Walaza Sibongile, Tempia Stefano, Dreyer Andries, Dawood Halima, Variava Ebrahim, Martinson Neil A, Moyes Jocelyn, Cohen Adam L, Wolter Nicole, von Mollendorf Claire, von Gottberg Anne, Haffejee Sumayya, Treurnicht Florette, Hellferscee Orienka, Ismail Nazir, Cohen Cheryl
Centres for Respiratory Diseases and Meningitis and.
Public Health.
Open Forum Infect Dis. 2017 Aug 7;4(3):ofx116. doi: 10.1093/ofid/ofx116. eCollection 2017 Summer.
Understanding the burden and clinical presentation of tuberculosis in patients with severe respiratory illness (SRI) has important implications for anticipating treatment requirements.
Hospitalized patients aged ≥15 years with SRI at 2 public teaching hospitals in periurban areas in 2 provinces (Edendale Hospital in Pietermaritzburg, KwaZulu-Natal Province and Tshepong Hospital in Klerksdorp, North West Province) were enrolled prospectively from 2012 to 2014. Tuberculosis testing included smear microscopy, culture, or Xpert MTB/Rif.
We enrolled 2486 individuals with SRI. Of these, 2097 (84%) were tested for tuberculosis, 593 (28%) were positive. Tuberculosis detection rate was 18% (133 of 729) in individuals with acute (≤14 days) presentation and 34% (460 of 1368) in those with chronic (>14 days) presentation. Among laboratory-confirmed tuberculosis cases, those with acute presentation were less likely to present with cough (88% [117 of 133] vs 97% [447 of 460]; ajusted odds ratio [aOR] = 0.2, 95% confidence interval [CI] = 0.1-0.5), night sweats (57% [75 of 132] vs 73% [337 of 459]; aOR = 0.4, 95% CI = 0.3-0.7), or be started on tuberculosis treatment on admission (63% [78 of 124] vs 81% [344 of 423]; aOR = 0.4, 95% CI = 0.3-0.7), but they were more likely to be coinfected with pneumococcus (13% [16 of 124] vs 6% [26 of 411]; aOR 2.3, 95% CI 1.3-5.3) than patients with chronic presentation. Annual incidence of acute and chronic tuberculosis-associated SRI per 100000 population was 28 (95% CI = 22-39) and 116 (95% CI = 104-128), respectively.
In this setting, tuberculosis, including acute presentation, is common in patients hospitalized with SRI.
了解重症呼吸系统疾病（SRI）患者中结核病的负担和临床表现对于预测治疗需求具有重要意义。
2012年至2014年，前瞻性纳入了两个省城郊地区两家公立教学医院中年龄≥15岁的SRI住院患者（夸祖鲁 - 纳塔尔省彼得马里茨堡的伊登代尔医院和西北省克莱克斯多普的切蓬医院）。结核病检测包括涂片显微镜检查、培养或Xpert MTB/Rif检测。
我们纳入了2486例SRI患者。其中，2097例（84%）接受了结核病检测，593例（28%）检测呈阳性。急性（≤14天）发病患者的结核病检出率为18%（729例中的133例），慢性（>14天）发病患者的检出率为34%（1368例中的460例）。在实验室确诊的结核病病例中，急性发病患者出现咳嗽的可能性较小（88%[133例中的117例]对97%[460例中的447例]；校正优势比[aOR]=0.2，95%置信区间[CI]=0.1 - 0.5）、盗汗的可能性较小（57%[132例中的75例]对73%[459例中的337例]；aOR = 0.4，95% CI = 0.3 - 0.7），或入院时开始接受结核病治疗的可能性较小（63%[124例中的78例]对81%[423例中的344例]；aOR = 0.4，95% CI = 0.3 - 0.7），但与慢性发病患者相比，他们更易合并肺炎球菌感染（13%[124例中的16例]对6%[411例中的26例]；aOR 2.3，95% CI 1.3 - 5.3）。每10万人口中急性和慢性结核病相关SRI的年发病率分别为28（95% CI = 22 - 39）和116（95% CI = 104 - 128）。
在这种情况下，包括急性发病的结核病在因SRI住院的患者中很常见。
