Magee Matthew J, Blumberg Henry M, Broz Dita, Furner Sylvia E, Samson Luke, Singh Sarman, Hershow Ronald C
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Southeast Asian J Trop Med Public Health. 2012 Mar;43(2):354-63.
We sought to determine tuberculosis (TB) prevalence including multidrug resistant (MDR)-TB among a cohort of high risk patients at two directly observed treatment short course (DOTS) clinics in Delhi, India. We also aimed to compare the sensitivity of acid-fast bacilli (AFB) smear tests for patients with HIV using sputum cultures as the gold standard. A cross-section study was conducted among adult patients (> or = 18 years old) with prolonged cough (greater than two weeks), night sweats, fever, and/or weight loss suspected of pulmonary TB between February and March 2006. Sputum samples were obtained and processed for 165 patients; 53 (32.1%) were culture positive for TB. Patients with TB were predominantly male (92.1%), young (median age of 32 years), and the HIV-seroprevalence was high (41.5%). In the multivariable analysis adjusted for age, HIV infection was significantly associated (POR = 2.0, p < 0.05) with the presence of TB disease. Among Mycobacterium tuberculosis isolates recovered from 53 cases, 25 (47.2%) were resistant to > or = 1 first line anti-TB drugs and 7 (13.2%) were MDR-TB. The sensitivity of AFB smears among HIV negative and positive participants was 35.5% and 18.0%, respectively. Our findings demonstrated that the sensitivity of AFB smears to detect TB among HIV positive patients was low. Additionally, we found that even in regions where population drug resistance estimates are low, sentinel surveillance of MDR-TB in high-risk populations is useful to prioritize target groups in need of additional prevention, monitoring and health outreach.
我们试图确定印度德里两家直接督导下的短程治疗（DOTS）诊所中一组高危患者的结核病（TB）患病率，包括耐多药结核病（MDR-TB）。我们还旨在以痰培养作为金标准，比较HIV患者的抗酸杆菌（AFB）涂片检测的敏感性。2006年2月至3月间，对出现咳嗽延长（超过两周）、盗汗、发热和/或体重减轻且疑似患有肺结核的成年患者（≥18岁）进行了一项横断面研究。采集了165例患者的痰标本并进行处理；53例（32.1%）结核培养呈阳性。结核病患者以男性为主（92.1%），较为年轻（中位年龄32岁），HIV血清阳性率较高（41.5%）。在对年龄进行校正的多变量分析中，HIV感染与结核病的存在显著相关（优势比=2.0，p<0.05）。在从53例病例中分离出的结核分枝杆菌菌株中，25例（47.2%）对≥1种一线抗结核药物耐药，7例（13.2%）为耐多药结核病。HIV阴性和阳性参与者中AFB涂片的敏感性分别为35.5%和18.0%。我们的研究结果表明，AFB涂片在检测HIV阳性患者结核病方面的敏感性较低。此外，我们发现，即使在人群耐药性估计较低的地区，对高危人群进行耐多药结核病哨点监测，有助于确定需要额外预防、监测和健康推广的目标群体的优先级。
