Department of Global Health, Amsterdam University Medical Centers, Amsterdam, Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.
Department of Global Health, Amsterdam University Medical Centers, Amsterdam, Netherlands.
Lancet Infect Dis. 2024 Jul;24(7):726-736. doi: 10.1016/S1473-3099(24)00011-2. Epub 2024 Mar 12.
Subclinical pulmonary tuberculosis, which presents without recognisable symptoms, is frequently detected in community screening. However, the disease category is poorly clinically defined. We explored the prevalence of subclinical pulmonary tuberculosis according to different case definitions.
We did a one-stage individual participant data meta-analysis of nationally representative surveys that were conducted in countries with high incidence of tuberculosis between 2007 and 2020, that reported the prevalence of pulmonary tuberculosis based on chest x-ray and symptom screening in participants aged 15 years and older. Screening and diagnostic criteria were standardised across the surveys, and tuberculosis was defined by positive Mycobacterium tuberculosis sputum culture. We estimated proportions of subclinical tuberculosis for three case definitions: no persistent cough (ie, duration ≥2 weeks), no cough at all, and no symptoms (ie, absence of cough, fever, chest pain, night sweats, and weight loss), both unadjusted and adjusted for false-negative chest x-rays and uninterpretable culture results.
We identified 34 surveys, of which 31 were eligible. Individual participant data were obtained and included for 12 surveys (620 682 participants) across eight countries in Africa and four in Asia. Data on 602 863 participants were analysed, of whom 1944 had tuberculosis. The unadjusted proportion of subclinical tuberculosis was 59·1% (n=1149/1944; 95% CI 55·8-62·3) for no persistent cough and 39·8% (773/1944; 36·6-43·0) for no cough of any duration. The adjusted proportions were 82·8% (95% CI 78·6-86·6) for no persistent cough and 62·5% (56·6-68·7) for no cough at all. In a subset of four surveys, the proportion of participants with tuberculosis but without any symptoms was 20·3% (n=111/547; 95% CI 15·5-25·1) before adjustment and 27·7% (95% CI 21·0-36·4) after adjustment. Tuberculosis without cough, irrespective of its duration, was more frequent among women (no persistent cough: adjusted odds ratio 0·79, 95% CI 0·63-0·97; no cough: adjusted odds ratio 0·76, 95% CI 0·62-0·93). Among participants with tuberculosis, 29·1% (95% CI 25·2-33·3) of those without persistent cough and 23·1% (18·8-27·4) of those without any cough had positive smear examinations.
The majority of people in the community who have pulmonary tuberculosis do not report cough, a quarter report no tuberculosis-suggestive symptoms at all, and a quarter of those not reporting any cough have positive sputum smears, suggesting infectiousness. In high-incidence settings, subclinical tuberculosis could contribute considerably to the tuberculosis burden and to Mycobacterium tuberculosis transmission.
Mr Willem Bakhuys Roozeboom Foundation.
无症状的亚临床肺结核常在社区筛查中发现。然而，该疾病类别在临床上的定义较差。我们根据不同的病例定义，探讨了亚临床肺结核的患病率。
我们对 2007 年至 2020 年间在结核病发病率高的国家进行的全国代表性调查进行了一项基于个体参与者数据的单阶段荟萃分析，这些调查基于年龄在 15 岁及以上的参与者的胸部 X 光和症状筛查，报告了肺结核的患病率。调查之间的筛查和诊断标准是标准化的，结核通过阳性分枝杆菌痰培养来定义。我们根据三种病例定义估计了亚临床结核病的比例：无持续咳嗽（即，持续时间≥2 周）、无咳嗽和无症状（即无咳嗽、发热、胸痛、盗汗和体重减轻），分别为未经调整和调整假阴性胸部 X 射线和无法解释的培养结果。
我们确定了 34 项调查，其中 31 项符合条件。我们获得了个人参与者的数据，并纳入了来自 8 个非洲国家和 4 个亚洲国家的 12 项调查（620682 名参与者）的数据进行分析。对 602863 名参与者的数据进行了分析，其中 1944 名患有结核病。未经调整的亚临床结核病比例为无持续咳嗽 59.1%（1149/1944；95%CI 55.8-62.3），任何持续时间的咳嗽无 39.8%（773/1944；36.6-43.0）。调整后的比例为无持续咳嗽 82.8%（95%CI 78.6-86.6），无咳嗽 62.5%（56.6-68.7）。在四个调查的一个子集中，无任何症状但患有结核病的参与者比例为未经调整的 20.3%（111/547；95%CI 15.5-25.1），调整后的为 27.7%（95%CI 21.0-36.4）。无论咳嗽持续时间如何，女性中无咳嗽的结核病更为常见（无持续咳嗽：调整后的优势比 0.79，95%CI 0.63-0.97；无咳嗽：调整后的优势比 0.76，95%CI 0.62-0.93）。在患有结核病的参与者中，29.1%（95%CI 25.2-33.3）无持续咳嗽者和 23.1%（18.8-27.4）无任何咳嗽者的痰液涂片检查呈阳性。
社区中大多数患有肺结核的人没有报告咳嗽，四分之一的人完全没有肺结核症状，而四分之一没有任何咳嗽的人痰液涂片检查呈阳性，这表明具有传染性。在高发病率地区，亚临床结核病可能会对结核病负担和分枝杆菌传播产生重大影响。
Willem Bakhuys Roozeboom 基金会。
