Symptom and chest radiographic screening for infectious tuberculosis prior to starting isoniazid preventive therapy: yield and proportion missed at screening
Symptom and chest radiographic screening for infectious tuberculosis prior to starting isoniazid preventive therapy: yield and proportion missed at screening
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DOI：
10.1097/01.aids.0000391018.72542.46
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发表时间：
2010-11-01
期刊：
影响因子：
3.8
通讯作者：
Grant, Alison D.
中科院分区：
文献类型：
--
作者：
Churchyard, Gavin J.;Fielding, Katherine L.;Grant, Alison D.
目的：该分析描述了异烟肼预防性治疗（IPT）前筛查时结核病的患病率和风险因素;使用胸部X线摄影与单纯症状相比结核病的额外产量，以及筛查遗漏的结核病风险因素。设计：南非金矿社区范围IPT试验的横断面分析。方法：在开始IPT之前，使用症状（咳嗽>2周，体重减轻，盗汗）和胸部X线检查对参与者进行肺结核筛查。结核病嫌疑人收集痰液进行分枝杆菌调查。那些涂片阳性或培养无结核分枝杆菌鉴定的物种或文化分别被归类为有可能或明确的结核病。在参与者分发IPT，我们定义了一个'错过'的情况下，活动性肺结核的一个确定在90天内的登记screen.Results：2006年7月至2008年12月，在23 286名参与者的完整数据，未确诊的结核病[明确（284）和可能（31）]的患病率很高（315/23 286; 1.4%）。在症状筛查中增加胸部X线检查，使确诊结核病例增加了2.5倍（113例至281例）。在19609名正确筛查结核病并开始IPT并随访超过90天的患者中，只有39例（0.2%）活动性结核病病例被遗漏。筛查漏诊的结核病风险因素包括年龄增加[校正比值比（aOR）1.66/10岁增加，95%置信区间（CI）1.07-2.56]，非南非人，HIV护理（aOR 4.80，95% CI 1.63-14.1），体重较低（aOR 2.07/10 kg降低，95% CI 1.23-3.49）和饮酒结论：IPT前的结核病筛查可检出结核病的严重负担，漏诊率极低。胸部X线摄影显着提高了结核病病例的检出率。(C)2010年Wolters Kluwer Health竖条Lippincott威廉姆斯&威尔金斯
Objective: This analysis describes the prevalence of and risk factors for tuberculosis at screening prior to isoniazid preventive therapy (IPT); the additional yield of tuberculosis using chest radiography versus symptoms alone, and risk factors for tuberculosis missed by screening.Design: Cross-sectional analysis of a trial of community-wide IPT in South African gold mines.Methods: Participants were screened for tuberculosis prior to starting IPT using symptoms (cough >2 weeks, weight loss, night sweats) and chest radiography. Tuberculosis suspects had sputum collected for mycobacterial investigations. Those with a positive smear or culture with no speciation or culture identified as Mycobacterium tuberculosis were classified as having probable or definite tuberculosis, respectively. Among participants who were dispensed IPT, we defined a 'missed' case of active tuberculosis as one identified within 90 days of the enrolment screen.Results: Between July 2006 and December 2008, among 23 286 participants with complete data, the prevalence of undiagnosed tuberculosis [definite (284) and probable (31)] was high (315/23 286; 1.4%). The addition of chest radiography to symptom screening increased the number of definite tuberculosis cases detected by 2.5-fold (113 to 281 cases). Among 19 609 individuals correctly screened for tuberculosis who started IPT and had more than 90 days of follow-up, only 39 (0.2%) active tuberculosis cases were missed. Risk factors for tuberculosis missed by screening included increasing age [adjusted odds ratio (aOR) 1.66/10 year increase, 95% confidence interval (CI) 1.07-2.56], non-South African, in HIV care (aOR4.80, 95% CI 1.63-14.1), lower weight (aOR 2.07/10 kg decrease, 95% CI 1.23-3.49) and alcohol use (aOR2.52, 95% CI 1.31-4.86), which were similar to risk factors for tuberculosis detected by screening.Conclusion: Tuberculosis screening prior to IPT detects a substantial burden of tuberculosis and misses very few cases. Chest radiography significantly increased the yield of tuberculosis cases detected. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins