Ge Shijia, Liu Kui, Jiang Xineng, Feng Zhen, Chen Songhua, Feng Yaling, Jiang Guoyong, Yu Zhicheng, Song Lingyun, Shao Lingyun, Zhang Yilin, Sun Feng, Li Tao, Chen Bin, Li Yang, Zhang Wenhong
Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
Shanghai Sci-Tech Inno Center for Infection and Immunity, Shanghai, China.
Open Forum Infect Dis. 2025 May 12;12(5):ofaf275. doi: 10.1093/ofid/ofaf275. eCollection 2025 May.
Individuals with asymptomatic tuberculosis (TB) are considered a significant risk to the disease burden and transmission. However, the progression and treatment for asymptomatic TB remain incompletely described.
This prospective cohort study was embedded within a prevalence survey conducted in 2021 and 2022 in Lanxi County, China. All patients with pulmonary TB who consented to participate would be included in the study and were categorized as asymptomatic or symptomatic. For the primary analysis, asymptomatic TB was defined as the absence of current cough, fever, night sweats, weight loss, or hemoptysis. Patients were followed up until 10 November 2024.
Among 109 345 individuals screened, 193 were included, of whom 101 (52.3%) were symptomatic and 92 (47.7%) were asymptomatic. The proportion of asymptomatic TB varied from 32.5% to 62.7% depending on varying symptom negative threshold. Fewer asymptomatic patients were bacteriologically confirmed compared to symptomatic patients (71.7% [66/92] vs 90.1% [91/101], = .001). The median time for asymptomatic patients at screening to develop symptoms was 102 days. Most patients in both groups received treatment for active TB (97.8% vs 99.0%, = .606). The treatment success rate among asymptomatic patients was comparable to that of symptomatic patients (93.3% vs 96.0%, = .521), but their treatment duration was significantly shorter (196 vs 273 days, < .001).
In the community setting, a significant number of TB cases were asymptomatic and remained so for months. These cases demonstrated satisfactory treatment coverage and outcomes, with shorter durations compared to symptomatic TB, suggesting the potential for developing shorter regimens for asymptomatic TB.
无症状结核病患者被认为是疾病负担和传播的重大风险因素。然而，无症状结核病的进展和治疗情况仍未得到充分描述。
这项前瞻性队列研究纳入了2021年和2022年在中国兰西县进行的患病率调查。所有同意参与的肺结核患者均纳入研究，并分为无症状或有症状两类。在初步分析中，无症状结核病被定义为目前无咳嗽、发热、盗汗、体重减轻或咯血症状。对患者进行随访至2024年11月10日。
在筛查的109345人中，有193人被纳入研究，其中101人（52.3%）有症状，92人（47.7%）无症状。根据不同的症状阴性阈值，无症状结核病的比例在32.5%至62.7%之间变化。与有症状患者相比，无症状患者经细菌学确诊的较少（71.7%[66/92]对90.1%[91/101]，P = 0.001）。无症状患者在筛查时出现症状的中位时间为102天。两组中的大多数患者都接受了活动性结核病治疗（97.8%对99.0%，P = 0.606）。无症状患者的治疗成功率与有症状患者相当（93.3%对96.0%，P = 0.521），但他们的治疗时间明显更短（196天对273天，P < 0.001）。
在社区环境中，相当数量的结核病病例是无症状的，且持续数月。这些病例显示出令人满意的治疗覆盖率和结果，与有症状结核病相比治疗时间更短，这表明有可能为无症状结核病制定更短的治疗方案。
