Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries
Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries
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DOI：
10.1016/s0140-6736(98)12325-5
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发表时间：
1999-10-02
期刊：
影响因子：
168.9
通讯作者：
Jarvis, WR
中科院分区：
文献类型：
--
作者：
McDonald, LC;Archibald, LK;Jarvis, WR
背景 结核分枝杆菌的医院传播是一个全球性的公共卫生问题。尽管在医院住院患者中早期临床识别结核分枝杆菌对于有效控制感染至关重要，但对于 HIV 感染患者来说，这种识别可能很困难。为了了解结核分枝杆菌菌血症是否经常被忽视，我们在泰国一家传染病医院和马拉维一家综合医院进行了前瞻性血培养调查。方法连续发热（腋窝≥37.5°C或口腔≥38.0°C）住院患者（年龄≥18岁）入组；采集血液用于分枝杆菌培养和艾滋病毒检测。临床医生认为必要时会要求进行胸部X光检查和痰涂片等简单的诊断测试，并利用当地现有资源进行。结果 在纳入的344名患者中，255名（74％）感染了艾滋病毒，中位年龄为33岁（范围18-87岁），208名（61％）为男性。 34名（10%）患者患有NI结核菌血症；其中五名患者已经在接受抗结核治疗。只有 HIV 感染者才会出现结核分枝杆菌菌血症。在 29 名尚未接受抗结核治疗的结核分枝杆菌菌血症患者中，13 名 (45%) 的胸部 X 光片异常或痰涂片呈阳性。 16 名（55%）患者没有额外的诊断测试结果表明结核分枝杆菌感染；其中 18 人 (81%) 出现咳嗽。 解释 在结核分枝杆菌和 HIV 感染均流行的欠发达国家，发热医院住院患者中结核分枝杆菌菌血症可能经常未被识别。
Background Nosocomial transmission of Mycobacterium tuberculosis is a global public-health concern. Although early clinical recognition of M tuberculosis in hospital inpatients is critical for effective infection control, such recognition may be difficult in patients with HIV infection. To find out whether M tuberculosis bacteraemia frequently goes unrecognised, we did a prospective blood-culture survey in an infectious-diseases hospital in Thailand and a general hospital in Malawi,Methods Consecutive febrile (greater than or equal to 37.5 degrees C axillary or greater than or equal to 38.0 degrees C orally) hospital inpatients (aged greater than or equal to 18 years) were enrolled; blood was obtained for mycobacterial culture and HIV testing. Simple diagnostic tests, such as chest radiographs and sputum smears, were ordered by clinicians as deemed necessary, and were carried out with existing local resources.Findings Of 344 patients enrolled, 255 (74%) were HIV infected, the median age was 33 years (range 18-87), and 208 (61%) were male. 34 (10%) patients had NI tuberculosis bacteraemia; five of these patients were already on antituberculosis therapy. Only HIV-infected patients had M tuberculosis bacteraemia. Of the 29 patients with M tuberculosis bacteraemia who were not already receiving antituberculosis therapy, 13 (45%) had an abnormal chest radiograph or a positive sputum smear. 16 (55%) patients had no additional diagnostic test results to indicate M tuberculosis infection; 18 (81%) of these had a cough.Interpretation In less developed countries where both M tuberculosis and HIV infections are prevalent, M tuberculosis bacteraemia may frequently go unrecognised among febrile hospital inpatients.