Avaliação da tuberculose latente e de fatores de risco para o desenvolvimento da tuberculose ativa em servidores de uma unidade prisional do Oeste Paulista

Abstract

Tuberculosis (TB) is a disease with a high prevalence in individuals associated with the prison system, such as prison staff. Exposure to Mycobacterium tuberculosis (M. tuberculosis) increases the risk of latent TB, which, associated with risk factors, increases the chance for the development of active TB. The diagnosis of latent TB is made through the tuberculin test (PPD), but it has limitations regarding its effectiveness and interpretation. Currently, IFN-γ (IGRAs) release assays have been implemented, which evaluate the response of CD4 + T and CD8 + T cells against M. tuberculosis antigens, showing better results in relation to PPD. In Brazil, there are few studies evaluating latent TB through IGRAs and their association with risk factors in prison staff, so this study aims to better understand this dynamic. Thus, the objective of the study was to evaluate latent TB and the risk factors for the development of active TB in prison unit servers. For this purpose, prison staff (n = 88) from the Junqueirópolis Penitentiary Unit were studied to assess latent TB, the QFT-TB and PPD tests were performed, for the assessment of risk factors, the KAP questionnaire was applied to TB knowledge assessment, from the DASS 21 questionnaire for mental health assessment. The participants' lipid profile was also assessed. For the evaluation of the questionnaire, the analysis of the frequencies of the variables was performed, considering the TB-latent, latent TB with risk factor and risk factor as an independent variable, and blood lipids were collected to assess the lipid profile for measurement of total cholesterol, HDL and triglycerides. Anthropometric measurements (weight, height and abdominal circumference) were also measured, abdominal fat assessment was performed by measuring waist circumference (WC) and BMI was calculated according to WHO guidelines. The agreement between results of the PPD and QFT-TB Gold tests was measured using the kappa statistic (κ), with a 95% confidence interval (CI) and for the comparison of the dependent variable categories according to the independent variable, it was used the chi-square or Fisher's test, with statistical significance for p <0.05. Of the 88 participants studied, 30 tested positive for latent TB, 57 negative and one individual was indeterminate, the agreement between the tests was performed among 80 participants, being considered weak (κ = 0.258; 95% CI = 0.040 to 0.476). Regarding TB knowledge and attitudes, most participants received information and had good attitudes, but failures were observed about TB knowledge on servers. The servers 27/88 showed some sign of depression, anxiety and stress and the participants showed changes in the lipid profile, (45.98%) with overweight. There were cases of positivity for latent TB in the study population, as well as the presence of risk factors, such as lack of knowledge about TB, mental and lipid disorders. Demonstrating the importance of implementing an educational program on TB and other health parameters, as well as carrying out a screening routine for latent TB and risk factors, such as mental health and biochemical markers, such as lipids, in order to promote occupational health of these employees, in order to avoid the spread of TB among them, the population deprived of liberty and the general population.