Infectious and clinical tuberculosis trajectories: Bayesian modeling with case finding implications.
Infectious and clinical tuberculosis trajectories: Bayesian modeling with case finding implications.
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感染和临床结核病轨迹：贝叶斯模型与病例发现的影响。
DOI：
10.1073/pnas.2211045119
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发表时间：
2022-12-27
影响因子：
11.1
通讯作者：
中科院分区：
文献类型：
--
作者：
高达四分之一的结核病患者缺乏临床症状，但痰涂片显微镜检查的细菌负荷足够高。大多数目前的大规模筛查计划侧重于症状，并没有发现亚临床，涂阳结核病;然而，我们发现，这种形式的结核病有助于未来的传播。因此，用诊断方法取代症状筛查，在低资源环境中切实筛查最具传染性的结核病形式，可以提高结核病活动性病例发现的影响和效率。在结核病诊断研究和开发工作中，应更加优先考虑开发灵敏度目标宽松但快速、便携和成本目标雄心勃勃的检测方法（专为广泛筛查而设计）。发现未确诊结核病（TB）患者的重要性取决于他们未来的疾病轨迹。应优化系统筛查的检测方法，以发现那些结核病对未来传播或发病的贡献最大的人。在这项研究中，我们构建了一个数学模型，跟踪结核病患者在横截面时间点（“基线”）的未来轨迹，并根据细菌负荷（涂片阳性/阴性）和症状状态（症状性/亚临床）对其进行分类。我们使用贝叶斯方法来校准该模型，以从五个国家的历史生存数据和通知，死亡率和患病率数据中获得目标。我们将由此产生的疾病轨迹与传染性证据相结合，以估计每个基线结核状态对未来传播的贡献。对于基线时痰涂片阴性的亚临床结核病患者，预期的疾病未来持续时间较短（平均4.8 [95%不确定性区间3.3至8.4]个月）;几乎所有的疾病过程都以自发消退而非治疗结束。相比之下，基线涂片阳性亚临床结核病患者的未诊断疾病持续时间更长（15.9 [11.1至23.5]个月）;几乎所有人最终都出现症状并以治疗或死亡告终。尽管仅占流行疾病的11%至19%，但涂阳亚临床结核占未来传播的35%至51%，比有症状或涂阴结核的贡献更大。具有高细菌负荷的亚临床结核病在未来传播中占不成比例的份额。应优先考虑开发廉价、易于使用的检测方法，用于大规模筛查有症状和无症状的个体，类似于其他疾病的快速抗原检测，即使这些检测方法缺乏检测少杆菌病的灵敏度。
Up to a quarter of people with prevalent tuberculosis (TB) lack clinical symptoms yet have sufficiently high bacterial burden for detection by sputum smear microscopy. Most current mass screening programs focus on symptoms and do not detect subclinical, smear-positive TB; however, we find that this form of TB contributes the most to future transmission. Therefore, replacing symptom screening with diagnostics that can feasibly screen for the most infectious forms of TB in low-resource settings could improve the impact and efficiency of TB active case finding. The development of assays with relaxed targets for sensitivity but ambitious targets for rapidity, portability, and cost—designed specifically for widespread screening—should be more highly prioritized in TB diagnostic research and development efforts. The importance of finding people with undiagnosed tuberculosis (TB) hinges on their future disease trajectories. Assays for systematic screening should be optimized to find those whose TB will contribute most to future transmission or morbidity. In this study, we constructed a mathematical model that tracks the future trajectories of individuals with TB at a cross-sectional timepoint (“baseline”), classifying them by bacterial burden (smear positive/negative) and symptom status (symptomatic/subclinical). We used Bayesian methods to calibrate this model to targets derived from historical survival data and notification, mortality, and prevalence data from five countries. We combined resulting disease trajectories with evidence on infectiousness to estimate each baseline TB state’s contribution to future transmission. For a person with smear-negative subclinical TB at baseline, the expected future duration of disease was short (mean 4.8 [95% uncertainty interval 3.3 to 8.4] mo); nearly all disease courses ended in spontaneous resolution, not treatment. In contrast, people with baseline smear-positive subclinical TB had longer undiagnosed disease durations (15.9 [11.1 to 23.5] mo); nearly all eventually developed symptoms and ended in treatment or death. Despite accounting for only 11 to 19% of prevalent disease, smear-positive subclinical TB accounted for 35 to 51% of future transmission—a greater contribution than symptomatic or smear-negative TB. Subclinical TB with a high bacterial burden accounts for a disproportionate share of future transmission. Priority should be given to developing inexpensive, easy-to-use assays for screening both symptomatic and asymptomatic individuals at scale—akin to rapid antigen tests for other diseases—even if these assays lack the sensitivity to detect paucibacillary disease.
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结核病的自然病史：艾滋病毒阴性患者未经治疗的肺结核的持续时间和死亡：系统评价。
影响因子：
3.7
作者：
Tiemersma EW;van der Werf MJ;Borgdorff MW;Williams BG;Nagelkerke NJ
通讯作者：
Nagelkerke NJ
影响因子：
11.8
作者：
Tostmann, Alma;Kik, Sandra V.;van Soolingen, Dick
通讯作者：
van Soolingen, Dick
DOI：
10.5588/ijtld.21.0105
发表时间：
2021-12-01
期刊：
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
影响因子：
--
作者：
Chatterjee S;Toshniwal MN;Bhide P;Sachdeva KS;Rao R;Laurence YV;Kitson N;Cunnama L;Vassall A;Sweeney S;Baena IG
通讯作者：
Baena IG
影响因子：
10
作者：
Hernández-Garduño, E;Cook, V;FitzGerald, JM
通讯作者：
FitzGerald, JM
影响因子：
3.7
作者：
Hai Viet Nguyen;Tiemersma, Edine W.;Nhung Viet Nguyen
通讯作者：
Nhung Viet Nguyen