Brighton and Sussex University Hospitals National Health Service Trust, Royal Sussex County Hospital, Brighton, UK.
Int J Tuberc Lung Dis. 2011 Feb;15(2):205-10, i.
In high tuberculosis (TB) burden, resource-poor countries, sputum smear microscopy remains the mainstay of diagnosis. The low sensitivity of this test means that patients with smear-negative but culture-positive TB pass undetected through the health care system. Such clinical episodes are missed opportunities for diagnosis and interruption of transmission, which might be averted through the application of more sensitive diagnostic tests.
To estimate the proportion of incident TB cases that might have been detected earlier than the actual date of diagnosis if a test more sensitive than smear microscopy had been used at an earlier presentation episode.
Retrospective cohort study in urban Peru, investigating health care facility interactions for symptoms suggestive of TB prior to TB diagnosis through patient interviews and a review of clinical records.
Of 212 participants enrolled, 58% had one or more clinical interactions prior to their diagnostic episode. Of those with a prior episode, the median number of episodes was three. The median delay to diagnosis from first presentation was 26 days.
There are clear missed opportunities for earlier TB diagnosis, delaying treatment initiation and continued spread of Mycobacterium tuberculosis to the community. The implementation of sensitive diagnostic tests appropriate to resource-poor settings should be given high priority.
在结核病负担高、资源匮乏的国家，痰涂片显微镜检查仍然是诊断的主要方法。这种检测方法的灵敏度较低，意味着那些痰涂片阴性但培养阳性的结核病患者会在医疗系统中被漏诊。这些临床发作是诊断和中断传播的错失机会，如果在早期出现症状时应用更敏感的诊断检测方法，这些机会可能会被避免。
如果在早期就诊时使用比痰涂片显微镜检查更敏感的检测方法，估计可能会更早发现比实际诊断日期更早的结核病病例比例。
这是一项在秘鲁城市进行的回顾性队列研究，通过对疑似结核病症状的患者进行访谈和临床记录回顾，调查了他们在确诊前的医疗保健机构就诊情况。
在 212 名入组患者中，58%的患者在确诊前有一次或多次临床就诊。在有前期就诊的患者中，就诊次数中位数为三次。从首次就诊到诊断的中位延迟时间为 26 天。
显然存在早期结核病诊断的错失机会，这会延迟治疗的开始，并导致结核分枝杆菌继续向社区传播。在资源匮乏的环境中，应高度优先实施适合的敏感诊断检测方法。
