High resolution imaging and five-year tuberculosis contact outcomes.
High resolution imaging and five-year tuberculosis contact outcomes.
复制标题
高分辨率成像和五年结核病接触结果。
DOI：
10.1101/2023.07.03.23292111
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Esmail H
中科院分区：
文献类型：
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作者：
Esmail H
背景结核病(TB)疾病在临床潜伏期的演变仍不完全清楚。方法对250例未感染HIV的成年家庭接触者进行18F-脱氧葡萄糖正电子发射和计算机断层扫描(PET/CT)，112例患者在5~15个月后复查。按照南非和世卫组织的指导方针，参与者没有接受预防性治疗。所有参与者都进行了密集的自发基线筛查，然后是诱导痰样本，然后平均观察4.7年的培养阳性疾病。评估基线PET/CT异常与培养阳性疾病的关系。结果基线时，59名参与者(23.6%)的肺部PET/CT结果与结核病相符，其中29名(11.6%)被定义为亚临床结核病，30名(12%)亚临床非活动性结核病。83例(33.2%)合并其他肺实质异常，108例(43.2%)肺功能正常。对14例培养阳性肺结核患者进行了超过1107人年的随访。通过密集基线筛查发现了6例病例，南非基于症状的筛查战略都会漏掉所有病例，世卫组织建议的胸部X光筛查战略只发现了一例。在研究期间，与肺实质正常的患者(10/29[34.5%]比2/108[1.9%]，危险比22.37[4.89-102.47，p<；0.001])相比，那些在PET/CT上有基线亚临床结核病变的患者更有可能被诊断为培养阳性结核病。结论这些发现挑战了潜伏期/活动性结核病模式，表明亚临床疾病在微生物检测和/或症状出现之前4年就已经存在。这对结核病的筛查和管理具有重要意义。
Background The evolution of tuberculosis (TB) disease during the clinical latency period remains incompletely understood. Methods 250 HIV-uninfected, adult household contacts of rifampicin-resistant TB with a negative symptom screen underwent baseline 18F-Fluorodeoxyglucose positron emission and computed tomography (PET/CT), repeated in 112 after 5-15 months. Following South African and WHO guidelines, participants did not receive preventive therapy. All participants had intensive baseline screening with spontaneous, followed by induced, sputum sampling and were then observed for an average of 4.7 years for culture-positive disease. Baseline PET/CT abnormalities were evaluated in relation to culture-positive disease. Results At baseline, 59 (23.6%) participants had lung PET/CT findings consistent with TB of which 29 (11.6%) were defined as Subclinical TB, and 30 (12%) Subclinical TB-inactive. A further 83 (33.2%) had other lung parenchymal abnormalities and 108 (43.2%) had normal lungs. Over 1107-person years of follow-up 14 cases of culture-positive TB were diagnosed. Six cases were detected by intensive baseline screening, all would have been missed by the South African symptom-based screening strategy and only one detected by a WHO-recommended chest X-Ray screening strategy. Those with baseline Subclinical TB lesions on PET/CT were significantly more likely to be diagnosed with culture-positive TB over the study period, compared to those with normal lung parenchyma (10/29 [34.5%] vs 2/108 [1.9%], Hazard Ratio 22.37 [4.89-102.47, p<0.001]). Conclusions These findings challenge the latent/active TB paradigm demonstrating that subclinical disease exists up to 4 years prior to microbiological detection and/or symptom onset. There are important implications for screening and management of TB.