Lockman S, Hone N, Kenyon T A, Mwasekaga M, Villauthapillai M, Creek T, Zell E, Kirby A, Thacker W L, Talkington D, Moura I N, Binkin N J, Clay L, Tappero J W
Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
Int J Tuberc Lung Dis. 2003 Aug;7(8):714-23.
In countries with high HIV rates, diagnosis of lower respiratory disease etiology is both challenging and clinically important.
To determine the etiology of lower respiratory tract disease among persons with suspected tuberculosis (TB) and abnormal chest X-rays in a setting with very high HIV seroprevalence.
Cross-sectional prevalence data from a prospective cohort of predominantly hospitalized adults with suspected TB in Botswana, January-December 1997.
Of 229 patients, 86% were HIV-positive and 71% had a pathogen identified. TB was confirmed in 52%, 17% had acute mycoplasma pneumonia, 3% had Pneumocystis carinii, 27% grew a bacterial pathogen from sputum and 8% from blood. Ninety-four per cent of TB diagnoses were made through expectorated sputum and only 5% of TB cases were diagnosed by sputum induction alone. Polymerase chain reaction (PCR) for Mycobacterium tuberculosis had positive and negative predictive values of 94% and 59%, respectively. Male sex, cough < 2 weeks, and tuberculin skin test > or = 5 mm were independently associated with culture-positive TB among persons with negative acid-fast bacilli smears. Co-infection with two or more pathogens occurred in 25%.
Mycoplasma pneumoniae infection was quite common despite clinical suspicion of TB, and sputum induction and PCR did not significantly improve our ability to diagnose TB, although clinical presentation had some predictive value.
在艾滋病毒感染率较高的国家，下呼吸道疾病病因的诊断既具有挑战性又具有临床重要性。
在艾滋病毒血清阳性率非常高的环境中，确定疑似结核病（TB）且胸部X线异常者下呼吸道疾病的病因。
1997年1月至12月在博茨瓦纳对主要为疑似结核病的住院成人前瞻性队列进行的横断面患病率数据。
229例患者中，86%为艾滋病毒阳性，71%鉴定出病原体。52%确诊为结核病，17%患有急性支原体肺炎，3%患有卡氏肺孢子虫，27%痰中培养出细菌病原体，8%血中培养出细菌病原体。94%的结核病诊断通过咳痰做出，仅5%的结核病病例仅通过诱导痰诊断。结核分枝杆菌聚合酶链反应（PCR）的阳性和阴性预测值分别为94%和59%。男性、咳嗽<2周以及结核菌素皮肤试验≥5mm与抗酸杆菌涂片阴性者中培养阳性结核病独立相关。25%的患者发生两种或更多种病原体的合并感染。
尽管临床怀疑为结核病，但肺炎支原体感染相当常见，诱导痰和PCR并未显著提高我们诊断结核病的能力，尽管临床表现有一定的预测价值。
