Exhaled Mycobacterium tuberculosis Predicts Incident Infection in Household Contacts.
Exhaled Mycobacterium tuberculosis Predicts Incident Infection in Household Contacts.
复制标题
DOI：
10.1093/cid/ciac455
复制
发表时间：
2023-02-08
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
通过早期识别传染性个体来阻止结核分枝杆菌（Mtb）的传播是根除结核病（TB）的关键。在这里，我们评估口罩采样作为一种工具，分层肺结核（PTB）个人的感染风险，他们的家庭接触。冈比亚（2016年8月至2017年11月）的46名结核病阳性PTB患者同意在开始治疗前进行面罩采样。在217名家庭接触者中，有181人的Mtb感染事件被定义为指标诊断后6个月QuantiFERON转换或干扰素-γ增加≥1 IU/mL。采用多水平混合效应逻辑回归分析，按家庭进行聚类调整，以确定事件感染的预测因素。 在91%的PTB口罩样本中检测到结核分枝杆菌，且IS 6110拷贝数差异很大（5.3 × 102至1.2 × 107）。在45%的病例中观察到高Mtb水平（≥20 000 IS 6110拷贝），与低阳性/阴性Mtb水平的病例相比，与接触者中Mtb感染事件的可能性增加独立相关（校正比值比，3.20 [95%置信区间，1.26-8.12]; P = .01）。口罩Mtb水平是一个更好的预测事件Mtb感染比痰菌负荷，胸部放射学特征，或睡眠接近。口罩采样提供了一种敏感和非侵入性的工具，以支持在高结核病负担环境中最具传染性的个体分层。我们的方法可以更好地了解复杂环境中的社区传播。口罩采样提供了一种新的临床工具，比痰菌负荷更可靠地告知肺结核（TB）的传染性，并有可能改变结核病高负担环境中的公共卫生干预措施。
Halting transmission of Mycobacterium 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. Forty-six sputum-positive PTB patients in The Gambia (August 2016–November 2017) consented to mask sampling prior to commencing treatment. Incident Mtb infection 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. Mtb was detected in 91% of PTB mask samples with high variation in IS6110 copies (5.3 × 102 to 1.2 × 107). A high mask Mtb level (≥20 000 IS6110 copies) was observed in 45% of cases and was independently associated with increased likelihood of incident Mtb infection in contacts (adjusted odds ratio, 3.20 [95% confidence interval, 1.26–8.12]; P = .01), compared with cases having low-positive/negative mask Mtb levels. Mask Mtb level was a better predictor of incident Mtb infection than sputum bacillary load, chest radiographic characteristics, or sleeping proximity. Mask 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. Face mask sampling offers a novel clinical tool that informs infectiousness of pulmonary tuberculosis (TB) more reliably than sputum bacillary load and has the potential to transform public health interventions in high-TB-burden settings.
登录
查看更多内容
DOI：
10.1016/s2213-2600(17)30060-7
发表时间：
2017-04
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Andrews JR;Nemes E;Tameris M;Landry BS;Mahomed H;McClain JB;Fletcher HA;Hanekom WA;Wood R;McShane H;Scriba TJ;Hatherill M
通讯作者：
Hatherill M
影响因子：
--
作者：
Patterson, Benjamin;Morrow, Carl;Wood, Robin
通讯作者：
Wood, Robin
影响因子：
9.4
作者：
Kamerbeek, J;Schouls, L;vanEmbden, J
通讯作者：
vanEmbden, J
DOI：
10.1164/rccm.201409-1704oc
发表时间：
2015-03-01
影响因子：
24.7
作者：
Andrews, Jason R.;Hatherill, Mark;Scriba, Thomas J.
通讯作者：
Scriba, Thomas J.
影响因子：
3.7
作者：
Acuña-Villaorduña C;Schmidt-Castellani LG;Marques-Rodrigues P;White LF;Hadad DJ;Gaeddert M;Ellner JJ;Fennelly KP;Palaci M;Dietze R;Jones-López EC
通讯作者：
Jones-López EC