Exhaled Mycobacterium tuberculosis predicts incident infection in household contacts
Exhaled Mycobacterium tuberculosis predicts incident infection in household contacts
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呼出的结核分枝杆菌可预测家庭接触者的感染事件
DOI：
10.1101/2021.11.06.21266008
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Williams C
中科院分区：
文献类型：
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作者：
Williams C
背景通过早期识别感染个体来阻止结核分枝杆菌（Mtb）的传播是根除结核病的关键。在这里，我们评估口罩采样作为一种工具，用于分层肺结核（PTB）个体对其家庭接触者的感染风险。方法冈比亚46例痰阳性肺结核患者（2016年8月- 2017年11月）同意在开始治疗前进行面罩取样。在他们的217名家庭接触者中，有181人在指标诊断后6个月被定义为QuantiFERON转换或干扰素γ增加≥1 IU/mL。采用多水平混合效应logistic回归分析和家庭聚类调整来确定事件感染的预测因子。结果91%的PTB掩膜标本中检出smtb， IS6110拷贝变异较大（5.3 × 102 ~ 1.2 × 107）。在45%的病例中观察到高maskmtb水平（≥20,000 IS6110拷贝），与低maskmtb水平阳性/阴性的病例相比，与接触者感染mtb事件的可能性增加独立相关（校正优势比为3.20[95%置信区间，1.26-8.12]；P= 0.01）。与痰杆菌载量、胸片特征或睡眠距离相比，maskmtb水平能更好地预测感染发生率。结论smask取样是一种敏感且无创的工具，可支持结核病高负担环境中最具传染性个体的分层。我们的方法可以更好地了解复杂环境中的社区传播。
BackgroundHalting transmission ofMycobacterium tuberculosis(Mtb) by identifying infectious individuals early is key to eradicating tuberculosis (TB). Here we evaluate face mask sampling as a tool for stratifying the infection risk of individuals with pulmonary TB (PTB) to their household contacts.MethodsForty-six sputum-positive PTB patients in The Gambia (August 2016–November 2017) consented to mask sampling prior to commencing treatment. IncidentMtbinfection was defined in 181 of their 217 household contacts as QuantiFERON conversion or an increase in interferon-γ of ≥1 IU/mL, 6 months after index diagnosis. Multilevel mixed-effects logistical regression analysis with cluster adjustment by household was used to identify predictors of incident infection.ResultsMtbwas detected in 91% of PTB mask samples with high variation in IS6110 copies (5.3 × 102to 1.2 × 107). A high maskMtblevel (≥20 000 IS6110 copies) was observed in 45% of cases and was independently associated with increased likelihood of incidentMtbinfection in contacts (adjusted odds ratio, 3.20 [95% confidence interval, 1.26–8.12];P= .01), compared with cases having low-positive/negative maskMtblevels. MaskMtblevel was a better predictor of incidentMtbinfection than sputum bacillary load, chest radiographic characteristics, or sleeping proximity.ConclusionsMask sampling offers a sensitive and noninvasive tool to support the stratification of individuals who are most infectious in high-TB-burden settings. Our approach can provide better insight into community transmission in complex environments.