Triasih Rina, Robertson Colin, Duke Trevor, Graham Stephen M
Department of Pediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; Centre for International Child Health, Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Australia.
Trop Med Int Health. 2015 Jun;20(6):737-43. doi: 10.1111/tmi.12484. Epub 2015 Mar 6.
To identify characteristics of the child contact, index case or environment that are associated with infection or tuberculosis in child contacts in an urban community in Indonesia.
Children who were close contacts of an index case with pulmonary tuberculosis were screened for infection and disease in Yogyakarta, Indonesia from August 2010 to December 2012. Data of the index case and child were collected prospectively, and all child contacts had clinical assessment, tuberculin skin test (TST) and chest X-ray performed. Those with clinically suspected tuberculosis also had sputum examined by Xpert MTB/RIF and culture. Child contacts were managed according to national guidelines, followed for 12 months and had a final classification of either tuberculosis 'disease', latent tuberculous infection (LTBI) or 'exposed only'.
About 269 children of 141 index cases were investigated. Final classification was tuberculosis in 25 (9%) and LTBI in 121 (45%). The risk of infection was significantly greater if the source case was female (AOR 1.7; 95% CI: 1.0-2.8), had sputum smear-positive tuberculosis (AOR 3.0; 95% CI 1.5-6.0) or slept in the same room (AOR 1.7, 95% CI 1.0-2.9). A positive TST was independently associated with a diagnosis of tuberculosis (AOR 7.3; 95% CI 2.4-22).
This study highlights the high risk and the risk factors associated with tuberculosis and LTBI among child contacts in Indonesia.
确定在印度尼西亚一个城市社区中，与儿童接触者感染或患结核病相关的儿童接触者、索引病例或环境的特征。
2010年8月至2012年12月期间，在印度尼西亚日惹对肺结核索引病例的密切接触儿童进行感染和疾病筛查。前瞻性收集索引病例和儿童的数据，所有儿童接触者均进行临床评估、结核菌素皮肤试验（TST）和胸部X光检查。临床疑似结核病的患者还通过Xpert MTB/RIF和培养进行痰检。儿童接触者按照国家指南进行管理，随访12个月，并最终分类为结核病“疾病”、潜伏结核感染（LTBI）或“仅暴露”。
对141例索引病例的约269名儿童进行了调查。最终分类为结核病的有25例（9%），LTBI的有121例（45%）。如果源病例为女性（比值比1.7；95%置信区间：1.0 - 2.8）、痰涂片阳性肺结核（比值比3.0；95%置信区间1.5 - 6.0）或睡在同一房间（比值比1.7，95%置信区间1.0 - 2.9），感染风险显著更高。TST阳性与结核病诊断独立相关（比值比7.3；95%置信区间2.4 - 22）。
本研究强调了印度尼西亚儿童接触者中结核病和LTBI的高风险及相关危险因素。
