Epidemiology of Culture-Negative Pulmonary Tuberculosis-Alameda County, 2010-2019.
Epidemiology of Culture-Negative Pulmonary Tuberculosis-Alameda County, 2010-2019.
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培养阴性肺结核流行病学 - 阿拉米达县，2010-2019 年。
DOI：
10.1097/phh.0000000000001715
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Chitnis,AmitS
中科院分区：
文献类型：
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作者：
Chen,Jennie;Marusinec,Rachel;Brown,Robert;Shiau,Rita;Jaganath,Devan;Chitnis,AmitS
目的：描述培养阴性 PTB 的流行病学。设计、背景、参与者：我们利用 2010 年至 2019 年阿拉米达县结核病监测数据。培养阴性 PTB 病例符合美国国家结核病监测系统定义的 PTB 临床标准，但不符合实验室标准。我们分别使用泊松和加权线性回归计算了培养阴性 PTB 的年发病率和比例趋势。我们进一步比较了培养阴性与培养阳性 PTB 病例的人口统计学和临床特征。结果：2010-2019 年间，共有 870 例 PTB 病例，其中 152 例（17%）培养阴性。培养阴性PTB的发生率下降了76%，从1.9/10万下降到0.46/10万（趋势P<.01），而培养阳性PTB的发生率下降了37%（6.5/10万下降到4.1/10万，趋势P=.1）。培养阴性的 PTB 病例比培养阳性的 PTB 病例患者更年轻（7.9% 为< 15 岁儿童 vs 1.1%；P<.01），是抵达后 5 年内的新移民（38.2% vs 25.5%；P<.01），并且有结核病接触史（11.2% vs 2.9%；P<.01）。培养阴性 PTB 病例患者比培养阳性 PTB 病例患者因结核症状（57.2% vs 74.7%；P<. 01）或胸部影像学检查出现空洞（13.1% vs 38.8%；P<. 01）而接受评估的可能性较小。同时，培养阴性的 PTB 病例患者在结核病治疗期间死亡的可能性较低（2.0% vs 9.6%；P <. 01）。结论：与培养阳性的 TB 相比，培养阴性的 PTB 发病率下降得不成比例，并引发了对检测差距的担忧。扩大对新移民和结核病接触者的筛查计划以及对危险因素的更多认识可能会增加培养阴性肺结核的检出率。
Objective:Describe epidemiology of culture-negative PTB.Design, Setting, Participants:We utilized Alameda County TB surveillance data from 2010 to 2019. Culture-negative PTB cases met clinical but not laboratory criteria for PTB per US National Tuberculosis Surveillance System definitions. We calculated trends in annual incidence and proportion of culture-negative PTB using Poisson and weighted linear regression, respectively. We further compared demographic and clinical characteristics among culture-negative versus culture-positive PTB cases.Results:During 2010-2019, there were 870 cases of PTB, of which 152 (17%) were culture-negative. The incidence of culture-negative PTB declined by 76%, from 1.9/100 000 to 0.46/100 000 (P for trend<. 01), while the incidence of culture-positive PTB reduced by 37%(6.5/100 000 to 4.1/100 000, P for trend=. 1). Culture-negative PTB case-patients were more likely than culture-positive PTB case-patients to be younger (7.9% were children< 15 years old vs 1.1%; P<. 01), recent immigrants within 5 years of arrival (38.2% vs 25.5%; P<. 01), and have a TB contact (11.2% vs 2.9%; P<. 01). Culture-negative PTB case-patients were less likely than culture-positive PTB case-patients to be evaluated because of TB symptoms (57.2% vs 74.7%; P<. 01) or have cavitation on chest imaging (13.1% vs 38.8%; P<. 01). At the same time culture-negative PTB case-patients were less likely to die during TB treatment (2.0% vs 9.6%; P<. 01).Conclusions:The incidence of culture-negative PTB disproportionately declined compared with culture-positive TB and raises concern for gaps in detection. Expansion of screening programs for recent immigrants and TB contacts and greater recognition of risk factors may increase detection of culture-negative PTB.