Kenyon T A, Copeland J E, Moeti T, Oyewo R, Binkin N
The BOTUSA Project, Gaborone, Botswana.
Int J Tuberc Lung Dis. 2000 Oct;4(10):962-7.
A US government office located in Botswana where two office employees, one negative and one positive for the human immunodeficiency virus (HIV), were diagnosed with pulmonary tuberculosis (TB) in January 1998. One employee had been symptomatic with untreated laryngeal TB for 8 months.
To determine the extent of and risk factors for TB transmission in the office.
Office contacts were interviewed and a tuberculin skin test (TST) was performed. A positive TST was defined as > or = 10 mm induration for employees from countries where TB is highly endemic, and as > or = 5 mm induration for those from low prevalence counties.
Of 79 office contacts investigated, 54/57 (94.7%) born in high TB prevalence countries had a positive TST compared with 4/22 (18.2%) from low prevalence countries (RR 5.1, 95% CI 2.1-12.7, P < 0.001). Of 20 US-born contacts, three (15%) had documented TST conversion, two of whom were co-workers of the employee with laryngeal TB. Isolates of Mycobacterium tuberculosis from the TB cases had matching DNA fingerprints.
Delayed diagnosis in a setting of high TB prevalence may have contributed to transmission within a US government office located in Botswana. Transmission may have been underestimated due to the high background prevalence of tuberculous infection in the population. Recent tuberculous transmission to persons living with HIV infection may be playing an important role in the escalating TB epidemic in Africa.
位于博茨瓦纳的一个美国政府办公室，1998年1月，两名办公室员工被诊断出患有肺结核（TB），其中一名人类免疫缺陷病毒（HIV）检测呈阴性，另一名呈阳性。一名员工有症状的未经治疗的喉结核已持续8个月。
确定该办公室内结核病传播的程度和危险因素。
对办公室接触者进行访谈并进行结核菌素皮肤试验（TST）。对于来自结核病高流行国家的员工，TST阳性定义为硬结≥10mm；对于来自低流行国家的员工，定义为硬结≥5mm。
在接受调查的79名办公室接触者中，出生于结核病高流行国家的54/57（94.7%）TST呈阳性，而来自低流行国家的4/22（18.2%）呈阳性（相对危险度5.1，95%可信区间2.1 - 12.7，P < 0.001）。在20名美国出生的接触者中，有3人（15%）记录有TST血清转化，其中2人是患有喉结核员工的同事。结核病病例的结核分枝杆菌分离株具有匹配的DNA指纹。
在结核病高流行环境中诊断延迟可能导致了位于博茨瓦纳的一个美国政府办公室内的传播。由于人群中结核感染的高背景流行率，传播可能被低估。近期结核传播给HIV感染者可能在非洲不断升级的结核病流行中起重要作用。
