Feasibility of Identifying Household Contacts of Rifampin-and Multidrug-resistant Tuberculosis Cases at High Risk of Progression to Tuberculosis Disease

被引：31

作者：

Gupta, Amita ^{[1
,2
]}

Swindells, Susan ^{[3
]}

Kim, Soyeon ^{[4
]}

Hughes, Michael D. ^{[5
]}

Naini, Linda ^{[6
]}

Wu, Xingye ^{[5
]}

Dawson, Rodney ^{[7
,8
]}

Mave, Vidya ^{[1
,2
]}

Sanchez, Jorge ^{[9
]}

Mendoza, Alberto ^{[10
]}

Gonzales, Pedro ^{[9
]}

Kumarasamy, Nagalingeswaran ^{[11
]}

Comins, Kyla ^{[10
]}

Conradie, Francesca ^{[12
]}

Shenje, Justin ^{[13
]}

Fontain, Sandy Nerette ^{[14
]}

Garcia-Prats, Anthony ^{[15
]}

Asmelash, Aida ^{[16
]}

Nedsuwan, Supalert ^{[17
]}

Mohapi, Lerato ^{[18
]}

Lalloo, Umesh G. ^{[19
]}

Garcia Ferreira, Ana Cristina ^{[20
]}

Mugah, Christopher ^{[21
]}

Harrington, Mark ^{[22
]}

Jones, Lynne ^{[4
]}

Cox, Samyra R. ^{[1
]}

Smith, Betsy ^{[23
]}

Shah, N. Sarita ^{[24
]}

Hesseling, Anneke C. ^{[15
]}

Churchyard, Gavin ^{[25
,26
,27
]}

机构：

[1] Johns Hopkins Univ, Dept Med, Baltimore, MD 21287 USA

[2] Johns Hopkins Univ, Byramjee Jeejeebhoy Govt Med Coll, Clin Res Site, Pune, Maharashtra, India

[3] Univ Nebraska Med Ctr, Omaha, NE USA

[4] Frontier Sci & Technol Res Fdn Inc, Amherst, NY USA

[5] Harvard TH Chan Sch Publ Hlth, Boston, MA USA

[6] Social & Sci Syst, Silver Spring, MD USA

[7] Univ Cape Town, Lung Inst, Cape Town, South Africa

[8] Univ Cape Town, Dept Med, Cape Town, South Africa

[9] Asociac Civil Impacta Salud & Educ, Lima, Peru

[10] Task Appl Sci Clin Res Site, Bellville, South Africa

[11] Chennai Antiviral Res & Treatment Clin Res Site, Chennai, Tamil Nadu, India

[12] Univ Witwatersrand, Helen Joseph Hosp, Johannesburg, South Africa

[13] South African TB Vaccine Initiat, Cape Town, South Africa

[14] GHESKIO Ctr Inst Infect Dis & Reprod Hlth, Port Au Prince, Haiti

[15] Stellenbosch Univ, Desmond Tutu TB Ctr, Dept Paediat & Child Hlth, Cape Town, South Africa

[16] Gaborone Clin Res Site, Gaborone, Botswana

[17] PHPT Changrai Prachanukroh Hosp, Chiang Rai, Thailand

[18] Univ Witwatersrand, Soweto Clin Res Site, Johannesburg, South Africa

[19] Durban Univ Technol, Durban Int Clin Res Site, Durban, South Africa

[20] Fiocruz MS, INI, Rio De Janeiro, Brazil

[21] Kenya Govt Med Res Ctr, Kisumu, Kenya

[22] Treatment Act Grp, New York, NY USA

[23] NIH, Bldg 10, Bethesda, MD 20892 USA

[24] US Ctr Dis Control & Prevent, Atlanta, GA USA

[25] Aurum Inst, Parktown, South Africa

[26] Univ Witwatersrand, Sch Publ Hlth, Johannesburg, South Africa

[27] South African Med Res Council, Advancing Care & Treatment, Johannesburg, South Africa

来源：

CLINICAL INFECTIOUS DISEASES | 2020年 / 70卷 / 03期

关键词：

household contacts; multidrug-resistant tuberculosis; TB infection; TB disease; preventive therapy; TRANSMISSION; YIELD;

D O I：

10.1093/cid/ciz235

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. We assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial. Methods. We conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing. Results. From October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged >= 5 and were infected with HIV; and 610 (61%) were aged >= 5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy. Conclusions. The majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.

引用

页码：425 / 435

页数：11

共 30 条

[21] Yield of intensified tuberculosis case-finding activities using Xpert (R) MTB/RIF among risk groups in Nepal [J].