Kaynak S, Bauer C, Richter V, Richter E, Niemann S
Kreisverwaltung Wittenberg, Fachdienst Gesundheit.
Gesundheitswesen. 2012 Jun;74(6):351-7. doi: 10.1055/s-0031-1285862. Epub 2011 Aug 24.
In Germany the number of new tuberculosis incidents continues to decline slightly. Cases of illnesses are often diagnosed late, due to the uncharacteristic course of tuberculosis. The success in environment investigations by health authorities in finding incidents within one infection chain depends on the compliance of patients among other factors. Tuberculosis occurs especially in groups with social disadvantages. In this population segment the identification of contact persons of a patient with infectious tuberculosis presents difficulties. Moreover, identifying the source of infection is frequently not successful. For these reasons, additional infections and sicknesses are caused. The cultural pathogen proof, including type differentiation and resistance testing, continues to be the "gold standard" in tuberculosis diagnostics and is required for the examination of outbreaks. Molecular methods for fine typification of isolated bacterial strains and their subsequent comparison constitute an important tool in the infection epidemiology investigation of incident clustering.
The objective of this work is the description of a tuberculosis infection chain in Saxony-Anhalt, which was discovered by means of a molecular biological method. The conservative method represents the environment investigations for the expedient selection of contact persons. The investigations always take 2 directions in the process. On the one hand, it is searched for the still unknown source of infection. On the other hand, persons are to be identified, who have been infected before the diagnosis became known. The diagnostics for contact persons includes besides the lung X-ray checkup exam, the Mendel Mantoux tuberculin skin test (THT), sputum tests and the Interferon Gamma (INF-γ) tests (IGRA). In described case, the molecular biological method of spoliogotyping was employed as additional instrument. Therein, fingerprint maps of the patients' tuberculosis strings were created and compared. Infection chains resulting from the environment investigations were thereby secured.
We report on a tuberculosis outbreak in a district of the state of Saxony-Anhalt, which occurred in the time from June 2007 to May 2010. As result of the environment investigations, an infection chain of 13 ill patients (77% ♂, 23% ♀) was identified. In 11 cases the correlation of the infection chain was proven by spoligotyping (9 ♂, 2 ♀). 2 cases (1 ♂, 1 ♀) without verification of the pathogen cannot be attributed on basis of the epidemiological correlations.
在德国，新的结核病发病数持续略有下降。由于结核病病程不典型，疾病病例往往诊断较晚。卫生当局在环境调查中成功发现同一感染链内的发病情况，这取决于诸多因素，其中包括患者的依从性。结核病尤其在社会弱势群体中出现。在这一人群中，识别传染性结核病患者的接触者存在困难。此外，确定感染源往往并不成功。出于这些原因，导致了更多的感染和疾病发生。包括类型区分和耐药性检测在内的培养病原体检测，仍然是结核病诊断的“金标准”，也是疫情调查所必需的。对分离出的细菌菌株进行精细分型并随后进行比较的分子方法，是聚集性发病感染流行病学调查的重要工具。
本研究的目的是描述通过分子生物学方法在萨克森 - 安哈尔特州发现的一条结核病感染链。保守方法代表了为合理选择接触者而进行的环境调查。调查过程始终有两个方向。一方面，寻找仍未知的感染源。另一方面，识别在诊断公布之前就已被感染的人员。对接触者的诊断除了肺部X光检查外，还包括孟德尔曼托克斯结核菌素皮肤试验（THT）、痰液检测和干扰素γ（INF - γ）检测（IGRA）。在所描述的案例中，采用了 spoligotyping 分子生物学方法作为辅助手段。在此过程中，创建并比较了患者结核菌株的指纹图谱。由此确保了环境调查得出的感染链。
我们报告了萨克森 - 安哈尔特州一个地区在2007年6月至2010年5月期间发生的一起结核病疫情。环境调查的结果是，确定了一条由13名患病患者组成的感染链（男性占77%，女性占23%）。在11例中，通过spoligotyping证实了感染链的相关性（9名男性，2名女性）。2例（1名男性，1名女性）未证实病原体，无法根据流行病学相关性进行归因。
