Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.
Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.
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DOI：
10.1186/1471-2458-8-107
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发表时间：
2008-04-04
影响因子：
4.5
通讯作者：
Van Rie, Annelies
中科院分区：
文献类型：
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作者：
Kipp, Aaron M;Stout, Jason E;Van Rie, Annelies
背景：美国报告的肺外结核（EPTB）的比例逐渐增加。艾滋病毒感染和外国出生越来越多地与结核病相关，了解它们对结核病临床表现的影响是重要的。方法：对1993年1月1日至2006年12月31日向北卡罗莱纳州公共卫生部门报告的6124例肺结核患者进行病例对照研究。采用多变量logistic回归获得调整后的优势比，以衡量外国出生地区和美国出生种族/民族与HIV状态与EPTB的关联。结果：所有结核病患者中，EPTB 1366例（22.3%），HIV合并感染563例（9.2%），外国出生1299例（21.2%）。在HIV阴性患者中，EPTB与外国出生（调整后的OR为1.36至5.09，取决于出生地区）和美国出生的黑人/非裔美国人（OR为1.84；95% CI为1.42,2.39）相关。在HIV感染患者中，EPTB与美国出生、黑人/非裔美国人（OR 2.60; 95% CI 1.83, 3.71）和美洲出生的外国人（OR 5.12; 95% CI 2.84, 9.23）相关。结论：即使在没有HIV感染的情况下，外国出生的结核病患者也比美国出生的结核病患者更容易发生EPTB。在美国，越来越多的外国出生和艾滋病毒导致的结核病病例可能会导致EPTB的持续负担。需要进一步的研究来探索为什么EPTB的发生和类型因出生地区而异，以及宿主遗传和/或细菌变异是否可以解释EPTB的这些差异。
BACKGROUND: The proportion of extrapulmonary tuberculosis (EPTB) reported in the United States has been gradually increasing. HIV infection and foreign birth are increasingly associated with tuberculosis and understanding their effect on the clinical presentation of tuberculosis is important.METHODS: Case-control study of 6,124 persons with tuberculosis reported to the North Carolina Division of Public health from January 1, 1993 to December 31, 2006. Multivariate logistic regression was used to obtain adjusted odds ratios measuring the associations of foreign birth region and US born race/ethnicity, by HIV status, with EPTB.RESULTS: Among all patients with tuberculosis, 1,366 (22.3%) had EPTB, 563 (9.2%) were HIV co-infected, and 1,299 (21.2%) were foreign born. Among HIV negative patients, EPTB was associated with being foreign born (adjusted ORs 1.36 to 5.09, depending on region of birth) and with being US born, Black/African American (OR 1.84; 95% CI 1.42, 2.39). Among HIV infected patients, EPTB was associated with being US born, Black/African American (OR 2.60; 95% CI 1.83, 3.71) and with foreign birth in the Americas (OR 5.12; 95% CI 2.84, 9.23).CONCLUSION: Foreign born tuberculosis cases were more likely to have EPTB than US born tuberculosis cases, even in the absence of HIV infection. Increasing proportions of foreign born and HIV-attributable tuberculosis cases in the United States will likely result in a sustained burden of EPTB. Further research is needed to explore why the occurrence and type of EPTB differs by region of birth and whether host genetic and/or bacterial variation can explain these differences in EPTB.