Zusammenfassung:
Die vorliegende Arbeit untersucht die Prävalenz der Tuberkulose-Infektion in einem
pneumologischen Patientenkollektiv eines innerstädtischen Akutkrankenhauses mittels
intrakutanem Tuberkulintest nach Mendel-Mantoux (MM5-Test). Die Interpretation des
MM5-Testes erfolgte nach den Richtlinien der American Thoracic Society und des Centers
for Disease Control nach der Größe der Induration in Millimetern und dem individuellen
Risikoprofil der Patienten.
Insgesamt hatten 252 der 697 untersuchten Patienten eine Tuberkuloseinfektion (36,2
%), dabei waren 55 der 697 Patienten (7,9 %) an einer aktiven Tuberkulose erkrankt
oder hatten eine alte Tuberkulose in der Vorgeschichte. 30,7 % (197/642) der Untersuchten
mit einer anderen Diagnose als Tuberkulose (COPD, Pneumonie, Malignom, Sonstige) wiesen
einen positiven MM5-Test auf. Die Sensitivität des MM5-Testes für die akute Tuberkulose-Erkrankung
beträgt in dieser Untersuchung 95 %.
Die Studie zeigt eine hohe Prävalenz der Tuberkulose-Infektion in einem pneumologischen,
hospitalisierten Patientenkollektiv. Der intrakutane Tuberkulintest stellt aktuell
den diagnostischen Standard zur Identifizierung einer latenten Tuberkuloseinfektion
dar, daher ist der Nutzen einer Tuberkulin-Screening-Untersuchung bei Patienten, die
einer Risikogruppe mit erhöhter Tuberkulose-Prävalenz angehören, in der Literatur
unumstritten. Weitere Untersuchungen sind sinnvoll, um den Nutzen eines routinemäßig
durchgeführten Tuberkulin-Screenings bei stationären pneumologischen Patienten zu
ermitteln.
Intracutaneous Tuberculin Skin Testing Using the Mantoux Technique: Tuberculin Reactivity
Among Hospitalized Patients in a Pneumological Department:
Detection of latent tuberculosis infection is an important step in the control of
tuberculosis. The tuberculin skin test is the only proven method for identifying tuberculosis
infection in patients who do not have tuberculosis disease. The prevalence of tuberculosis
infection among hospitalized patients in a pneumological department of an inner-city
hospital was evaluated, using the intradermal tuberculin skin test (Mantoux technique).
Interpretation of the Mantoux test was based on the size of induration in millimeters
and the individual risk profile of the patients, according to the guidelines of the
American Thoracic Society and the Centers for Disease Control, revised in 1989. Of
697 tested patients, 252 showed test results consistent with tuberculosis infection
(36,2 %). 55 of these 697 patients had active tuberculosis disease or a prior history
of tuberculosis (7,9 %). A positive tuberculin skin test was found in 197 of 642 patients
(30,7 %) with a diagnosis different from tuberculosis (COPD, pneumonia, cancer and
others). In our study, the sensitivity of the tuberculin skin test for active tuberculosis
infection was 95 %. The present study revealed a high prevalence of tuberculosis infection
among hospitalized patients in a pneumological department. Further studies are needed
to assess the usefulness of routine tuberculin skin testing in hospitalized populations.
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1 Herrn Prof. Dr. med. Heinrich Matthys zum 65. Geburtstag gewidmet
Priv.-Doz. Dr. med C St Kortsik
Pneumologische Abteilung St. Hildegardis-Krankenhaus
Hildegardstr. 2 55131 Mainz
