Lee Seung Chul, Yoon Soon Ho, Goo Jin Mo, Yim Jae Joon, Kim Chang Ki
Division of HIV and Tuberculosis Control, Korea Centers for Disease Control and Prevention, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2017 Nov;32(11):1779-1783. doi: 10.3346/jkms.2017.32.11.1779.
Close contacts with infectious tuberculosis (TB) are persons at high risk for developing active disease. We preliminarily introduced submillisievert chest computed tomography (CT) scan (effective dose, 0.19-0.25 millisievert) in a contact investigation of multi-drug resistant (MDR)-TB. Baseline CT scan showed minimal nodules or branching opacities in two of six contacts. A two-month follow-up examination revealed a radiologic progression in contact 1, subsequently having the microbiologic diagnosis of MDR-TB at an asymptomatic early stage, whereas nodules transiently increased after 3 months in contact 2, followed by a decrease after one year. Contact 1 was cured after 1.5-year of anti-MDR-TB treatment. In conclusion, early identification of secondary MDR-TB is feasible with submillisievert chest CT scans in contact investigations of MDR-TB, minimizing of MDR-TB transmission and offering a favorable treatment outcome. This was a clinical trial study and was registered at www.ClinicalTrials.gov (Identifier: NCT02454738).
感染性肺结核（TB）的密切接触者是发生活动性疾病的高危人群。我们在耐多药（MDR）-TB接触者调查中初步引入了亚毫西弗胸部计算机断层扫描（CT）（有效剂量为0.19 - 0.25毫西弗）。基线CT扫描显示，6名接触者中有2人有微小的结节或分支状混浊。两个月的随访检查显示接触者1出现了影像学进展，随后在无症状早期经微生物学诊断为MDR-TB，而接触者2的结节在3个月后短暂增加，1年后减小。接触者1经过1.5年的抗MDR-TB治疗后治愈。总之，在MDR-TB接触者调查中，通过亚毫西弗胸部CT扫描早期识别继发性MDR-TB是可行的，可最大限度减少MDR-TB传播并带来良好的治疗效果。这是一项临床试验研究，并已在www.ClinicalTrials.gov上注册（标识符：NCT02454738）。
