Transmission of Mycobacterium tuberculosis From Patients Who Are Nucleic Acid Amplification Test Negative
Transmission of Mycobacterium tuberculosis From Patients Who Are Nucleic Acid Amplification Test Negative
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DOI：
10.1093/cid/ciy365
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发表时间：
2018-12-01
影响因子：
11.8
通讯作者：
Dorman, Susan E.
中科院分区：
文献类型：
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作者：
Xie, Yingda L.;Cronin, Wendy A.;Dorman, Susan E.
背景资料。在有肺结核(TB)症状和体征的成年人中，认识到传染性结核病对空气传播感染隔离和公共卫生活动具有影响。痰涂片阴性的结核病患者约占结核病传播的五分之一。呼吸道标本核酸扩增试验(NAAT)结果为阴性的结核病患者的结核病传播风险尚未确定。我们试图评估NAAT阴性结核病患者的结核病传播风险。方法：我们回顾了2004年至2009年马里兰州结核病项目收集的数据，在此期间，常规进行了使用结核分枝杆菌直接检测(MTD)的NAAT。具有匹配基因型别的痰结核分枝杆菌(M.TB)分离株的患者被归类为聚类群。传播顺序由个体首次培养阳性标本的收集顺序近似。结果：在809例培养确诊的结核病患者中，782例(96.7%)存在结核分枝杆菌基因。对于NAA阴性的结核病患者，最小传播风险估计为5.1%(95%可信区间0-11.4)。对于涂阳肺结核患者，最小传播风险估计为11.2%(95%可信区间为7.2~15.3)。结论：NAAT阴性肺结核患者的最小传播风险低于涂阳肺结核患者。然而，NAA阴性结核病患者的传播风险似乎不可忽视。
Background. Among adults with signs and symptoms of pulmonary tuberculosis (TB), recognition of transmissible TB has implications for airborne infection isolation and public health activities. Sputum smear-negative TB patients account for around one-fifth of tuberculosis transmission. The tuberculosis transmission risk of TB patients with negative results on nucleic acid amplification test (NAAT) of respiratory specimens has not been established. We sought to estimate the tuberculosis transmission risk of NAAT-negative TB patients.Methods: We retrospectively reviewed Maryland TB program data collected from 2004 to 2009, during which time NAAT using the Mycobacterium Tuberculosis Direct Test (MTD) was performed routinely. Patients with sputum Mycobacterium tuberculosis (M. tb) isolates having matching genotypes were assigned to clusters. Transmission sequence was approximated by collection order of individuals' first culture-positive specimens. Minimum transmission risks of NAAT (MTD)-negative TB patients and of smear-negative TB patients were estimated based on individuals' positions within clusters.Results: Among 809 patients with culture-confirmed TB, M. tb genotypes were available for 782 (96.7%). For NAA-negative TB patients, the minimum transmission risk estimate was 5.1% (95% CI 0-11.4). For smear-negative TB patients, the minimum transmission risk estimate was 11.2% (95% CI 7.2-15.3).Conclusions: Minimum transmission risk of NAAT-negative TB patients was lower than that of smear-negative TB patients. However, transmission risk of NAA-negative TB patients appears to not be negligible.