Drug adherence and efficacy of smear microscopy in the diagnosis of pulmonary tuberculosis after 2 months of medication in North-western Tanzania
Drug adherence and efficacy of smear microscopy in the diagnosis of pulmonary tuberculosis after 2 months of medication in North-western Tanzania
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DOI：
10.1016/j.ijid.2017.07.025
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发表时间：
2017-10-01
影响因子：
8.4
通讯作者：
Kasang, Christa
中科院分区：
文献类型：
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作者：
Kidenya, Benson R.;Mshana, Stephen E.;Kasang, Christa
目的：本研究旨在评估第 2 个月时结核病 (TB) 药物依从性水平和涂片显微镜诊断肺结核的功效。方法：在坦桑尼亚西北部的四个地点进行了一项前瞻性研究。对新的涂片阳性肺结核患者进行了随访，并在治疗 2 个月后评估了他们对结核病药物治疗的依从性。此外，治疗2个月和5个月后进行抗酸杆菌（AFB）涂片镜检。所有涂片阳性样本均进行geneXpert (MTB/RIF)检测并在Lowenstein Jensen (LJ)培养基上培养。结果：共纳入331名涂片阳性的新诊断肺结核患者。中位年龄为 36 [四分位距 (IQR)：28-45] 岁，男性略占多数，即 187 名参与者 (56.5%)。共有 105 名患者（31.7%）感染艾滋病毒。在 331 名患者中，有 36 名患者 (10.9%) 两个月后 AFB 涂片仍呈阳性。其中 19 例 (52.8%) GeneXpert MTB RIF 呈阳性，且没有利福平耐药。值得注意的是，只有 13 例 (31.1%) 培养呈阳性（存活）。第 5 个月时，没有患者呈阳性。56/331 (16.9%) [95% CI = 12.9-21.0] 的患者在治疗的前 2 个月中对结核病药物的依从性较差。结论：超过三分之二的涂阳患者错误地将强化阶段治疗延长了一个月；这可能会导致成本增加和药物毒性。应提倡用药 2 个月后进行培养以确认涂片阳性。在我们的环境中，结核病治疗药物的依从性良好，并且与成功治愈相关。未观察到耐多药结核病（MDR-TB）。应保持乐观态度，继续监测并强调结核病药物依从性，以控制发展中国家的结核病。 (C) 2017 年作者。由爱思唯尔有限公司代表国际传染病学会出版。
Objectives: The study aimed at assessing the Tuberculosis (TB) medication adherence level and the efficacy of smear microscopy in the diagnosing pulmonary TB at month 2.Methods: A prospective study was conducted at the four sites located in the Northern-western Tanzania. New smear positive, pulmonary TB patients were followed up and their adherence to TB medication assessed after 2 months of the treatment. In addition, the acid fast bacilli (AFB) smear microscopy was performed after 2 and 5 months of the treatment. All smear positive samples were subjected to geneXpert (MTB/RIF) assay and culture on the Lowenstein Jensen (LJ) media.Results: A total of 331 smear positive, newly diagnosed patients with pulmonary TB were enrolled. The median age was 36 [Interquartile range (IQR): 28-45] years and males formed the slightly majority, 187 (56.5%) of the participants. A total of 105 (31.7%) patients were infected with HIV. Out of 331 patients, 36 (10.9%) were still AFB smear positive at the end of two month. Of these 19 (52.8%) were positive on GeneXpert MTB RIF and none was Rifampicin resistant. Of note, only 13 (31.1%) were culture positive (viable). None of the patients was positive at month 5. Poor adherence to TB medications in the first 2 months of treatment was observed in 56/331 (16.9%) [95% CI = 12.9-21.0] of the patients.Conclusion: Over two thirds of smear positive patients are wrongly put in one month extension of the intensive phase treatment; this may cause increased costs and drug toxicity. Culture should be advocated to confirm smear positivity after 2 months of medications. TB treatment drug adherence in our setting is good and is associated with successful cure. No multidrug resistant tuberculosis (MDR-TB) was observed. Continued surveillance and emphasizing of TB drug adherence should be kept upbeat in order to control tuberculosis in developing countries. (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.