Solsona J, Caylà J A, Nadal J, Bedia M, Mata C, Brau J, Maldonado J, Milà C, Alcaide J, Altet N, Galdós-Tangüis H
Centro de Prevenció i Control de la Tuberculosi CAP Drassanes, Barcelona, Spain.
Eur J Epidemiol. 2001;17(2):123-8. doi: 10.1023/a:1017580329538.
The homeless are at very high risk of suffering tuberculosis (TB). The aims of this study were to determine the prevalence and risk factors for tuberculosis infection and disease among the homeless in Barcelona and to evaluate the roles of case finding and contact investigation.
Observational prevalence study carried out between 1997 and 1998.
447 homeless patients (394 men and 53 women) were evaluated before admission to shelters and free-meal services. At the same time, 48 co-residents with smear-positive TB patients in 2 long-term shelters were evaluated too. A chest X-ray and Tuberculin Skin Test were performed on all subjects. Sputum smears were processed by the Ziehl-Neelsen and Löwenstein-Jensen procedures in patients with radiographic findings consistent with pulmonary TB.
Of the 447 homeless examined, 335 (75%) were infected with Mycobacterium tuberculosis. Active pulmonary TB was diagnosed in five persons (1.11%), and 62 (13.8%) had radiographic evidence of inactive pulmonary TB. Tuberculosis infection was associated with age and smoking, but not with sex or alcohol abuse. No significant differences in infection rates were found between the main group and 48 homeless co-residents of smear-positive subjects. Only 16.9% of the homeless with active TB in Barcelona in the same period were diagnosed through active case-finding, the remainder being mainly detected in hospitals (69.8%) and other several centres (13.3%).
Homeless individuals have a very high risk of TB infection and disease and contact investigation requires specific methods for them. Programmes of screening and supervised treatment should be ensured in this group.
无家可归者患结核病（TB）的风险极高。本研究的目的是确定巴塞罗那无家可归者中结核感染和疾病的患病率及危险因素，并评估病例发现和接触者调查的作用。
1997年至1998年进行的观察性患病率研究。
447名无家可归患者（394名男性和53名女性）在进入收容所和免费餐饮服务机构之前接受了评估。同时，对2个长期收容所中48名与涂片阳性结核病患者共同居住的人也进行了评估。对所有受试者进行了胸部X光检查和结核菌素皮肤试验。对胸部X光检查结果符合肺结核的患者，采用萋尼氏和罗-琴氏方法进行痰涂片检查。
在接受检查的447名无家可归者中，335人（75%）感染了结核分枝杆菌。5人（1.11%）被诊断为活动性肺结核，62人（13.8%）有非活动性肺结核的影像学证据。结核感染与年龄和吸烟有关，但与性别或酗酒无关。主要组与48名涂片阳性受试者的无家可归共同居住者之间的感染率没有显著差异。同期巴塞罗那活动性肺结核的无家可归者中，只有16.9%是通过主动病例发现确诊的，其余主要在医院（69.8%）和其他几个中心（13.3%）被发现。
无家可归者有极高的结核感染和患病风险，接触者调查需要针对他们的特定方法。应确保为该群体开展筛查和监督治疗项目。
