Transmission of tuberculosis from smear negative patients:: a molecular epidemiology study
Transmission of tuberculosis from smear negative patients:: a molecular epidemiology study
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DOI：
10.1136/thx.2003.011759
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发表时间：
2004-04-01
期刊：
影响因子：
10
通讯作者：
FitzGerald, JM
中科院分区：
文献类型：
--
作者：
Hernández-Garduño, E;Cook, V;FitzGerald, JM
工作背景：虽然涂阳肺结核患者（TB）被认为比涂阴患者更具传染性，但后者也可以传播TB。在一项对大温哥华地区791名患者的分子流行病学研究中，在评估潜在偏倚后，通过RFLP（假设参与最近的传播）估计来自两组涂片阴性聚集性患者的TB传播的发作次数。第1组（n=79）包括肺结核或肺+肺外疾病（PTB或PTB+EPTB）的患者;第2组（n=129）包括第1组中的所有患者+肺外病例单独。结果：在总样本中，平均（SD）年龄为51（21）岁，54.3%为男性，17.0%的患者聚集。与涂阴病人相比，涂阳病人更容易聚集在一起（OR=2.0，95% CI 1.1 - 3.6）和有乙醇滥用史（OR=2.7，95% CI 1.0 - 6.7），糖尿病（OR=2.8，95% CI 1.1 - 7.0），注射药物使用（OR=3.1，95% CI 1.1 - 8.3），既往住院（OR=8.5，95% CI 5.1 - 14.0）。涂阴聚集性结核病传播的比例在第1组为17.3%~ 22.2%，在第2组为25%~ 41%。结论：在大温哥华地区，涂阴结核病至少占结核菌培养阳性病例的1/6。
Background: While smear positive patients with tuberculosis (TB) are considered more infectious than smear negative patients, the latter can also transmit TB.Methods: In a molecular epidemiology study of 791 patients in the Greater Vancouver regional district, the number of episodes of TB transmission from two groups of smear negative clustered patients by RFLP (assumed to be involved in recent transmission) was estimated after assessing for potential bias. Group 1 (n=79) included patients with pulmonary TB or pulmonary + extrapulmonary disease (PTB or PTB+EPTB); group 2 (n=129) included all patients in group 1 + extrapulmonary cases alone.Results: In the total sample the mean (SD) age was 51 (21) years, 54.3% were male, and 17.0% of patients were clustered. Compared with smear negative patients, smear positive patients were more likely to be in a cluster (OR=2.0, 95% CI 1.1 to 3.6) and to have had a history of ethanol abuse (OR=2.7, 95% CI 1.0 to 6.7), diabetes mellitus (OR=2.8, 95% CI 1.1 to 7.0), injection drug use (OR=3.1, 95% CI 1.1 to 8.3), and to have had a previous hospital admission (OR=8.5, 95% CI 5.1 to 14.0). The proportion of episodes of transmission from smear negative clustered patients ranged from 17.3% to 22.2% in group 1 and from 25% to 41% in group 2.Conclusion: In Greater Vancouver, smear negative cases appear responsible for at least one sixth of culture positive episodes of TB transmission.