Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli
Transmission of Mycobacterium tuberculosis from patients smear-negative for acid-fast bacilli
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DOI：
10.1016/s0140-6736(98)03406-0
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发表时间：
1999-02-06
期刊：
影响因子：
168.9
通讯作者：
Small, PM
中科院分区：
文献类型：
--
作者：
Behr, MA;Warren, SA;Small, PM
背景痰液抗酸杆菌镜检是一种简单、快速的检测方法，可用于传染性结核病的初步诊断。虽然痰涂片抗酸杆菌阴性的结核病患者的传染性低于痰涂片阳性的患者，但理论和经验证据都表明，他们仍然可以传播结核分枝杆菌。我们的目的是估计从痰检阴性individual.Methods的结核病的分子流行病学在旧金山弗朗西斯科正在进行的研究的一部分，结核病患者与分枝杆菌分离株具有相同的DNA指纹被分配到集群，被认为是涉及最近的传输。结核病继发病例，其分枝杆菌分离株具有相同的DNA，与其假定的源病例相关联，以估计从涂片阴性患者的传播。进行敏感性分析，以评估潜在的偏见，由于源病例，不明来源的情况下，和HIV-1 co-infection.Findings的错误分类1574例培养阳性的结核病和DNA指纹可用于1359（86%）这些患者。在71个感染了具有匹配指纹的菌株的患者群中，28个（39% [95%CI 28-52]）具有涂片阴性的推定来源。在这71个集群中有183例继发病例，其中至少32例归因于涂片阴性患者的感染（17% [12-24]），涂片阴性与涂片阳性患者相比的相对传播率计算为0.22（95%CI 0.16-0.32）。敏感性分析和分层的HIV-1状态没有影响这些estimation.Interpretation在旧金山弗朗西斯科，抗酸杆菌涂片确定最具传染性的患者，但与涂片阴性培养阳性结核病患者出现负责约17%的结核病传播。
Background The microscopic examination of sputum for acid-fast bacilli, is a simple and rapid test that is used to provide a presumptive diagnosis of infectious tuberculosis. While patients with tuberculosis with sputum smears negative for acid-fast bacilli are less infectious than those with positive smears, both theoretical and empirical evidence suggest that they can still transmit Mycobacterium tuberculosis. We aimed to estimate the risk of transmission from smear-negative individuals.Methods As part of an ongoing study of the molecular epidemiology of tuberculosis in San Francisco, patients with tuberculosis with mycobacterial isolates with the same DNA fingerprint were assigned to clusters that were assumed to have involved recent transmission. Secondary cases with tuberculosis, whose mycobacterial isolates had the same DNA, were linked to their presumed source case to estimate transmission from smear-negative patients. Sensitivity analyses were done to assess potential bias due to misclassification of source cases, unidentified source cases, and HIV-1 co-infection.Findings 1574 patients with culture-positive tuberculosis were reported and DNA fingerprints were available for 1359 (86%) of these patients. Of the 71 clusters of patients infected with strains that had matching fingerprints, 28 (39% [95% CI 28-52]) had a smear-negative putative source. There were 183 secondary cases in these 71 clusters, of whom a minimum of 32 were attributed to infection by smear-negative patients (17% [12-24]), The relative transmission rate of smear-negative compared with smear-positive patients was calculated as 0.22 (95% CI 0.16-0.32). Sensitivity analyses and stratification for HIV-1 status had no impact on these estimates.Interpretation In San Francisco, the acid-fast-bacilli smear identifies the most infectious patients, but patients with smear-negative culture-positive tuberculosis appear responsible for about 17% of tuberculosis transmission.