Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness.
Sputum Microscopy With Fluorescein Diacetate Predicts Tuberculosis Infectiousness.
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DOI：
10.1093/infdis/jix229
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发表时间：
2017-09-01
期刊：
影响因子：
--
通讯作者：
Evans CA
中科院分区：
文献类型：
--
作者：
Datta S;Sherman JM;Tovar MA;Bravard MA;Valencia T;Montoya R;Quino W;D'Arcy N;Ramos ES;Gilman RH;Evans CA
二醋酸黄绿素显微镜检查用于评估预处理的结核分枝杆菌的代谢活性。较低的结果预测更大的传染性，在传播结核病的家庭接触。二醋酸黄绿素显微镜阴性细菌可能更适合空气传播结核病，因此更具传染性。结核病患者的痰液中含有代谢活跃和不活跃的结核分枝杆菌亚群，其传染性尚不清楚。我们用荧光素二乙酸酯（FDA，评估M。结核代谢活性）来预测传染性。使用FDA显微镜、培养和抗酸显微镜对肺结核患者治疗前痰中的结核分枝杆菌进行定量。对这35例患者的209名家庭接触者进行了6年的结核病流行病学调查。FDA显微镜检查结果为阳性，中位数为119（四分位数间距[IQR]，47-386）个细菌/μL痰液，是抗酸显微镜检查阳性细菌浓度（2069 [IQR，1358-3734]个细菌/μL）的5.1%（IQR，2.4%-11%）。在随访期间，6.4%（13/209）的接触者被诊断为结核病。对于FDA显微镜检查阳性M.结核病，10%的接触者患上了结核病。这显著高于FDA显微镜检查结果高于中位数的患者接触者的2.7%（粗风险比[HR]，3.8; P = .03）。在调整了疾病严重程度、药物预防、耐药性和社会决定因素后，这种相关性保持了统计学显著性（调整后HR，3.9; P = .02）。 FDA镜检阴性的结核分枝杆菌与更大的传染性矛盾地相关。这些预处理样本中FDA显微镜检查阴性的细菌可能是一种不染色、代谢缓慢的表型，更适合于空气传播。
Fluorescein diacetate microscopy was used to assess Mycobacterium tuberculosis metabolic activity in pretreatment sputa. Lower results predicted greater infectiousness in transmitting tuberculosis to household contacts. Fluorescein diacetate microscopy–negative bacteria may be better adapted to airborne tuberculosis transmission and consequently more contagious. Sputum from patients with tuberculosis contains subpopulations of metabolically active and inactive Mycobacterium tuberculosis with unknown implications for infectiousness. We assessed sputum microscopy with fluorescein diacetate (FDA, evaluating M. tuberculosis metabolic activity) for predicting infectiousness. Mycobacterium tuberculosis was quantified in pretreatment sputum of patients with pulmonary tuberculosis using FDA microscopy, culture, and acid-fast microscopy. These 35 patients’ 209 household contacts were followed with prevalence surveys for tuberculosis disease for 6 years. FDA microscopy was positive for a median of 119 (interquartile range [IQR], 47–386) bacteria/µL sputum, which was 5.1% (IQR, 2.4%–11%) the concentration of acid-fast microscopy–positive bacteria (2069 [IQR, 1358–3734] bacteria/μL). Tuberculosis was diagnosed during follow-up in 6.4% (13/209) of contacts. For patients with lower than median concentration of FDA microscopy–positive M. tuberculosis, 10% of their contacts developed tuberculosis. This was significantly more than 2.7% of the contacts of patients with higher than median FDA microscopy results (crude hazard ratio [HR], 3.8; P = .03). This association maintained statistical significance after adjusting for disease severity, chemoprophylaxis, drug resistance, and social determinants (adjusted HR, 3.9; P = .02). Mycobacterium tuberculosis that was FDA microscopy negative was paradoxically associated with greater infectiousness. FDA microscopy–negative bacteria in these pretreatment samples may be a nonstaining, slowly metabolizing phenotype better adapted to airborne transmission.
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DOI：
10.1016/s0732-8893(03)00138-x
发表时间：
2003-11-01
影响因子：
2.9
作者：
Burdz, TVN;Wolfe, J;Kabani, A
通讯作者：
Kabani, A
影响因子：
6.4
作者：
Brooks-Pollock, Ellen;Becerra, Mercedes C.;Murray, Megan B.
通讯作者：
Murray, Megan B.
影响因子：
3.2
作者：
MEDZON, EL;BRADY, ML
通讯作者：
BRADY, ML
影响因子：
2.3
作者：
Ashiru, Olubisi T.;Pillay, Manormoney;Sturm, A. Willem
通讯作者：
Sturm, A. Willem
DOI：
10.4269/ajtmh.2009.08-0627
发表时间：
2009-12
期刊：
The American journal of tropical medicine and hygiene
影响因子：
--
作者：
Ford CM;Bayer AM;Gilman RH;Onifade D;Acosta C;Cabrera L;Vidal C;Evans CA
通讯作者：
Evans CA