Parvaresh Laila, Bag Shopna K, Cho Jin-Gun, Heron Neil, Assareh Hassan, Norton Sophie, Corbett Stephen, Marais Ben J
Public Health Unit, Western Sydney Local Health District, North Parramatta, New South Wales, Australia.
The University of Sydney, Sydney, New South Wales, Australia.
BMJ Open Respir Res. 2018 Oct 25;5(1):e000341. doi: 10.1136/bmjresp-2018-000341. eCollection 2018.
Treatment of latent tuberculosis infection (LTBI) is an important component of strategies to achieve global tuberculosis (TB) elimination, but implementation is rarely monitored. This is a retrospective review of TB contact tracing outcomes at one of the busiest TB clinics in Australia, measured against the Centre for Disease Control and Prevention performance indicators. In total, 45 of 53 (85%) pulmonary TB cases had 171 close contacts, of whom 139 (81%) were evaluated with a tuberculin skin test (TST); 58 of 139 (42%) were positive at baseline. Among 57 close contacts of 16 sputum smear-positive TB cases, the elicitation, evaluation, initiation of LTBI treatment and completion rates were 93%, 86%, 14% and 100%, and among 114 close contacts of 37 sputum smear-negative pulmonary TB cases 81%, 83%, 16% and 89%, respectively. Of 79 contacts with an initial negative TST, 19 of 47 (40%) demonstrated TST conversion when retested; 5 of 19 (26%) were offered LTBI treatment. Four secondary TB cases were identified. One incident TB case developed a pleural effusion 5 months after TST conversion, despite LTBI treatment. Apart from young children, LTBI treatment was inconsistently initiated in household TB contacts. Safe and pragmatic treatment options, as well as functional monitoring frameworks, are essential to improve LTBI treatment implementation.
潜伏性结核感染（LTBI）的治疗是实现全球结核病消除战略的重要组成部分，但实施情况很少受到监测。这是一项对澳大利亚最繁忙的结核病诊所之一的结核病接触者追踪结果进行的回顾性研究，对照疾病控制与预防中心的绩效指标进行衡量。总共53例肺结核病例中的45例（85%）有171名密切接触者，其中139名（81%）接受了结核菌素皮肤试验（TST）评估；139名中的58名（42%）基线时呈阳性。在16例痰涂片阳性肺结核病例的57名密切接触者中，LTBI治疗的引出、评估、启动率和完成率分别为93%、86%、14%和100%，在37例痰涂片阴性肺结核病例的114名密切接触者中分别为81%、83%、16%和89%。在79名初始TST阴性的接触者中，47名中的19名（40%）再次检测时出现TST转换；19名中的5名（26%）接受了LTBI治疗。发现了4例继发性结核病例。1例新发结核病例在TST转换后5个月出现胸腔积液，尽管接受了LTBI治疗。除幼儿外，家庭结核病接触者中LTBI治疗的启动不一致。安全实用的治疗选择以及功能监测框架对于改善LTBI治疗的实施至关重要。
