a Korean tertiary referral center between January 2011 and June 2017. In total, 740 patients with IBD who underwent LTBI screening tests and were followed-up for ${\geq}1$ year after TNF inhibitor treatment initiation were enrolled. LTBI was detected on the basis of tuberculin skin test results, interferon-gamma release assay results, chest X-ray findings, and previous tuberculosis treatment history. The patients were classified into LTBI (n = 84) or non-LTBI (n = 656) group. The risk of developing tuberculosis in each group was assessed on the basis of standardized incidence ratio (SIR) and 95% confidence interval (CI) for active tuberculosis. Results: Mean patient age was 33.1 years, and patients with Crohn's disease were predominant (80.7%). Within 1 year after the initiation of TNF inhibitor treatment, 1 patient in the LTBI group (1/84; 1.2%) and 7 patients in the non-LTBI group (7/656; 1.1%) developed active tuberculosis. The overall 1-year incidence of tuberculosis among the patients was significantly higher than that among the general population (SIR, 14.0; 95% CI, 7.0-28.0), and SIR was not affected by LTBI status (LTBI group: 14.5, 95% CI, 2.0-102.6; non-LTBI group: 14.0, 95% CI, 6.7-29.4). Conclusion: Patients with IBD undergoing TNF inhibitor treatment showed a higher 1-year incidence of tuberculosis than the general population irrespective of LTBI status.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1241-1251
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• 2018

Background/Aims: To estimate the level of agreement and positivity rates of latent tuberculosis infection (LTBI) tests prior to the use of tumor necrosis factor (TNF) inhibitors in relation to underlying rheumatic diseases and endemic tuberculosis levels. Methods: The Ovid-Medline, Embase, and Cochrane Libraries were searched for articles before October 2013 involving LTBI screening in rheumatic patients, including rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis. Results: In pooled analyses, 5,224 rheumatic patients had undergone both a tuberculin skin test (TST) and an interferon-gamma release assay (IGRA) before TNF inhibitors use. The positivity of TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB (T-SPOT) tests were estimated to be 29%, 17%, and 18%, respectively. The agreement percentage between the TST and QFT-GIT, and between the TST and T-SPOT were 73% and 75%. Populations from low-to-moderate endemic TB presented with slightly less agreement (71% between TST and QFT-GIT, and 74% between TST and T-SPOT) than patients from high endemic countries (73% between TST and QFT-GIT, and 81% between TST and T-SPOT). By underlying disease stratification, a lower level of agreement between TST and QFT-GIT was found among AS (64%) than among JIA (77%) and RA patients (73%). Conclusions: We reaffirm the current evidence for accuracy of LTBI test done by TST and IGRA among rheumatic patients is inconsistent. Our stratified analysis suggests different screening strategies might be needed in clinical settings considering the endemic status in the patient's country of origin and the precise nature of underlying diseases.

• Annals of dermatology
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• 제30권6호
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• pp.716-720
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• 2018

Perforating granuloma annulare (PGA), a rare variant of granuloma annulare, is characterized by transepidermal elimination of altered collagen that clinically manifests an umbilicated papule with a central crust. It can be confused with papulonecrotic tuberculid (PNT) because of their similar appearance. Unlike PGA, PNT is usually related to tuberculosis infection with a typical histologic finding of wedgeshaped dermal necrosis. Here, we report the first Korean case of PGA mimicking PNT both clinically and histologically. A 43-year-old Korean woman presented with erythematous papules localized on the extensor surface of her limbs for one year. Some of these papules had a central umbilication or a crust. Regarding comorbidity, she had latent tuberculosis diagnosed with $QuantiFERON^{(R)}-TB$ Gold test about five months ago. She was on antituberculous medication. Initially, a diagnosis of papulonecrotic tuberculid accompanied by latent tuberculosis was considered. However, despite taking the antituberculous medication for five months, her skin lesions were not improved. Biopsy specimen from her arm lesion showed wedge-shaped area of necrosis in the dermis. Additionally, there were multiple focal mucin depositions and palisading granulomatous inflammation throughout the dermis. A diagnosis of PGA was made and she was treated with topical corticosteroid. After two weeks of applying topical corticosteroid, most of her skin lesions disappeared, leaving some hyperpigmented scars.

• Pediatric Infection and Vaccine
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• 제23권1호
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• pp.18-24
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• 2016

목적: 국내와 같이 결핵의 유병률이 높은 지역에서 결핵을 정확하게 진단하는 것은 중요하다. 본 예비연구는 국내의 소아청소년에서 결핵진단 시 TST 및 2가지 IGRA 검사법 (QFT-G 및 T-SPOT.TB) 간의 일치도를 알아보고자 하였다. 방법: 2014년 1월부터 2015년 4월까지 잠복결핵감염 또는 결핵질환의 진단을 위해 서울아산병원을 방문한 20세 이하 환자 중, TST, T-SPOT.TB 및 QFT-G 검사 중 최소 2가지 이상의 검사를 동시에 시행한 경우를 연구에 포함하였다. 이들의 의무기록을 후향적으로 분석하여 각 검사 간의 일치도를 평가하였다. 결과: 연구에 포함된 총 20명의 연령의 중앙값은 13.3세(범위: 3.8-18.1세)이었고, 이 중 11명은 면역저하와 관련된 기저질환이 있었다. T-SPOT.TB와 QFT-G 결과의 일치도는 90%였으며, TST와 T-SPOT.TB의 일치도는 50%, TST와 QFT-G의 일치도는 42.9%였다. T-SPOT.TB, QFT-G 및 TST의 결핵질환에 대한 특이도는 93.3%, 86.7% 및 58.3%였다. 결론: T-SPOT.TB과 QFT-G 간의 일치도는 높으나 TST와 T-SPOT.TB 또는 QFT-G 간의 일치도는 낮았다. 추후 국내 소아청소년의 정확한 결핵의 진단을 위한 각 검사들의 일치도 및 진단적 유용성에 대한 추가적인 연구가 필요하다.

• Pediatric Infection and Vaccine
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• 제15권1호
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• pp.52-58
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• 2008

목 적 : 잠복 결핵 감염 진단 시 사용되는 고전적인 방법인 투베르쿨린 피부 반응 검사(TST) 외 전혈에서 인터페론 감마의 분비능을 측정하는 검사가 개발된 이후 많은 연구들이 그 유용성을 입증하였으나, 소아에서는 그러한 평가가 제한되어 있다. 본 연구는 결핵에 노출된 소아의 잠복 결핵 감염 진단에 있어 QuantiFERON-TB Gold 검사의 유용성을 알아보고자 하였다. 방 법 : 2006년 1월부터 2007년 12월까지 분당 서울 대학교 병원에 결핵 환자와 접촉하여 내원한 소아를 대상으로 흉부 방사선 사진, TST 및 QuantiFERON-TB Gold 검사를 시행하였다. 초기 TST가 음성인 경우, 3개월 뒤 추적 검사를 시행하였다. TST 결과에 따라 초기 TST가 양성인 경우 감염 여부는 확실치 않으나 잠복 감염의 가능성이 있는 군, 초기 TST는 음성이었으나 3개월 뒤 검사에서 양성 전환된 경우는 잠복 결핵 감염군, 처음과 3개월 뒤 TST가 모두 음성인 경우는 감염되지 않은 군으로 정의하였다. 초기 TST가 음성이었으나 추적검사를 하지 않은 경우는 분석에서 제외시켰다. 결 과 : 대상군은 총 49명(남자 22명, 여자 27명) 이었으며, 중앙 연령은 75세(범위; 3개월-14.7세)이었다. QuantiFERON-TB Gold 검사 양성을 보인 소아는 총 5명으로, 감염 여부는 확실치 않으나 잠복 감염의 가능성이 있는 13명 중 3례(23.1%), 잠복 결핵 감염으로 진단된 8명 중 1례(13%), 그리고 감염되지 않은 21명 중 1례(5%)가 포함되었다. QuantiFERON-TB Gold와 TST의 일치도는 0.72이었다(${\kappa}=0.101$). TST와 비교하였을 때 QuantiFERON-TB Gold의 민감도는 12.5%(1/8), 특이도는 95.2%(20/ 21)으로 나타났다. 결 론 : 결핵에 노출된 소아의 잠복결핵감염의 진단에 있어서 QuantiFERON-TB Gold 검사는 TST에 비하여 민감도가 매우 낮아서 임상적 유용성이 불확실하며 더 많은 연구가 필요하다.

• Tuberculosis and Respiratory Diseases
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• 제83권4호
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• pp.283-288
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• 2020

Background: Latent tuberculosis (TB) infection among TB contacts is diagnosed using plain chest radiography and interferon-gamma release assays (IGRAs). However, plain chest radiographs often miss active TB, and the results of IGRA could fluctuate over time. The purpose of this study was to elucidate changes in the results of the serial IGRAs and in the findings of the serial submillisievert chest computed tomography (CT) scans among the close contacts of active pulmonary TB patients. Methods: Patients age 20 or older with active pulmonary TB and their close contacts were invited to participate in this study. Two types of IGRA (QuantiFERON-TB Gold In-Tube assay [QFT-GIT] and the T-SPOT.TB test [T-SPOT]) and submillisievert chest CT scanning were performed at baseline and at 3 and 12 months after enrollment. Results: In total, 19 close contacts participated in this study. One was diagnosed with active pulmonary TB and was excluded from further analysis. At baseline, four of 18 contacts (22.2%) showed positive results for QFT-GIT and T-SPOT; there were no discordant results. During the follow-up, transient and permanent positive or negative conversions and discordant results between the two types of IGRAs were observed in some patients. Among the 17 contacts who underwent submillisievert chest CT scanning, calcified nodules were identified in seven (41.2%), noncalcified nodules in 14 (82.4%), and bronchiectasis in four (23.5%). Some nodules disappeared over time. Conclusion: The results of the QFT-GIT and T-SPOT assays and the CT images may change during 1 year of observation of close contacts of the active TB patients.

• 한국콘텐츠학회논문지
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• 제18권5호
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• pp.432-445
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• 2018

예비보건의료인들을 포함한 보건 의료인들은 결핵에 노출될 위험이 상대적으로 높기 때문에 이들이 적절한 수준의 지식과 예방행위를 구비하는 것이 중요하다. 예비보건의료인들을 위한 결핵 교육 모형을 구축함에 있어서 문헌고찰을 실시함과 동시에 129명의 예비 보건 의료인과 14인의 의료인들을 대상으로 설문조사와 전화 인터뷰를 실시하였다. 그 결과는 다음과 같다.; 첫째, 문헌 고찰에 근거하여 결핵의 역학, 결핵의 전파 및 병태생리, 검사와 진단, 잠복결핵, 결핵의 치료, 그리고 결핵의 예방 등을 포함한 총 6개의 교육 주제가 파악되었다. 둘째, 예비보건의료인들은 결핵의 역학, 전파 및 병태생리, 잠복결핵 분야에 대해 상대적으로 낮은 지식수준을 보였다. 그러므로 교육과정을 계획할 때, 이러한 지식이 낮은 영역에 더 많은 시간이 할애되어야 할 것이다. 셋째, 의료인들은 결핵역학 교육 시, 결핵의 정의와 유형이 잘 포함되어야 한다고 강조하였으며, 결핵의 전파와 병태생리를 교육할 때에는 병원감염과 감염회로에 관한 내용이 포함되어야 된다고 답변하였다. 이에 덧붙여, 의료인들은 결핵의 진단과 집단검진을 강조하였으며, 잠복결핵 교육 시에는 개인보호장구 착용에 관한 내용이 포함되어야 한다고 반응하였다. 또한, 결핵의 치료에 대한 교육 시, 환자 교육 및 결핵약의 부작용에 대한 내용이 포함되어야 하며, 덧붙여 예비보건의료인들의 자기건강증진 행위 및 체계적인 결핵 교육이 결핵 예방의 중요한 수단이라고 정의하였다. 이러한 결과는 제한된 수의 응답자들과 표집 오차를 포함하고 있기에 결과를 일반화하는데 신중을 기해야 한다. 그러므로 더 큰 연구집단을 이용한 후속 연구를 통해 결핵 교육 모형을 개발하는 것이 필요하다.

• Tuberculosis and Respiratory Diseases
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• 제67권5호
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• pp.454-457
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• 2009

Infliximab, a TNF-${\alpha}$ antagonist, has been used to treat refractory rheumatoid arthritis, ankylosing spondylitis, Crohn's disease and Behcet's disease. Tuberculosis (TB) is a well-known opportunistic infection in patients receiving infliximab. Therefore, patients should be screened and treated for latent or active TB infection before being administered infliximab. Recently, we encountered a case of military TB during infliximab therapy in a patient suffering from Behcet's disease and uveitis. We report this case with a review of the relevant literature.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.349-355
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• 2015

Background: The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. Methods: The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. Results: The mean duration of follow-up was $3.9{\pm}0.9years$. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ ${\geq}$ 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). Conclusion: Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.