Limited Utility of Name-Based Tuberculosis Contact Investigations among Persons Using Illicit Drugs: Results of an Outbreak Investigation
Limited Utility of Name-Based Tuberculosis Contact Investigations among Persons Using Illicit Drugs: Results of an Outbreak Investigation
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DOI：
10.1007/s11524-009-9378-z
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发表时间：
2009-09-01
影响因子：
6.6
通讯作者：
Oeltmann, John E.
中科院分区：
文献类型：
--
作者：
Asghar, Rana Jawad;Patlan, David E.;Oeltmann, John E.
由结核病患者点名的人是传统结核病接触调查的重点。然而，使用非法药物的患者往往不愿透露接触者的名字。2004年1月至2005年5月，迈阿密报告了18例耐异烟肼结核分枝杆菌(SPOLOG型)匹配的病例；大多数患者经常光顾妓院，没有说出可能感染的接触者的名字。我们回顾了医疗记录，并重新采访了患者关于经常接触者和经常出现的地点，以描述传播模式并提出建议，以控制该人群中的结核病。观察到的接触者没有被点名，但在与患者相同的精神病院遇到。通过结核病皮肤试验(TST)评估接触者是否有潜在的结核病感染。18例患者均为肺结核。12人(67%)报告使用了可卡因，14人(78%)有任何非法药物使用。在评估的187名接触者中，91名(49%)被点名，16名(8%)参加了患者报告的教堂，61名(33%)使用了患者报告的透析中心，19名(10%)在当地的戒毒所观察到接触者。与指定的接触者相比，观察到的接触者出现TST阳性结果的可能性是指定接触者的8倍(相对风险=7.8；95%可信区间=3.8-16.1)。透析中心和教会接触者没有增加TST阳性结果的风险。对于使用非法药物或以非法药物使用为特征的频繁场所的结核病患者，检测观察到的接触者可能比传统的基于姓名的接触者调查提供更高的收益。
Persons named by a patient with tuberculosis (TB) are the focus of traditional TB contact investigations. However, patients who use illicit drugs are often reluctant to name contacts. Between January 2004 and May 2005, 18 isoniazid-resistant TB cases with matching Mycobacterium tuberculosis genotypes (spoligotypes) were reported in Miami; most patients frequented crack houses and did not name potentially infected contacts. We reviewed medical records and reinterviewed patients about contacts and locations frequented to describe transmission patterns and make recommendations to control TB in this population. Observed contacts were not named but were encountered at the same crack houses as the patients. Contacts were evaluated for latent TB infection with a tuberculosis skin test (TST). All 18 patients had pulmonary TB. Twelve (67%) reported crack use and 14 (78%) any illicit drug use. Of the 187 contacts evaluated, 91 (49%) were named, 16 (8%) attended a church reported by a patient, 61 (33%) used a dialysis center reported by a patient, and 19 (10%) were observed contacts at local crack houses. Compared to named contacts, observed contacts were eight times as likely to have positive TST results (relative risk = 7.8; 95% confidence interval = 3.8-16.1). Dialysis center and church contacts had no elevated risk of a positive TST result. Testing observed contacts may provide a higher yield than traditional name-based contact investigations for tuberculosis patients who use illicit drugs or frequent venues characterized by illicit drug use.