Tuberculosis transmission by patients with smear-negative pulmonary tuberculosis in a large cohort in the Netherlands
Tuberculosis transmission by patients with smear-negative pulmonary tuberculosis in a large cohort in the Netherlands
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DOI：
10.1086/591974
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发表时间：
2008-11-01
影响因子：
11.8
通讯作者：
van Soolingen, Dick
中科院分区：
文献类型：
--
作者：
Tostmann, Alma;Kik, Sandra V.;van Soolingen, Dick
背景痰涂片显微镜检查通常用于诊断结核病（TB）。虽然痰涂片阴性结核病患者的传染性低于痰涂片阳性结核病患者，但他们也有助于结核病传播。本研究的目的是确定在荷兰由涂阴肺结核患者引起的结核病传播事件的比例。本研究纳入了1996-2004年期间荷兰所有经培养确诊的结核病患者。对痰标本中结核分枝杆菌分离株DNA指纹图谱相同的患者进行聚类分析。一个群集中的第一例患者被视为索引患者;所有其他患者被视为继发病例。此外，我们研究了传统的接触跟踪从源的传输。我们分析了394个聚类，共1285例患者。仅根据分子联系，12.6%的继发病例可归因于从痰涂片阴性结核病患者传播。与涂阳肺结核患者相比，涂阴肺结核患者的相对传播率为0.24（95%置信区间为0.20-0.30）。与痰涂片阳性结核病指标患者群中的继发病例相比，痰涂片阴性结核病指标患者群中的继发病例更常出现痰涂片阴性状态（比值比，1.86; 95%置信区间，1.18-2.93）。传统的接触者追踪显示，26（6.2%）的417个来源，由市卫生服务确定，涂阴性结核病。在荷兰，涂片阴性、培养阳性的结核病患者占结核病传播的13%。拥有充足资源的国家应扩大其结核病控制工作，包括预防痰涂片阴性、培养阳性肺结核患者的传播。
Background. Sputum smear microscopy is commonly used for diagnosing tuberculosis (TB). Although patients with sputum smear-negative TB are less infectious than patients with smear-positive TB, they also contribute to TB transmission. The objective of this study was to determine the proportion of TB transmission events caused by patients with smear-negative pulmonary TB in The Netherlands.Methods. All patients in The Netherlands with culture-confirmed TB during the period 1996-2004 were included in this study. Patients with identical DNA fingerprints in Mycobacterium tuberculosis isolates from sputum samples were clustered. The first patients in a cluster were considered to be the index patients; all other patients were considered to have secondary cases. In addition, we examined transmission from sources by conventional contact tracing.Results. We analyzed 394 clusters with a total of 1285 patients. On the basis of molecular linkage only, 12.6% of the secondary cases were attributable to transmission from a patient with smear-negative TB. The relative transmission rate among patients with smear-negative TB, compared with patients with smear-positive TB, was 0.24 (95% confidence interval, 0.20-0.30). Secondary cases in clusters with an index patient with smear-negative TB more frequently had smear-negative status (odds ratio, 1.86; 95% confidence interval, 1.18-2.93), compared with secondary cases in clusters with an index patient with smear-positive TB. Conventional contact tracing revealed that 26 (6.2%) of the 417 sources, as identified by the Municipal Health Services, had smear-negative TB.Conclusions. In The Netherlands, patients with smear-negative, culture-positive TB are responsible for 13% of TB transmission. Countries that have ample resources should expand their TB-control efforts to include prevention of transmission from patients with smear-negative, culture-positive pulmonary TB.