Tuberculosis Infection among Young Nursing Trainees in South India

Background

Among healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.

Methodology/Principal Findings

Among 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). A majority (95%) were females, and almost 80% were under 22 years of age. Detailed TB exposure information was obtained using interviews and clinical log books. Prevalence of latent TB infection (LTBI) was estimated using Bayesian latent class analyses (LCA). Logistic regression analyses were done to determine the association between LTBI prevalence and TB exposure and risk factors. 219 of 436 students (50.2%, 95% CI: 45.4–55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare.

Conclusions

Our study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions.     

Tuberculosis and Alcoholism

Of 227 chronic alcoholics studied in jail, 20 (9%) had a previous diagnosis of tuberculosis. The chest radiographs of 202 of these inmates were compared with those of 187 inmates serving sentences for other offences. Significant findings compatible with tuberculosis were noted in 34 of 202 (16.8%) chronic alcoholics and in two of 187 (1.1%) other offenders. Tuberculin testing of 98 inmates revealed that 80.6% of the chronic alcoholics and 33.3% of the other offenders had positive skin tests. It is suggested that the mixing in jail of a potentially highly infectious group with susceptible individuals is undesirable and that other methods of management should be considered.     

Psychiatry and Tuberculosis

Studies on the psychosomatic aspects of tuberculosis have not brought to light a clearcut correlation between a specific personality structure and susceptibility to the illness. The recommendation is made to look for several rather than for one personality type. It is suggested that people should be studied who react to stress with loss of appetite and loss of sleep. This character structure in contrast to that where the person withdraws into sleep and overeats might make a person prone to tuberculosis.The somatopsychic influence of tuberculosis needs to be interpreted in terms of the localization of the lesion as well as infectiousness and conspicuousness of the disease.Some common sociopsychological factors of tuberculosis have been mentioned. Reports on mental illness and tuberculosis and on diet were reviewed.