Fox Gregory J, Dobler Claudia C, Marks Guy B
Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia, NSW 2050.
Cochrane Database Syst Rev. 2011 Sep 7;2011(9):CD008477. doi: 10.1002/14651858.CD008477.pub2.
Tuberculosis is a major global health challenge that is caused by a bacteria which is spread by airborne droplets. Mostly patients are identified in high-burden countries when they visit health care facilities ('passive case finding'). Contacts of tuberculosis patients are a high-risk group for developing the disease. Actively screening contacts of people with confirmed tuberculosis may improve case detection rates and control of the disease.
This study aims to compare whether active case finding among contacts of people with confirmed tuberculosis increases case detection compared to usual practice.
In April 2011 we searched CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE, EMBASE, LILACS and mRCT. We also checked article reference lists, the International Journal of Tuberculosis and Lung Disease and contacted relevant researchers and organizations.
Randomized and quasi-randomized trials of active case finding to detect tuberculosis disease among close and casual contacts of patients with microbiologically proven pulmonary tuberculosis (by sputum smear and/or culture).
Two authors independently assessed eligibility and the methodological quality of the trials that were extracted using a search method that was outlined previously.
No trials met the inclusion criteria for this review. One RCT did test the effect of active case finding in contacts, but the intervention in that trial also included screening for, and treatment of, LTBI in contacts; and the separate effect of active case finding could not be estimated.
AUTHORS' CONCLUSIONS: There are currently insufficient data from randomized controlled trials or quasi-randomized controlled trials to evaluate the effect of active case finding for tuberculosis among contacts of patients with confirmed disease. While observational studies show that contacts have a higher risk of developing tuberculosis than the general population, further research is needed to determine whether active case finding among contacts significantly increases case detection rates.
结核病是一项重大的全球卫生挑战，由通过空气飞沫传播的细菌引起。大多数患者是在高负担国家前往医疗机构就诊时被确诊（“被动病例发现”）。结核病患者的接触者是感染该疾病的高危人群。对确诊结核病患者的接触者进行主动筛查可能会提高病例发现率并控制疾病传播。
本研究旨在比较与常规做法相比，对确诊结核病患者的接触者进行主动病例发现是否能增加病例发现数。
2011年4月，我们检索了Cochrane系统评价数据库（2011年第2期）、MEDLINE、EMBASE、拉丁美洲及加勒比地区卫生科学数据库（LILACS）和mRCT。我们还查阅了文章参考文献列表、《国际结核病和肺部疾病杂志》，并联系了相关研究人员和组织。
针对微生物学确诊的肺结核患者（通过痰涂片和/或培养）的密切和偶然接触者，开展主动病例发现以检测结核病的随机和半随机试验。
两位作者独立评估了使用先前概述的检索方法提取的试验的纳入资格和方法学质量。
没有试验符合本综述的纳入标准。一项随机对照试验确实测试了主动病例发现在接触者中的效果，但该试验中的干预措施还包括对接触者进行潜伏性结核感染的筛查和治疗；无法估计主动病例发现的单独效果。
目前，随机对照试验或半随机对照试验中没有足够的数据来评估对确诊疾病患者的接触者进行主动病例发现以检测结核病的效果。虽然观察性研究表明，接触者患结核病的风险高于一般人群，但仍需要进一步研究来确定对接触者进行主动病例发现是否能显著提高病例发现率。
