Conover C, Ridzon R, Valway S, Schoenstadt L, McAuley J, Onorato I, Paul W
Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Int J Tuberc Lung Dis. 2001 Jan;5(1):59-64.
An out-patient methadone treatment program MTP).
To investigate transmission of multidrug-resistant tuberculosis (MDR-TB) in the MTP.
Cases were defined as MTP clients or staff who developed TB between 1 January 1994 and 1 January 1996, with at least one positive culture for Mycobacterium tuberculosis resistant to isoniazid and rifampin. Contacts were identified, located and evaluated.
Thirteen cases of MDR-TB occurred among 462 clients and staff. One fifth (6/30) of the members of a counseling group for human immunodeficiency virus (HIV) infected clients developed MDR-TB. Individuals known to be HIV positive were at greater risk for TB than those who were HIV negative (RR 5.2, 95%CI 1.2-22.7). Of 449 clients and staff identified as contacts, 393 (87.5%) were located and screened. Among those with a negative baseline tuberculin skin test, 18.5% (56/303) were skin test converters. Attendance at the MTP during a period when the index case was infectious was associated with an increased risk of conversion (RR 2.5, 95%CI 1.1-6.0).
Extensive transmission of MDR-TB occurred at an out-patient MTP serving numerous clients with HIV infection. This outbreak underscores the importance of developing effective strategies to prevent TB transmission in this setting.
一个门诊美沙酮治疗项目（MTP）。
调查美沙酮治疗项目中耐多药结核病（MDR-TB）的传播情况。
病例定义为在1994年1月1日至1996年1月1日期间患结核病的MTP客户或工作人员，其结核分枝杆菌培养至少有一次对异烟肼和利福平耐药呈阳性。确定、查找并评估接触者。
在462名客户和工作人员中发生了13例耐多药结核病。一个为感染人类免疫缺陷病毒（HIV）客户提供咨询的小组中，五分之一（6/30）的成员感染了耐多药结核病。已知HIV呈阳性的个体患结核病的风险高于HIV呈阴性的个体（相对危险度5.2，95%可信区间1.2 - 22.7）。在确定为接触者的449名客户和工作人员中，393人（87.5%）被找到并接受了筛查。在基线结核菌素皮肤试验阴性的人群中，18.5%（56/303）的人皮肤试验结果出现转换。在指示病例具有传染性期间参加MTP与转换风险增加相关（相对危险度2.5，95%可信区间1.1 - 6.0）。
在一个为众多感染HIV的客户提供服务的门诊MTP中发生了耐多药结核病的广泛传播。这次疫情凸显了制定有效策略以预防该环境中结核病传播的重要性。
