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新加坡传染性肺结核患者的 IGRA 阴性密切接触者中结核病的危险因素。

Risk factors for tuberculosis among close IGRA-negative contacts of persons with infectious tuberculosis in Singapore.

机构信息

National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore.

National Tuberculosis Registry, National Tuberculosis Programme, Singapore.

出版信息

Int J Infect Dis. 2024 Oct;147:107166. doi: 10.1016/j.ijid.2024.107166. Epub 2024 Jul 9.

Abstract

OBJECTIVES

Contacts of patients with infectious tuberculosis (TB) testing positive on interferon-gamma release assay (IGRA) are followed up to exclude active disease. However, identifying factors that predispose IGRA-negative contacts to TB could improve screening and follow-up strategies in a medium TB burden country such as Singapore.

METHODS

We conducted a retrospective study of IGRA-negative contacts aged ≥2 years identified during contact investigation between January 2014 and December 2022. We examined the risk factors associated with developing active TB among contacts previously testing IGRA-negative, using univariate and multivariable logistic regression and odds ratios with 95% confidence intervals.

RESULTS

Of 60,377 IGRA-negative contacts, 150 developed TB disease, and half were notified within 23 months of index patient diagnosis. IGRA-negative contacts of a smear-positive index patient were more likely to develop TB. Independent risk factors for TB were age >50 years, Malay ethnicity, having diabetes or end-stage renal failure, a "family" relationship with the index patient, or exposure in a dormitory or nursing home.

CONCLUSIONS

Identifying risk factors could help optimise follow-up strategies and preventive treatment in IGRA-negative individuals. The incidence rate of TB in this group was 150 per 100,000 population, substantially higher than in the community, with a median 92 weeks to develop disease. Findings suggest that follow-up should be extended to 24 months for contacts with these risk factors.

摘要

目的

对干扰素-γ释放试验(IGRA)阳性的传染性肺结核(TB)患者的接触者进行随访,以排除活动性疾病。然而,确定使 IGRA 阴性接触者易患 TB 的因素,可以改善在新加坡等中 TB 负担国家的筛查和随访策略。

方法

我们对 2014 年 1 月至 2022 年 12 月期间接触者调查中发现的年龄≥2 岁的 IGRA 阴性接触者进行了回顾性研究。我们使用单变量和多变量逻辑回归以及 95%置信区间的比值比,检查了先前 IGRA 阴性接触者发生活动性 TB 的相关危险因素。

结果

在 60377 名 IGRA 阴性接触者中,有 150 人患上了 TB 病,其中一半是在索引患者诊断后 23 个月内通知的。IGRA 阴性的痰涂片阳性索引患者的接触者更有可能患上 TB。TB 的独立危险因素是年龄>50 岁、马来族裔、患有糖尿病或终末期肾病、与索引患者有“家庭”关系、或在宿舍或疗养院接触。

结论

确定危险因素可以帮助优化 IGRA 阴性个体的随访策略和预防治疗。该组的 TB 发病率为每 100,000 人 150 例,远高于社区,中位发病时间为 92 周。研究结果表明,对于具有这些危险因素的接触者,随访时间应延长至 24 个月。

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