Division of Infection and Immunity, Department of Infection, University College London, London, United Kingdom.
PLoS One. 2012;7(7):e40774. doi: 10.1371/journal.pone.0040774. Epub 2012 Jul 27.
A high burden of tuberculosis (TB) occurs in sub-Saharan African countries and many cases of active TB and drug-resistant TB remain undiagnosed. Tertiary care hospitals provide an opportunity to study TB co-morbidity with non-communicable and other communicable diseases (NCDs/CDs). We evaluated the burden of undiagnosed pulmonary TB and multi-drug resistant TB in adult inpatients, regardless of their primary admission diagnosis, in a tertiary referral centre.
METHODOLOGY/PRINCIPAL FINDINGS: In this prospective study, newly admitted adult inpatients able to produce sputum at the University Teaching Hospital, Lusaka, Zambia, were screened for pulmonary TB using fluorescent smear microscopy and automated liquid culture. The burden of pulmonary TB, unsuspected TB, TB co-morbidity with NCDs and CDs was determined. Sputum was analysed from 900 inpatients (70.6% HIV infected) 277 (30.8%) non-TB suspects, 286 (31.8%) TB suspects and 337 (37.4%) were already receiving TB treatment. 202/900 (22.4%) of patients had culture confirmed TB. TB co-morbidity was detected in 20/275 (7.3%) NCD patients, significantly associated with diabetes (P = 0.006, OR 6.571, 95%CI: 1.706-25.3). 27/202 (13.4%) TB cases were unsuspected. There were 18 confirmed cases of MDR-TB, 5 of which were unsuspected.
CONCLUSIONS/SIGNIFICANCE: A large burden of unsuspected pulmonary TB co-morbidity exists in inpatients with NCDs and other CDs. Pro-active sputum screening of all inpatients in tertiary referral centres in high TB endemic countries is recommended. The scale of the problem of undiagnosed MDR-TB in inpatients requires further study.
撒哈拉以南非洲国家的结核病（TB）负担沉重，许多活动性 TB 和耐药性 TB 病例仍未得到诊断。三级保健医院为研究与非传染性和其他传染性疾病（NCD/CD）共存的 TB 提供了机会。我们评估了在赞比亚卢萨卡的一所三级转诊中心，无论其主要入院诊断如何，对成年住院患者中未确诊的肺结核和耐多药 TB 的负担。
方法/主要发现：在这项前瞻性研究中，对赞比亚卢萨卡大学教学医院新入院的能产生痰的成年住院患者进行了荧光涂片显微镜检查和自动化液体培养，以筛查肺结核。确定了肺结核、未确诊 TB、NCD 和 CD 合并 TB 的负担。分析了 900 名住院患者（70.6%HIV 感染）、277 名非 TB 疑似患者、286 名 TB 疑似患者和 337 名已接受 TB 治疗的患者的痰标本。202/900 名（22.4%）患者的培养物证实有 TB。在 20/275 名（7.3%）NCD 患者中发现了 TB 合并症，与糖尿病显著相关（P=0.006，OR 6.571，95%CI：1.706-25.3）。27/202 名（13.4%）TB 病例未被怀疑。有 18 例确诊的耐多药-TB 病例，其中 5 例未被怀疑。
结论/意义：在患有 NCD 和其他 CD 的住院患者中，存在大量未被怀疑的肺结核合并症。建议在高结核病流行国家的三级转诊中心对所有住院患者进行主动痰筛查。未确诊的耐多药-TB 住院患者的问题规模需要进一步研究。
