USAID/Challenge TB, Addis Ababa, Ethiopia.
Oromia Regional Laboratory, Ministry of Health, Oromiya, Ethiopia.
BMC Infect Dis. 2019 Jan 17;19(1):60. doi: 10.1186/s12879-019-3716-x.
Every year around 4 million people with tuberculosis (TB) are not detected. Thus may not get the medical care that they need and deserve from their respective health systems. Ethiopia is included in the 12 countries who contribute 75% of the globally estimated "missed" cases. This study assessed if there are missed Pulmonary TB (PTB) cases among inpatients of a large referral hospital in Ethiopia.
A cross sectional survey was conducted in the general medical wards of the large referral hospital from June to August 2015. Inpatients not diagnosed with TB were screened for TB symptoms and requested to submit a morning sputum sample for smear microscopy and molecular testing by GeneXpert MTB/RIF assay. The results of the symptom screening, smear and GeneXpert testing were analyzed as the main outcome characteristics for "missed" PTB cases.
Over the 3-month period, 300 inpatients were evaluated for TB. The patients median age was 38 years (IQR 26-51.5), 41% were female, median reported duration of sickness before admission was 30 days (IQR 14-240), and median body mass index (BMI) was 21.5 (IQR 20-22.67). HIV status was documented for 198/300 (66%) of patients, 37 (18.7%) were found to be HIV positive, with a median CD4 count of 176 (IQR 52-400). All 300 inpatients submitted a sputum sample and 10 (3.3%) were found to be GeneXpert MTB positive, with 4/10 also being smear positive. All GeneXpert positive inpatients reported having a cough of > 2 weeks duration. Eight had at least 3 common symptoms of TB (i.e. cough, fever, weight loss or night sweat). Co-morbidity with Diabetes Mellitus (DM) and HIV was found in 1/10 and 4/10 cases respectively.
Bacteriological confirmed TB cases were found to have been "missed" amongst the general medical ward inpatients in the hospital. The identified TB cases all reported typical signs and symptoms of TB. Basic clinical practices were not being followed (i.e. history taking/documentation and requesting of appropriate laboratory tests) by the attending health care workers (HCWs) in the hospital. The index of suspicion for TB disease needs to improve and the use of more sensitive technologies, such as GeneXpert could assist the diagnosis of TB. However, the findings of the study need to be investigated in other hospital settings in Ethiopia.
每年约有 400 万结核病（TB）患者未被发现。因此，他们可能无法从各自的卫生系统获得所需的医疗护理。埃塞俄比亚是全球估计“漏报”病例中占 75%的 12 个国家之一。本研究评估了在埃塞俄比亚一家大型转诊医院的住院患者中是否存在潜伏性肺结核（PTB）病例。
2015 年 6 月至 8 月，在大型转诊医院的普通内科病房进行了横断面调查。未被诊断为结核病的住院患者进行了结核病症状筛查，并要求他们提交一份晨痰样本进行涂片显微镜检查和 GeneXpert MTB/RIF 检测。对症状筛查、涂片和 GeneXpert 检测结果进行分析，作为“漏诊”PTB 病例的主要结局特征。
在 3 个月的时间里，对 300 名住院患者进行了结核病评估。患者的中位年龄为 38 岁（IQR 26-51.5），41%为女性，中位入院前患病时间为 30 天（IQR 14-240），中位体重指数（BMI）为 21.5（IQR 20-22.67）。198/300（66%）名患者记录了 HIV 状况，其中 37 名（18.7%）HIV 阳性，中位 CD4 计数为 176（IQR 52-400）。所有 300 名住院患者都提交了一份痰样本，其中 10 份（3.3%）被发现 GeneXpert MTB 阳性，其中 4 份也为涂片阳性。所有 GeneXpert 阳性的住院患者均报告咳嗽时间超过 2 周。8 人有至少 3 种常见的结核病症状（即咳嗽、发热、体重减轻或夜间出汗）。10 例中有 1 例合并糖尿病（DM），4 例合并 HIV。
在医院的普通内科病房住院患者中发现了经过细菌学证实的结核病病例被“漏诊”。确诊的结核病病例均报告有典型的结核病症状和体征。医院的主治医护人员（HCWs）未遵循基本的临床实践（即病史采集/记录和适当的实验室检查请求）。对结核病疾病的怀疑指数需要提高，使用更敏感的技术，如 GeneXpert，可能有助于结核病的诊断。然而，该研究的结果需要在埃塞俄比亚的其他医院环境中进行调查。
