Datta Sumona, Sherman Jonathan M, Bravard Marjory A, Valencia Teresa, Gilman Robert H, Evans Carlton A
Innovation for Health and Development (IFHAD), Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru Infectious Diseases and Immunity and Wellcome Trust Centre for global Health Research, Imperial College London, United Kingdom.
Innovation for Health and Development (IFHAD), Laboratory for Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru Innovacion por la Salud y el Desarollo (IPSYD), Asociación Benéfica Prisma, Lima, Peru.
Clin Infect Dis. 2015 Apr 15;60(8):1186-95. doi: 10.1093/cid/ciu1153. Epub 2014 Dec 23.
It is difficult to determine whether early tuberculosis treatment is effective in reducing the infectiousness of patients' sputum, because culture takes weeks and conventional acid-fast sputum microscopy and molecular tests cannot differentiate live from dead tuberculosis.
To assess treatment response, sputum samples (n=124) from unselected patients (n=35) with sputum microscopy-positive tuberculosis were tested pretreatment and after 3, 6, and 9 days of empiric first-line therapy. Tuberculosis quantitative viability microscopy with fluorescein diacetate, quantitative culture, and acid-fast auramine microscopy were all performed in triplicate.
Tuberculosis quantitative viability microscopy predicted quantitative culture results such that 76% of results agreed within ±1 logarithm (rS=0.85; P<.0001). In 31 patients with non-multidrug-resistant (MDR) tuberculosis, viability and quantitative culture results approximately halved (both 0.27 log reduction, P<.001) daily. For patients with non-MDR tuberculosis and available data, by treatment day 9 there was a >10-fold reduction in viability in 100% (24/24) of cases and quantitative culture in 95% (19/20) of cases. Four other patients subsequently found to have MDR tuberculosis had no significant changes in viability (P=.4) or quantitative culture (P=.6) results during early treatment. The change in viability and quantitative culture results during early treatment differed significantly between patients with non-MDR tuberculosis and those with MDR tuberculosis (both P<.001). Acid-fast microscopy results changed little during early treatment, and this change was similar for non-MDR tuberculosis vs MDR tuberculosis (P=.6).
Tuberculosis quantitative viability microscopy is a simple test that within 1 hour predicted quantitative culture results that became available weeks later, rapidly indicating whether patients were responding to tuberculosis therapy.
很难确定早期结核病治疗是否能有效降低患者痰液的传染性，因为培养需要数周时间，而传统的痰涂片抗酸染色显微镜检查和分子检测无法区分活的和死的结核杆菌。
为评估治疗反应，对未选择的痰涂片镜检阳性结核病患者（n = 35）的痰标本（n = 124）在经验性一线治疗前以及治疗3、6和9天后进行检测。结核杆菌定量活力显微镜检查（使用二醋酸荧光素）、定量培养和抗酸金胺显微镜检查均重复进行三次。
结核杆菌定量活力显微镜检查可预测定量培养结果，76%的结果在±1对数范围内相符（rS = 0.85；P <.0001）。在31例非耐多药（MDR）结核病患者中，活力和定量培养结果每天大约减半（均减少0.27对数，P <.001）。对于有非MDR结核病且有可用数据的患者，到治疗第9天，100%（24/24）的病例活力降低超过10倍，95%（19/20）的病例定量培养结果降低。另外4例随后被发现患有MDR结核病的患者在早期治疗期间活力（P = 0.4）或定量培养（P = 0.6）结果无显著变化。非MDR结核病患者和MDR结核病患者在早期治疗期间活力和定量培养结果的变化有显著差异（均P <.001）。抗酸显微镜检查结果在早期治疗期间变化很小，非MDR结核病与MDR结核病的这种变化相似（P = 0.
