Department of Respiratory Medicine, Homerton University Hospital, London, Department of Respiratory Medicine.
Department of Respiratory Medicine, School of Basic & Medical Biosciences, King's College London, London.
Int J Tuberc Lung Dis. 2018 Aug 1;22(8):863-870. doi: 10.5588/ijtld.17.0652.
Although cough in tuberculosis (TB) is presumed to be important for transmission, there is little objective supporting evidence.
To describe 24-h cough frequency in a group with TB, and investigate associations with household rates of infection.
Patients with a new diagnosis of pulmonary TB underwent 24-h cough frequency measurement at or just before initiation of anti-tuberculosis treatment. A group with latent Mycobacterium tuberculosis infection (LTBI) acted as controls. Rates of infection among household contacts of sputum smear-positive TB were measured using the interferon-gamma release assay and the tuberculin skin test, and compared with variables relating to the contacts themselves, and to the index case, including cough frequency.
Daily cough frequency in TB patients (n = 44) was variable (geometric mean [GM] 174, interquartile range [IQR] 68-475 coughs/24 h), higher than in LTBI (n = 17; GM 19 coughs/24 h, IQR 8-53; P < 0.001), and higher during the day than overnight (GM 8.9 coughs/h, IQR 4.1-19.0 vs. GM 2.9 coughs/h, IQR 0.7-13.4; P < 0.0001). Also, 24-h cough frequency in TB was associated with sputum smear status (P = 0.040), but not smoking (P = 0.475). Multivariable logistic regression confirmed that infection in contacts was independently associated with index case sputum smear grade (P = 0.014) and cough frequency (P = 0.022).
Measurement of 24-h cough frequency in pulmonary TB helps predict infectiousness and transmission patterns.
虽然结核病（TB）患者的咳嗽被认为对传播很重要，但很少有客观的证据支持这一点。
描述一组结核病患者的 24 小时咳嗽频率，并研究其与家庭感染率的关系。
新诊断为肺结核的患者在开始抗结核治疗之前或同时进行 24 小时咳嗽频率测量。潜伏性结核分枝杆菌感染（LTBI）患者作为对照组。使用干扰素释放试验和结核菌素皮肤试验测量痰涂片阳性结核病患者家庭接触者的感染率，并将其与接触者自身以及与索引病例相关的变量（包括咳嗽频率）进行比较。
TB 患者（n = 44）的日咳嗽频率变化较大（几何平均值[GM]为 174，四分位距[IQR]为 68-475 次/24 h），高于 LTBI 患者（n = 17；GM 为 19 次/24 h，IQR 为 8-53；P < 0.001），白天高于夜间（GM 为 8.9 次/小时，IQR 为 4.1-19.0 与 GM 为 2.9 次/小时，IQR 为 0.7-13.4；P < 0.0001）。此外，TB 患者的 24 小时咳嗽频率与痰涂片状态相关（P = 0.040），但与吸烟无关（P = 0.475）。多变量逻辑回归证实，接触者的感染与索引病例的痰涂片等级（P = 0.014）和咳嗽频率（P = 0.022）独立相关。
测量肺结核患者的 24 小时咳嗽频率有助于预测传染性和传播模式。
