High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa
High Prevalence of Pulmonary Tuberculosis but Low Sensitivity of Symptom Screening among HIV-Infected Pregnant Women in South Africa
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DOI：
10.1371/journal.pone.0062211
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发表时间：
2013-04-17
期刊：
影响因子：
3.7
通讯作者：
Martinson, Neil A.
中科院分区：
文献类型：
--
作者：
Hoffmann, Christopher J.;Variava, Ebrahim;Martinson, Neil A.
症状筛查是在HIV感染者中加强肺结核(TB)病例发现(ICF)的推荐组成部分。对有症状的人进行进一步调查，以排除或诊断肺结核病，从而减少需要进行昂贵实验室检查的人数。那些实验室评估为肺结核病阴性或没有症状的人可能有资格接受抗逆转录病毒疗法(ART)和/或结核病异烟肼预防疗法(IPT)。世界卫生组织(WHO)建议使用由四部分组成的症状筛查来识别结核病嫌疑人和那些可能患有结核病的人。一项对HIV感染者的研究的荟萃分析计算出，在临床护理中的患者中，四部分症状筛查-咳嗽、发烧、盗汗或体重减轻-的敏感度为90.1%，使其成为识别大多数结核病患者的有效工具。强化病例发现的一个重要人群没有包括在荟萃分析中，那就是感染艾滋病毒的孕妇。我们对在南非社区诊所接受产前护理的艾滋病毒感染孕妇进行了横断面调查。我们对所有参与者进行了四项症状回顾、痰涂片镜检和分枝杆菌培养。在1415名妇女中，226名(16%)有阳性症状筛查，35名(2.5%)新诊断为培养阳性结核病。筛查时正在接受结核病治疗的有12人，其中47人(3.3%)患有结核病流行。在没有已知结核病的妇女中进行症状筛查的敏感性为28%，特异性为84%。在识别患有结核病的妇女方面，症状筛查的表现不佳，这表明可能需要其他方法来加强病例发现，以便对这一人群有效。
Symptom screening is a recommended component of intensified case-finding (ICF) for pulmonary tuberculosis (TB) among HIV-infected individuals. Symptomatic individuals are further investigated to either exclude or diagnose pulmonary TB, thus reducing the number of individuals requiring costly laboratory investigation. Those with laboratory evaluations negative for pulmonary TB or who lack symptoms may be eligible for antiretroviral therapy (ART) and/or TB isoniazid preventive therapy (IPT). A four-part symptom screen has been recommended by the World Health Organization (WHO) for identifying TB suspects and those unlikely to have TB. A meta-analysis of studies among HIV-infected individuals calculated a sensitivity of 90.1% for the four-part symptoms screen - of any of cough, fever, night sweats, or weight loss - among patients in clinical care, making it an effective tool for identifying most patients with TB. An important population for intensified case-finding not included in that meta-analysis was HIV-infected pregnant women. We undertook a cross-sectional survey among HIV-infected pregnant women receiving prenatal care at community clinics in South Africa. We obtained a four-symptom review and sputum smear microscopy and mycobacterial culture on all participants. Among 1415 women, 226 (16%) had a positive symptom screen, and 35 (2.5%) were newly diagnosed with culture-positive TB. Twelve were on TB treatment at the time of screening, yielding 47 (3.3%) women with prevalent TB. Symptom screening among women without known TB had a sensitivity of 28% and specificity of 84%. The poor performance of symptom screening to identify women with TB suggests that other approaches may be needed for intensified case-finding to be effective for this population.