Boardman Nicole J, Moore Tiffany, Freiman Jennifer, Tagliaferri Geri, McMurray Dakota, Elson Diana, Lederman Edith
United States Immigration and Customs Enforcement Health Service Corps, Washington, District of Columbia, USA.
Clin Infect Dis. 2021 Jul 1;73(1):115-120. doi: 10.1093/cid/ciaa434.
Rapid screening for tuberculosis (TB) disease at intake into immigrant detention facilities allows for early detection and treatment. Detention facilities with United States Immigration and Customs Enforcement (ICE) Health Service Corps (IHSC) medical staffing utilize chest radiography and symptom screening as the primary screening for pulmonary TB (PTB) disease. This analysis describes the demographic, clinical, and microbiological characteristics of individuals identified with TB disease at these facilities.
We conducted a retrospective analysis to describe the population of immigrant detainees identified via chest radiography with PTB disease between 1 January 2014 and 31 December 2016 at facilities with IHSC medical staffing. We collected demographic variables, clinical presentation, diagnostic testing results, and microbiological findings. We generated descriptive statistics and examined univariate and multivariate associations between the variables collected and symptomatic status.
We identified 327 patients with confirmed PTB disease (incidence rate, 92.8 per 100 000); the majority of patients were asymptomatic (79.2%) at diagnosis. Adjusting for all other variables in the model, the presence of cavitary lesions, acid-fast bacillus smear positivity, and multilobar presentation were significantly associated with symptomatic status. Among all patients identified with TB disease who had a tuberculin skin test (TST) result recorded, 27.2% were both asymptomatic and TST negative, including those with smear-positive disease.
Asymptomatic PTB disease is a significant clinical entity among immigrant detainees and placement in a congregate setting calls for aggressive screening to prevent transmission. Early identification, isolation, and treatment of TB disease benefit not only the health of the patient, but also the surrounding community.
在移民拘留设施接收移民时快速筛查结核病，有助于早期发现和治疗。配备美国移民和海关执法局（ICE）卫生服务团（IHSC）医务人员的拘留设施，将胸部X光检查和症状筛查作为肺结核（PTB）疾病的主要筛查手段。本分析描述了在这些设施中确诊患有结核病的人员的人口统计学、临床和微生物学特征。
我们进行了一项回顾性分析，以描述2014年1月1日至2016年12月31日期间在配备IHSC医务人员的设施中，通过胸部X光检查确诊患有PTB疾病的移民被拘留者群体。我们收集了人口统计学变量、临床表现、诊断检测结果和微生物学检查结果。我们生成了描述性统计数据，并研究了所收集变量与症状状态之间的单变量和多变量关联。
我们确定了327例确诊患有PTB疾病的患者（发病率为每10万人92.8例）；大多数患者在诊断时无症状（79.2%）。在模型中对所有其他变量进行调整后，空洞性病变、抗酸杆菌涂片阳性和多叶表现与症状状态显著相关。在所有记录了结核菌素皮肤试验（TST）结果的结核病确诊患者中，27.2%既无症状且TST结果为阴性，包括涂片阳性患者。
无症状PTB疾病在移民被拘留者中是一个重要的临床问题，在集体环境中安置需要积极筛查以防止传播。结核病的早期识别、隔离和治疗不仅有利于患者健康，也有利于周围社区。
