The prevalence of patients with undiagnosed pulmonary tuberculosis, undergoing surgery at Pelonomi Tertiary Hospital
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Date
2021-06
Authors
Botha, Anna Margaretha
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: Tuberculosis (is a significant cause of death in South Africa (resulting in a massive financial burden on the economy of the country. Delayed diagnosis is a problem in low and middle income countries and can unintentionally cause other patients and personnel exposure, especially in enclosed areas such as theatres. The short and long term consequences of occupational acquired TB affect the health care worker s physical, physiological, and financial health. This might put much strain on the health care workers themselves, their families and the health care system. Method: This was a retrospective descriptive study done in May 2020, investigating all patients over the age of thirteen years that underwent surgery at Pelonomi Tertiary Hospital for one month (from 1 November 2019 till 30 November 2019) to evaluate how many of these patients might have had active tuberculosis (known or unknown) on the day that they underwent surgery. All available laboratory TB test results of the patients were included from three months before the documented surgery date and up to three months post the surgery date. Any patient with a documented positive TB laboratory test result during this period and not on TB treatment for at least two weeks, was considered potentially infectious. Results: A total of 583 patients underwent surgery in November 2019. Of these 583 patients, 21 had a TB test done during the mentioned period, and results were captured on the Natio nal Health Laboratory Service database. Only one patient of the total 21 who was tested for tuberculosis had a positive TB test, which was done on the day of surgery. On admission, the patient presented with a lower respiratory tract infection before receiving his open L4 biopsy for possible infective spondylolysis surgery. The staff screened the patient for pulmonary TB (and an Xpert ® MTB/RIF Ultra (Xpert ® Ultra) test was done on 12/11/2019. The Xpert ® Ultra results reported on 13/11/2019 were positive and sensitive to Rifampicin, and the patient was subsequently started on treatment. On the day of surgery, the patient was assumed to only have a bacterial lower respiratory tract infection and was not managed a s a TB infected patient, and the necessary precautions were not taken, leading to exposure of the theatre staff and other patients to PTB. Conclusion: The proportion of undiagnosed TB infection under patients who were perioperatively tested was 4,8%. However, since only patients who were expected to be admitted to ICU after surgery or who had respiratory symptoms before surgery were tested for TB, this study could not determine the prevalence of TB in patients receiving surgery.
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Keywords
Dissertation (M.Med (Anaesthesiology))--University of the Free State, 2021, Drug, Emergent, Interferon, Lat, Respiratory, Tuberculin, Tuberculosis, Upper, Ultraviolet, Urgent, World