Recurrence of tuberculosis in a low-incidence setting
Recurrence of tuberculosis in a low-incidence setting
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DOI：
10.1183/09031936.00104108
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发表时间：
2009-01-01
影响因子：
24.3
通讯作者：
Marks, G. B.
中科院分区：
文献类型：
--
作者：
Dobler, C. C.;Crawford, A. B. H.;Marks, G. B.
活动性肺结核治疗后的初始疾病发作复发可能是由于内源性再激活或外源性再infection.Cases复发肺结核在澳大利亚新南威尔士州1994年至2006年之间确定的数据关联分析与病例说明的验证性审查。纳入了在该时间段内发生1次以上培养阳性疾病发作且已完成初始疾病发作治疗的患者。结核分枝杆菌的基因分型被用来确定复发是否可能是由于再激活或再感染。1994年至2006年期间有5,723例结核病报告，其中3,731例培养阳性。在平均5.7年的随访中，15例（0.4%）患者复发了培养阳性疾病（粗年发病率为每100，000人中71例）。结核病复发归因于11例（73%）病例的再激活（无法区分的菌株）和4例（27%）病例的再感染（不同菌株）。在结核病的低发病率环境中，一个控制方案，包括直接观察治疗活动性疾病，导致在一个非常低的复发率结核病在一个长期的后续行动。再感染的可能性小于再激活，但仍显著增加了疾病复发病例的数量。
Recurrence of active tuberculosis following treatment of an initial disease episode can occur due to endogenous re-activation or exogenous re-infection.Cases of recurrent tuberculosis in the Australian state of New South Wales between 1994 and 2006 were identified by data linkage analysis with confirmatory review of case notes. Patients with more than one culture-positive disease episode during that time period who had completed treatment for the initial disease episode were included. Genotyping of Mycobacterium tuberculosis was used to determine whether recurrence was likely to be due to re-activation or re-infection.There were 5,723 tuberculosis notifications between 1994 and 2006, 3,731 of which were culture-positive. Fifteen (0.4%) patients had recurrent culture-positive disease over a mean 5.7 yrs of follow-up (crude annual incidence 71 per 100,000 population). Recurrent tuberculosis was attributable to re-activation (indistinguishable strains) in 11 (73%) cases and to re-infection (different strains) in four (27%).In a low-incidence setting of tuberculosis, a control programme incorporating directly observed therapy for active disease resulted in a very low rate of recurrent tuberculosis over a long period of follow-up. Re-infection is less likely than re-activation, but still contributes significantly to the number of cases with recurrent disease.