Kim Lindsay, Heilig Charles M, McCarthy Kimberly D, Phanuphak Nittaya, Chheng Phalkun, Kanara Nong, Quy Hoang Thi, Sar Borann, Cain Kevin P, Varma Jay K
Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
J Acquir Immune Defic Syndr. 2012 Aug 15;60(5):519-24. doi: 10.1097/QAI.0b013e318256b3db.
Tuberculosis (TB) is the leading cause of death among people living with HIV and frequently transmitted among this susceptible group. Transmission can be reduced by infection control practices. Simple evidence-based methods to identify patients who should be isolated are not well described in the literature. We sought to identify a simple, sensitive symptom or symptom combination that healthcare providers in resource-limited settings can use to identify and isolate persons living with HIV with highly infectious TB.
Participants from 8 outpatient facilities in Cambodia, Thailand, and Vietnam underwent an extensive evaluation for TB. Patients with ≥1 positive sputum smear and Mycobacterium tuberculosis culture growth from a pulmonary site were defined as having highly infectious TB. We calculated sensitivity and prevalence of individual symptoms and >1000 symptom combinations.
Of 1980 participants, 272 (14%) had TB. Forty percent (n = 109) were highly infectious. Sensitivity for detecting highly infectious TB was highest for having the following symptoms in the past month as follows: weight loss (84%), cough (83%), fever (81%), and fatigue (78%); however, these symptoms were found in 46%-54% of all participants. Having 2 or 3 of 4 symptoms (prevalence, 26%-47%)-weight loss, fever, current cough, and night sweats-was 72%-90% sensitive for highly infectious TB.
The 2 or 3 of 4 symptom combinations of weight loss, fever, current cough, and night sweats, which are the same symptoms comprising the current World Health Organization-recommended TB diagnostic screen, are sensitive for detecting highly infectious TB in people living with HIV.
结核病是艾滋病毒感染者的主要死因，且常在这一易感人群中传播。感染控制措施可减少传播。文献中未充分描述用于识别应隔离患者的简单循证方法。我们试图确定一种简单、敏感的症状或症状组合，供资源有限环境中的医疗服务提供者用于识别和隔离患有高传染性结核病的艾滋病毒感染者。
来自柬埔寨、泰国和越南8个门诊机构的参与者接受了广泛的结核病评估。痰涂片≥1次阳性且肺部结核分枝杆菌培养生长的患者被定义为患有高传染性结核病。我们计算了个体症状及1000多种症状组合的敏感性和患病率。
1980名参与者中，272人（14%）患有结核病。40%（n = 109）具有高传染性。过去一个月出现以下症状对检测高传染性结核病的敏感性最高：体重减轻（84%）、咳嗽（83%）、发热（81%）和疲劳（78%）；然而，所有参与者中有46%-54%出现了这些症状。出现体重减轻、发热、当前咳嗽和盗汗这4种症状中的2种或3种（患病率为26%-47%）对高传染性结核病的敏感性为72%-90%。
体重减轻、发热、当前咳嗽和盗汗这4种症状中的2种或3种组合，与世界卫生组织目前推荐的结核病诊断筛查症状相同，对检测艾滋病毒感染者中的高传染性结核病具有敏感性。
