埃塞俄比亚亚的斯亚贝巴涂片阴性疑似肺结核患者中结核病、耐多药结核病及相关危险因素的流行情况。
Prevalence of tuberculosis, multidrug resistant tuberculosis and associated risk factors among smear negative presumptive pulmonary tuberculosis patients in Addis Ababa, Ethiopia.
机构信息
Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Department of Medical Laboratory Science, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
BMC Infect Dis. 2019 Jul 19;19(1):641. doi: 10.1186/s12879-019-4241-7.
BACKGROUND
The diagnoses of active smear negative PTB, remains difficult. As a result, treatment is often carried out empirically relaying on clinical criteria. The distribution and magnitude of smear negative PTB, smear negative MDR-TB and associated factors in the same day diagnosis strategy are not clearly known in the study area. Therefore, this study aimed to determine the prevalence of TB, MDR-TB and associated risk factors among presumptive smear negative pulmonary tuberculosis patients in Addis Ababa, Ethiopia.
METHODS
Analytic cross sectional study design was used. A total of 418 smear negative presumptive pulmonary TB patients were enrolled from selected health facilities since August 01, 2017 to January 5, 2018. Sputum samples were examined by Ziehl Neelsen microscopy, Xpert MTB/RIF assay and Culture. Drug susceptibility testing was performed by line probe assay and BACTEC MGIT 960 system. These laboratory tests were performed in Ethiopian Public Health Institute, National TB Reference Laboratory. Data was analyzed by SPSS Ver.20.
RESULTS
From the total of 418 enrolled patients, 27 (6.5%) were Xpert MTB/ RIF and 26 (6.4%) were culture confirmed smear negative PTB patients. The positivity rate among male and female was 10.2 and 3.5% (p = 0.005) respectively. From 26 culture positive isolates 3 (11.54%) were MDR TB; from MDR-TB confirmed isolates 2/23 (8.7%) were among new and 1/3 (33.3%) was among retreatment smear negative presumptive pulmonary TB patients. All Rifampicin resistant smear negative pulmonary TB isolates by Xpert MTB/ RIF assay were found to be MDR TB and 7/26 (26.9%) isolates were INH mono resistant. History of migration found to be a potential factor for developing smear negative pulmonary TB.
CONCLUSION
In this study a significant proportion of smear negative pulmonary TB was diagnosed. Furthermore, a high smear negative multi drug resistant (MDR) TB and other mono drug resistant TB prevalence was confirmed. Due to the limitations of smear microscopy which is used as a primary diagnostic tool, these TB strains are missed to be diagnosed and transmission continues in the community.
背景
活动性痰涂片阴性肺结核（PTB）的诊断仍然具有挑战性。因此，治疗通常依赖于临床标准进行经验性治疗。在同一日诊断策略中，痰涂片阴性 PTB、痰涂片阴性耐多药结核分枝杆菌（MDR-TB）以及相关因素的分布和程度在研究区域尚不清楚。因此，本研究旨在确定在埃塞俄比亚亚的斯亚贝巴，疑似痰涂片阴性肺结核患者中结核病、耐多药结核病的流行率以及相关的危险因素。
方法
采用分析性横断面研究设计。2017 年 8 月 1 日至 2018 年 1 月 5 日，从选定的医疗机构共纳入 418 例疑似痰涂片阴性肺结核患者。痰标本经萋-尼氏染色显微镜检查、Xpert MTB/RIF 检测和培养进行检查。药物敏感性检测采用线性探针分析和 BACTEC MGIT 960 系统进行。这些实验室检测在埃塞俄比亚公共卫生研究所国家结核病参考实验室进行。数据采用 SPSS 版本 20 进行分析。
结果
在纳入的 418 例患者中，有 27 例（6.5%）Xpert MTB/RIF 阳性，26 例（6.4%）培养阳性为痰涂片阴性 PTB 患者。男性和女性的阳性率分别为 10.2%和 3.5%（p=0.005）。从 26 例培养阳性分离株中，有 3 株（11.54%）为耐多药结核分枝杆菌；在耐多药结核分枝杆菌确诊分离株中，有 2/23（8.7%）为新发病例，1/3（33.3%）为复治痰涂片阴性疑似肺结核患者。Xpert MTB/RIF 检测中所有利福平耐药的痰涂片阴性肺结核分离株均为耐多药结核分枝杆菌，26 株中有 7 株（26.9%）为异烟肼单耐药。有迁移史被认为是发展为痰涂片阴性肺结核的潜在因素。
结论
在这项研究中，相当一部分痰涂片阴性肺结核得到了诊断。此外，还证实了高比例的痰涂片阴性耐多药（MDR）结核分枝杆菌和其他单耐药结核分枝杆菌的患病率。由于作为主要诊断工具的痰涂片镜检存在局限性，这些结核分枝杆菌菌株被漏诊，在社区中继续传播。
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