Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia
Delay in diagnosis of pulmonary tuberculosis increases the risk of pulmonary cavitation in pastoralist setting of Ethiopia
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DOI：
10.1186/s12890-019-0971-y
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发表时间：
2019-11-06
影响因子：
3.1
通讯作者：
Seyoum, Berhanu
中科院分区：
文献类型：
--
作者：
Getnet, Fentabil;Demissie, Meaza;Seyoum, Berhanu
背景肺结核（PTB）的诊断和治疗延误会导致严重的疾病、不良后果和传播增加。在受结核病影响的环境中，评估延迟程度及其对疾病进展的影响具有临床和规划意义。因此，本研究的目的是调查埃塞俄比亚索马里牧区诊断时延迟对患者传染性（空化和涂片阳性）的可能影响。方法于2017年12月至2018年10月进行横断面研究，在5家医院招募434例年龄bb0 = 15岁的新发和确诊肺结核患者。通过访谈、记录回顾、人体测量、抗酸杆菌和胸部x线摄影技术收集资料。采用对数二项回归模型揭示延迟与空化和涂片阳性相关因素的相关性，采用ROC曲线确定判别能力和阈值延迟。结果患者中位年龄为30岁。男性占62.9%，牧民占46.5%。中位诊断延迟为49天（IQR = 33-70）。空化与诊断延迟显著相关[P < 0.001]；在30天内确诊的患者中占22.2%，在30天以上确诊的患者中占51.7%。优化空化的阈值延迟为43天[AUC (95% CI) = 0.67(0.62-0.72)]。延迟超过49天的患者涂片阳性明显增加[p = 0.02]。与空化有关的其他因素是年龄
Background Delay in diagnosis and treatment of pulmonary tuberculosis (PTB) leads to severe disease, adverse outcomes and increased transmission. Assessing the extent of delay and its effect on disease progression in TB affected settings has clinical and programmatic importance. Hence, the aim of this study was to investigate the possible effect of delay on infectiousness (cavitation and smear positivity) of patients at diagnosis in Somali pastoralist area, Ethiopia. Methods A cross-sectional study was conducted between December 2017 and October 2018, and 434 newly coming and confirmed PTB patients aged >= 15 years were recruited in five facilities. Data were collected using interview, record-review, anthropometry, Acid-fast bacilli and chest radiography techniques. Log-binomial regression models were used to reveal the association of delay and other factors associated with cavitation and smear positivity, and ROC Curve was used to determine discriminative ability and threshold delays. Results Median age of patients was 30 years. Of all, 62.9% were males, and 46.5% were pastoralists. Median diagnosis delay was 49 days (IQR = 33-70). Cavitation was significantly associated with diagnosis delay [P < 0.001]; 22.2% among patients diagnosed within 30 days of illness and 51.7% if delay was over 30 days. The threshold delay that optimizes cavitation was 43 days [AUC (95% CI) = 0.67(0.62-0.72)]. Smear positivity was significantly increased in patients delayed over 49 days [p = 0.02]. Other factors associated with cavitation were age