García Ordóñez M A, Colmenero Castillo J D, Sánchez Simonet M V, García Delange M T, Causse Prados M, Juárez Fernández C
Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario Carlos Haya, Málaga.
Rev Clin Esp. 1999 May;199(5):275-9.
The investigation of contacts of patients with tuberculosis is a highly cost-effective measure to detect new cases of disease and infected individuals; nevertheless, its efficacy has not been contrasted with persons living with patients with tuberculosis (TB) coinfected with HIV. A total of 152 family contacts were studied corresponding to 84 HIV-positive tuberculosis patients. As a control group, 516 persons living with HIV-negative TB patients were included. Contacts were classified according to the bacteriologic status of the index case (IC): group I, contacts of patients with negative bacterioscopy and positive culture of respiratory specimens; group II, contacts of patients with negative bacterioscopy and positive culture of respiratory specimens, and group III, contacts of pulmonary and/or extrapulmonary TB patients with negative bacterioscopy and culture. Among IC coinfected with HIV there was a higher percentage of extrapulmonary clinical forms and therefore a lower proportion of bacillary forms, which accounted for a lower rate of infection among contacts of HIV-positive patients than among contacts of HIV-negative patients (20.4% vs 48.8%; OR: 3.7; 95% CI: 2.4-5.9). After controlling for bacteriologic status of the IC, differences remained when bacillary (group I) of HIV-coinfected patients were compared with those of patients not coinfected with HIV (35.9% vs 52.3%; OR: 2.1%; 95% CI: 1.2-5.9). Overall, 28 new TB cases were detected (4.2% of the total of studied persons living with TB patients) with no differences among contacts of both groups. The lower rate of infections among persons living with HIV-positive patients might be due not only to a lower number of pulmonary forms in HIV-coinfected IC and therefore less bacillary forms but also to a lower degree of crowding and a higher protection against exposure to their contacts.
对结核病患者的接触者进行调查是发现新发病例和感染者的一项极具成本效益的措施；然而，其效果尚未与感染艾滋病毒的结核病患者的接触者进行对比。共对84名艾滋病毒呈阳性的结核病患者的152名家庭接触者进行了研究。作为对照组，纳入了516名与艾滋病毒呈阴性的结核病患者生活在一起的人。接触者根据索引病例（IC）的细菌学状况进行分类：第一组，呼吸道标本细菌学检查阴性但培养呈阳性的患者的接触者；第二组，呼吸道标本细菌学检查阴性但培养呈阳性的患者的接触者，以及第三组，细菌学检查和培养均为阴性的肺结核和/或肺外结核患者的接触者。在艾滋病毒合并感染的索引病例中，肺外临床形式的比例较高，因此细菌形式的比例较低，这导致艾滋病毒呈阳性患者的接触者中的感染率低于艾滋病毒呈阴性患者的接触者（20.4%对48.8%；比值比：3.7；95%置信区间：2.4 - 5.9）。在控制索引病例的细菌学状况后，将艾滋病毒合并感染患者的细菌学检查阳性（第一组）与未感染艾滋病毒的患者进行比较时，差异仍然存在（35.9%对52.3%；比值比：2.1%；95%置信区间：1.2 - 5.9）。总体而言，共检测到28例新的结核病病例（占与结核病患者生活在一起的研究对象总数的4.2%），两组接触者之间无差异。艾滋病毒呈阳性患者的接触者中感染率较低可能不仅是因为艾滋病毒合并感染的索引病例中肺部形式数量较少，因此细菌形式较少，还因为拥挤程度较低以及对接触者的暴露防护较高。
