Padayatchi N., Daftary A., Moodley T., Madansein R., Ramjee A.
Centre for AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Department of Community Health, Nelson R Mandela School of Medicine, Durban, South Africa; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Cardio-Thoracic Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; King George V Hospital, Durban, South Africa
Padayatchi, N., Centre for AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa, Department of Community Health, Nelson R Mandela School of Medicine, Durban, South Africa; Daftary, A., Centre for AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Moodley, T., Centre for AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; Madansein, R., Department of Cardio-Thoracic Surgery, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; Ramjee, A., King George V Hospital, Durban, South Africa
BACKGROUND: Health care workers (HCWs) are at greater risk for tuberculosis (TB), including multidrugresistant TB (MDR-TB), compared to the general population. The psychosocial impact of nosocomial TB on HCWs has received little attention in the literature. METHODS: A retrospective medical record review from 1999 to 2003 found 15 HCWs who were treated for drug-resistant TB at a specialist hospital in South Africa. Five human immunodeficiency virus (HIV) negative doctors with no predisposing factors for drug resistance are included in this case series. We collectively present their clinical case histories based on medical records from 2000 to 2005, and explore the long-term psychosocial impact of TB from interviews conducted in 2009. RESULTS: Four doctors had primary MDR-TB and one had primary resistance to multiple first-line drugs. Time from symptom onset to commencement of effective treatment ranged from 8 to 39 weeks. Time for bacteriological confirmation of drug-resistant TB ranged from 6 to 24 weeks. All were cured within 3 years of initial presentation. Content analysis of follow-up interviews revealed five main themes: 1) prolonged morbidity, 2) psychological impact, 3) poor infection control, 4) weak support structures and 5) attrition from the field. CONCLUSION: Themes emergent from this case series encourage prioritisation of TB infection control education and practice to minimise HCW morbidity and prevent HCW attrition from high-burden resource-constrained settings. © 2010 The Union.
amikacin; clarithromycin; cycloserine; dexamethasone; ethambutol; ethionamide; isoniazid; ofloxacin; prednisone; pyrazinamide; rifampicin; streptomycin; terizidone; valproic acid; tuberculostatic agent; adult; antibiotic therapy; anxiety; article; bladder dysfunction; case study; clinical article; clinical effectiveness; controlled study; depression; disease predisposition; drug resistant tuberculosis; female; follow up; human; Human immunodeficiency virus infection; infection control; insomnia; interview; limb pain; limb weakness; male; medical record review; medical specialist; morbidity; multidrug resistant tuberculosis; muscle spasm; nausea; otosclerosis; panic; physician; priority journal; pruritus; psychological aspect; retrospective study; sensory neuropathy; shoulder pain; side effect; small intestine disease; social aspect; South Africa; tinnitus; tuberculous meningitis; antibiotic resistance; attitude to health; comparative study; complication; disease transmission; incidence; Mental Disorders; multidrug resistant tuberculosis; physician; prevention and control; prognosis; psychology; questionnaire; risk factor; serodiagnosis; time; transmission; Adult; Antitubercular Agents; Attitude to Health; Drug Resistance, Bacterial; Female; Follow-Up Studies; HIV Seronegativity; Humans; Incidence; Infectious Disease Transmission, Patient-to-Professional; Male; Mental Disorders; Physicians; Prognosis; Questionnaires; Retrospective Studies; Risk Factors; South Africa; Time Factors; Tuberculosis, Multidrug-Resistant; Adult; Antitubercular Agents; Attitude to Health; Drug Resistance, Bacterial; Female; Follow-Up Studies; HIV Seronegativity; Humans; Incidence; Infectious Disease Transmission, Patient-to-Professional; Male; Mental Disorders; Physicians; Prognosis; Questionnaires; Retrospective Studies; Risk Factors; South Africa; Time Factors; Tuberculosis, Multidrug-Resistant