涂阳肺结核患者密切接触者的结核病检出情况分析

目的 了解涂阳肺结核患者密切接触者中肺结核的发病情况,为结核病防控策略的制定提供科学依据。 方法 通过对1-138例涂阳肺结核患者的家庭密切接触者的X线和痰涂片检查来分析他们的结核病患病情况。同时,分析涂阳肺结核患者的密切接触者中患者配偶、父母和子女以及有无结核可疑症状者的家庭密切接触者和不同排菌程度肺结核患者的密切接触者中肺结核患者的检出情况。 结果涂阳肺结核患者家庭密切接触者中活动性肺结核患者的检出率为3.3%;涂阳肺结核患者家庭密切接触者中活动性肺结核患者的检出率配偶最高,分别是患者父母的1.9倍和患者子女的16倍;有结核可疑症状者的活动性肺结核患者检出率是无结核可疑症状者的活动性肺结核患者检出率的6.4倍,2者差异有统计学意义（μ＝7.8,P＜0.01）;涂片3+患者的密切接触者中活动性肺结核患者的检出率比涂片2+患者和涂片1+患者的密切接触者分别高出1.8和2.4个百分点。 结论 涂阳肺结核患者家庭密切接触者的结核病患病情况明显高于普通人群,特别是对患者的配偶、家庭密切接触者中有结核可疑症状者和排菌严重肺结核患者的家庭密切接触者应重点关注。因此,应加强对涂阳肺结核患者家庭密切接触者的监测和检查,尽早发现患者,缩短肺结核患者对正常人群的感染传播。     

涂阳肺结核病人家庭密切接触者筛查情况分析

目的了解涂阳肺结核病人家庭密切接触者中活动性肺结核检出情况。方法接受检查的家庭密切接触者771人,年龄〈15岁儿童进行结核菌素纯蛋白衍生物实验,对结核菌素强阳性反应（硬结≥20 mm或局部伴有水泡等）的儿童,和≥15岁人群均拍摄X线胸片,对X线胸片提示肺部有异常阴影者进行痰涂片和痰培养检查。结果涂阳肺结核病人家庭密切接触者中活动性肺结核病人检出率为3.8%,涂阳肺结核检出率为0.8%。肺部病灶有空洞和排菌量大的病人其家庭密切接触者活动性肺结核检出率高。家庭密切接触者中年龄〉60岁组其活动性肺结核检出率高于其他组,经统计学处理,与15~60岁组比,差异有统计学意义（P〈0.05）。结论对涂阳肺结核病人家庭密切接触者摄X线胸片筛查,有助于提高肺结核病人发现率,是发现肺结核病例的一种有效手段。     

涂阳肺结核病人家庭密切接触者X线胸片筛检情况分析

目的了解涂阳肺结核病人家庭密切接触者中活动性肺结核检出情况。方法接受检查的家庭密切接触者771人,年龄＜15岁儿童进行结核菌素纯蛋白衍生物试验,对结核菌素反应≥10mm或虽＜10mm但伴有水泡等强反应的儿童,和≥15岁人群均摄X线胸片,对X线胸片提示肺部有异常阴影者进行痰涂片和痰培养检查。结果涂阳肺结核病人家庭密切接触者中活动性肺结核病人检出率为3.8%,涂阳肺结核检出率为0.8%。肺部病灶有空洞和排菌量大的病人其家庭密切接触者活动性肺结核检出率高。家庭密切接触者中年龄＞60岁组其活动性肺结核检出率高于其他组,经统计学处理,与15～60岁组比,差异有统计学意义。结论对涂阳肺结核病人家庭密切接触者摄X线胸片筛查,有助于提高肺结核病人发现率,是发现肺结核病例的一种有效手段。     

涂阳肺结核患者密切接触者结核感染及危险因素分析

目的了解涂阳肺结核患者密切接触者结核感染情况及影响因素。方法采用T-SPOT.TB试剂盒检测与76例涂阳肺结核患者的243例密切接触者结核潜伏感染(LTBI)情况,采用Pearsonχ2检验分析LTBI的影响因素。结果 248例密切接触者中活动性肺结核检出率为2.02%,在243例密切接触者(剔除5例活动性肺结核患者)中T-SPOT.TB的阳性率为46.9%,经单因素分析显示于涂阳肺结核患者确诊前2个月内接触者及夫妻关系的密切接触者,LTBI危险性高,且差异有统计学意——分别为(χ2=6.925,P=0.006)和(χ2=8.447,P=0.038)。结论与涂阳肺结核患者密切接触者较普通人群结核感染发生率高,且不同接触人群LTBI发生比率不同。     

对广州市涂阳肺结核患者家庭密切接触者筛查的情况分析

目的 了解广州市涂阳肺结核患者(以下称“指示患者”)家庭密切接触者中活动性肺结核检出情况及有关影响因素.方法 采用整群分层随机抽样方法抽取广州市6个区的2011年1月至2011年12月在广州市结核病防治所登记的涂阳肺结核患者家庭密切接触者5664名进行结核病筛查现况调查,接受结核病筛查的家庭密切接触者5206名,对＜15岁的家庭密切接触者629名进行结核菌素纯蛋白衍生物(BCG-PPD)皮肤试验,其中结核菌素反应硬结平均直径≥15 mm或伴有水泡或溃破等强阳性反应的儿童144名;对≥15岁人群4577名拍摄胸片,胸片提示肺部有异常阴影者进行痰涂片和痰培养检查,用SPSS 16.0软件统计分析,计数资料及率的比较采取x2检验,P＜0.05为差异有统计学意义.结果 指示患者家庭密切接触者中活动性肺结核患者检出率为3.6％(187/5206),痰涂片阳性患者检出率为0.7％(36/5206),痰菌阳性患者检出率为1.3％(66/5206).629例15岁以下儿童BCG-PPD皮肤试验一般阳性和中度阳性的485名,强阳性144名,BCG-PPD皮肤试验强阳性儿童活动性肺结核检出率5.6％(8/144).指示患者家庭密切接触者中,男、女性活动性肺结核患者检出率分别为3.7％(86/2348)和3.5％(101/2858),差异无统计学意义(x2=0.062,P＞0.05).与指示患者是夫妻、父母或兄弟姐妹关系的密切接触者检出率分别为4.4％(74/1675)、4.3％(34/794)和5.7％(29/507),与指示患者是儿女或其他关系的检出率分别为2.4％(40/1682)和1.8％(10/548),不同关系组比较差异有统计学意义(x2=23.119,P＜0.01).初治指示患者家庭密切接触者检出率3.9％(160/4131),比复治指示患者家庭密切接触者检出率2.5％(27/1075)高,两组比较差异有统计学意义(x2=4.566,P＜0.05).结论 涂阳肺结核患者家庭密切接触者筛查是主动发现肺结核患者的有效手段,特别是初治指示患者的家庭密切接触者需更加注意,与指示患者是夫妻、父母或兄弟姐妹关系者是结核病筛查的重点.     

滨州市结核病防治院住院涂阳肺结核患者家庭密切接触者菌阳情况分析

发现涂阳患者、治愈菌阳患者，是我国结核病防治的重要措施之一。涂阳肺结核患者作为传染源，与之密切接触的家庭成员有高度被传染的危险，据报道在密切接触者中至少可检出1%～5%的新发活动性结核患者。本研究对山东省滨州市结核病防治院住院涂阳肺结核患者家庭密切接触者菌阳检出情况进行调查分析，为本地区制定肺结核患者发现、疫情控制措施提供参考。     

涂阳肺结核病人家庭密切接触者痰涂片阳性检出情况分析

目的了解涂阳肺结核病人家庭密切接触者痰涂片阳性检出情况。方法确认的家庭密切接触者36423人,每人提供3份痰标本(夜间痰、晨痰和即时痰),进行痰涂片检查。结果涂阳肺结核病人家庭密切接触者中涂阳检出率为1.0%;病人排菌量与家庭密切接触者涂阳检出率呈正相关关系;家庭密切接触者≤15岁年龄组和≥55岁以上年龄组的涂阳检出率要高于其他各组,分别为1.5%和2.1%,经统计学处理,有显著性差异。结论对涂阳病人家庭密切接触者进行痰涂片筛查,有助于提高涂阳病人的发现率。特别对排菌量在2+以上病人的家庭密切接触者,以及家庭密切接触者≤15年龄组和≥55岁年龄组的痰涂片筛查,可发现更多涂阳病人。     

武汉市635例初治涂阳肺结核患者家庭接触者肺结核发病情况分析

搜集2015年1月至2017年12月武汉市肺科医院住院的635例初治涂阳肺结核患者的临床资料,筛查1242名家庭接触者活动性肺结核的检出率。家庭接触者中活动性肺结核检出率为1.69%(21/1242)。家庭接触者中配偶、父母、子女或其他亲属活动性肺结核检出率分别为 1.51%(7/464)、3.66%(9/246)和0.94%(5/532),父母的肺结核检出率最高,差异有统计学意义(χ ²=7.036,P=0.008)。荧光染色分枝杆菌阳性、+、++、+++、++++患者家庭接触者检出率分别为0.60%(2/334)、0.50%(2/401)、1.11%(3/271)、4.32%(6/139)、8.25%(8/97),差异有统计学意义(χ ²=37.232,P=0.000)。初治涂阳肺结核并发气管支气管结核患者的家庭接触者活动性肺结核检出率为3.01%(10/332)。当初治涂阳肺结核患者痰菌量大、并发气管支气管结核,或接触者为患者父母则更易被传染。     

涂阳肺结核病人家庭密切接触者痰涂片阳性检出情况分析

目的 了解涂阳肺结核病人家庭密切接触者痰涂片阳性检出情况。方法确认的家庭密切接触者36423人，每人提供3份痰标本（夜间痰、晨痰和即时痰），进行痰涂片检查。结果涂阳肺结核病人家庭密切接触者中涂阳检出率为1．0％；病人排菌量与家庭密切接触者涂阳检出率呈正相关关系；家庭密切接触者≤15岁年龄组和≥55岁以上年龄组的涂阳检出率要高于其他各组，分别为1．5％和2．1％，经统计学处理，有显著性差异。结论对涂阳病人家庭密切接触者进行痰涂片筛查，有助于提高涂阳病人的发现率。特别对排菌量在2＋以上病人的家庭密切接触者，以及家庭密切接僦者≤15年龄组和≥55岁年龄组的痰涂片筛查．可发现理多涂阳病人．     

张掖市新涂阳肺结核病患者密切接触者的感染现状

目的了解甘肃省张掖市涂阳肺结核病患者密切接触者感染发病情况,及早发现活动性特别是传染性肺结核病患者,早期治疗,达到控制结核病传播的目的。方法对家庭密切接触者,15岁及以下人群做PPD试验、15岁以上人群胸透检查,对于PPD强阳性反应和胸透异常者拍后前位胸片一张,并要求送检3份痰标本,对发现的肺结核病患者,按照《中国结核病防治规划实施工作指南》的要求进行治疗管理。结果 2011—2015年张掖市登记的5 443例涂阳肺结核病患者,家庭密切接触者20 394人,平均每例新涂阳肺结核病患者有家庭密切接触者3.6例,接受检查的家庭密切接触者19 342人、受检率94.8%,接受检查的家庭密切接触者中检出涂阳肺结核病患者212例、检出率1.1%,差异有统计学意义(χ2=1.202,P0.01);家庭密切接触者中15岁及以下和55岁及以上年龄组患者最多,涂阳检出率分别为2.1%和1.8%,均高于其他年龄组,差异有统计学意义(χ2=38.131,P0.01)。结论对新涂阳患者家庭密切接触者进行痰涂片筛查,有助于提高涂阳患者发现率,特别是痰涂片"3+"以上的密切接触者,以及在家庭密切接触者中15岁及以下和55岁及以上年龄组的痰涂片筛查,可发现更多的涂阳患者。     

Risk factors for tuberculosis infection among household contacts in Bangkok, Thailand

A cross-sectional study was conducted to determine the prevalence of tuberculosis infection and risk factors for tuberculosis infection among household contacts aged less than 15 years in Bangkok, Thailand, between August 2002 and September 2003. During the study period, 342 index cases with sputum smear positive pulmonary tuberculosis patients were recruited into the study and their 500 household contacts aged under 15 years were identified. The prevalence of tuberculosis infection among household contacts was found to be 47.80% (95%CI = 43.41-52.19). In multivariate analysis, a generalized estimating equation (GEE) was used to determine the risk factors for tuberculosis infection among household contacts. The results indicated that the risk of tuberculosis infection was significantly associated with close contact (adjusted OR = 3.31, 95%CI = 1.46-7.45), exposure to female index case (adjusted OR = 2.75, 95%CI = 1.25-6.08), exposure to mother with tuberculosis (adjusted OR = 3.82, 95%CI = 1.44-10.14), exposure to father with tuberculosis (adjusted OR = 2.55, 95%CI = 1.19-5.46), exposure to index case with cavitation on chest radiograph (adjusted OR = 4.43, 95%CI = 2.43-8.05), exposure to index case with 3+ sputum smear grade (adjusted OR = 3.85, 95%CI = 1.92-7.70), and living in crowded household (adjusted OR = 2.63, 95%CI = 1.18-5.85). The distribution of tuberculosis infection and risk factors among contact cases are significant for health care staff in strengthening and implementing tuberculosis control programs in Thailand.     

An outbreak of Mycobacterium tuberculosis infection among young adults in close contact

We experienced an outbreak of tuberculosis among young adults in close contact. The index case (case 1) was 22-year-old builder and was symptomatic for 9 months before diagnosis as pulmonary tuberculosis (PTB). His sputum smear was positive for tubercle bacilli. On immediate family contacts examination carried out at our hospital, his brother and sister (case 3, case 4) were detected as having PTB. His mother (case 5) and father (case 6) were later detected as having PTB by their symptomatic visits after some months, as tuberculin test as not done at first examination. Case 7 was 19-year-old-man, and was undiagnosed for 5 months. His sputum smear was positive. Immediately, contacts examination for case 7 as carried out at our hospital, and his colleague (case 8) was detected as having PTB. By interview with the case 7, it was found that the case 1 and the case 7 were close friends and spent long time together. Case 10 was 30-year-old builder, and he was accidentally referred to our hospital and was diagnosed as PTB. By the interview with the case 10, it was found that the case 1 and case 10 were members of builders group. This fact was informed to the F health center, and contacts examination for other members of the group were carried out by the F health center, and two young men were detected as having PTB. Analysis of restriction fragment length polymorphism (RFLP) showed that the case 1, the case 5, the case 7, and the case 10 were caused by the same strain of M. tuberculosis. Based on these findings, it is highly suspected that this outbreak was origined from the case 1, and 13 developed tuberculosis and 13 were primarily infected among contacts. The characteristics of this outbreak was that the family and contacts examination were enforced and most of the cases were detected at our hospital. If the outbreak of tuberculosis highly suspected, physicians should actively cooperate with health centers for contacts examination.     

Is TB contact screening relevant in a developing country setting? Experiences from eastern Nepal, 1996-1998.

SETTING: A tuberculosis programme run by a non-governmental organisation in eight hill and mountain districts of eastern Nepal. OBJECTIVE: To assess the impact of contact screening on case-finding. DESIGN: A retrospective cohort study of contacts of smear-positive, smear-negative and extra-pulmonary tuberculosis patients diagnosed and registered during 1996-1998 ('index cases'). Contacts, defined as household members identified by index cases, were screened by sputum examination; two positive smears were taken to indicate smear-positive pulmonary disease. RESULTS: Approximately 50% (668) of registered cases identified contacts; 75% (2298) of the contacts identified provided one or more sputum specimens. An overall smear-positive case yield of 0.61% (14) was obtained from contacts tested, all except one of which were contacts of smear-positive index cases. For smear-positive index cases with a smear grading of > or = 2+, the yield was 7.2 times greater (P = 0.04) than for those with a grading of 1+. CONCLUSION: In this setting, sputum examination of household contacts of smear-negative and extrapulmonary tuberculosis cases is not justified. Further assessment is needed to evaluate the utility of testing contacts of smear-positive cases without symptom screening, and whether cost effectiveness can be improved by restricting testing to contacts of cases with high bacterial (> or = 2+) loads.     

Contact examination for tuberculosis in Hong Kong is useful.

SETTING: The tuberculosis programme of the Hong Kong Government Tuberculosis and Chest Service. OBJECTIVE: To determine the outcome of examination of household contacts in Hong Kong. DESIGN: A retrospective cohort study of all household contacts of 970 randomly selected index cases from a total of 5757 registered for treatment with the Chest Service. RESULTS: Of 2678 household contacts (three/index case) identified, 90% were examined; 41 active cases were found, at a rate of 1720/100000 (95%CI 1238-2329). The rate was highest among two extremes of age, 3604/100000 (95%CI 990-3615) in children < or = 5 years and 3347/100000 (95%CI 1456-6489) in those >60 years of age. Contacts of index cases whose sputum smear and culture were positive had the highest rate of disease, 2904/100000 (95%CI 1669-4673); but contacts with negative bacteriology also had a high rate of 1478/100000 (95%CI 678-2789). Active cases identified through contact tracing could be source cases rather than secondary cases. Eight per cent of children aged < or = 5 years had positive tuberculin reactions; as BCG vaccination is given to all newborns, with 99% coverage in Hong Kong in the past 30 years, it was difficult to estimate the rate of infection in these children. CONCLUSION: In Hong Kong, an area with an intermediate burden of tuberculosis, contact investigation is a very useful procedure for active case finding.     

一起校园肺结核疫情的流行病学调查分析

目的 对一起校园肺结核疫情进行调查和分析,发现学校结核病疫情处置工作中的难点和不足,为完善学校结核病控制策略提供思路和建议。方法 采用描述性流行病学方法,对2020年10月至2021年6月一起学校结核病疫情进行流行病学调查和分析。同时采用结核菌素皮肤试验(tuberculin skin test, TST)和胸部X线摄片(简称“胸片”)开展肺结核筛查和密切接触者调查。结果 在确诊1例痰涂片阳性肺结核病例之后,共开展4次密切接触者筛查并陆续确诊4例活动性结核病病例。其中,针对指示病例的54名密切接触者(学生47名,教职工7名)开展首次调查时,调查对象的胸片均未见异常,学生的TST强阳性率为4.44%(2/45),教职员工为1/7。本次疫情TST强阳性且排除活动性结核病的学生无人接受预防性治疗。与首次筛查相比,后续筛查中与指示病例同宿舍的学生TST阳转率为6/8、同小组学习的学生TST阳转率为4/5、经常性共同就餐的学生TST阳转率为3/3。此外,后续筛查中发现的4例肺结核新发患者均为随访过程中的TST阳转者。结论 本次学校肺结核疫情的流行病学调查分析提示,密切接触者调查和处置工作需要进一步加强,对新近感染的追踪应成为随访密切接触者的重要内容,预防性治疗对象的界定应更加明确并应提高预防干预的覆盖率。     

The value of contact procedures for tuberculosis in Edinburgh

We have reviewed the value of routine contact procedures (CP) in screening for tuberculosis in the Edinburgh area. Nine hundred and forty-seven index cases were notified during the 5-year period 1977-81; of these, 131 (14%) were detected by CP, 78 had previously undetected tuberculous disease and a further 53 required chemoprophylaxis (CPX). None had presented with symptoms, and disease was consequently detected at an earlier stage with fewer being sputum smear positive (10% vs 29% P less than 0.01). The 131 cases were found by CP during the screening of 4445 contacts, an overall yield of 2.9%. The highest yield was 18% for close contacts of sputum smear positive index cases, the yield for the casual contact being only 3%. The overall yield for contacts of smear negative respiratory and non-respiratory index cases was less than 2% in each group. Young contacts were particularly vulnerable and the yield in Asian children was 10.2%, twice that of the 4.9% in non-Asian children (P less than 0.001). The incidence of new cases in contacts who had previous BCG vaccination was significantly lower than that in non-vaccinated contacts (1.15% vs 3.06% P less than 0.001) suggesting a protective effect of 62%. One hundred and twenty-five (95%) of the 131 new cases were diagnosed within 3 months of first attendance, the remaining 5% at 6 months. The workload involved in screening contacts in this series could have been halved by restricting CP to all contacts of sputum smear positive index cases and only the close contacts of all other index cases. This would have resulted in missing 18% of the new cases, or three cases of tuberculosis and two cases requiring CPX per year, in a population of 608 000. Seventy-two (7.6%) of the 947 index cases were of Asian origin. Their disease occurred more in young adults, especially women, and was more frequently extrapulmonary in site (25% vs 12% in non-Asians P less than 0.01). We conclude that contact procedures remain valuable in the detection of new, asymptomatic cases of tuberculosis in Edinburgh and, by implication, in other urban areas of the United Kingdom. Particular efforts should be directed towards children, Asians and those without BCG vaccination, especially if they have been in contact with sputum smear positive index cases.     

四川省成都市入户调查集中推荐可疑症状者检查发现肺结核患者分析

目的 探讨入户调查、集中推荐发现病人方式对提高肺结核病人发现的作用。 方法 采取政府组织、部门参与、开展健康教育,发动群众自报互报;镇村干部配合、乡村医生入户调查、登记常住人口,以当面询问与观察的方式发现线索患者,并集中推荐到指定医院初筛,疑似患者由结防机构定诊。 结果 成都市于2009年先后在9个区县入户登记应调查人数3 910 504人,实际调查3 817 928人,调查率97.6%,新发现活动性肺结核411例,其中新发涂阳172例,占41.8%;新发现活动性病例数与涂阳新病例数分别占同期CDC登记总病例数的23.8%和21.9%。 结论 适时开展入户调查集中推荐可疑者就诊是提高病人发现率的有效方法 。通过入户调查、集中推荐工作的实施,有利于现代结核病控制策略落实到基层;有利于提高群众推荐可疑者、可疑者主动就诊的积极性,提高肺结核患者的发现。     

Infection and disease among household contacts of patients with multidrug-resistant tuberculosis.

SETTING: Urban public teaching and referral hospital in Espirito Santo, Brazil. OBJECTIVE: To assess whether rates of infection and progression to active tuberculosis (TB) differed between household contacts of patients with multidrug-resistant (MDR) and drug susceptible (DS) pulmonary tuberculosis. DESIGN: Household contacts were assessed for evidence of TB infection and disease by purified protein derivative (PPD) skin testing, physical examination, chest X-ray, and sputum smear and culture. RESULTS: Among 133 close contacts of patients with MDR-TB, 44% were PPD-positive (> or =10 mm) compared to 37% of 231 contacts of the DS-TB cases (P = 0.18, chi2 test, OR 1.2, 95%CI 0.8-2). In a multivariate logistic regression analysis, after allowance for between-household variation in PPD responses, PPD positivity among household contacts of patients with MDR-TB remained comparable to PPD positivity in contacts of patients with DS-TB (OR 2.1, 95%CI 0.7-6.5). Respectively six (4%) and 11 (4%) contacts of the MDR- and DS-TB cases were found to have active TB at the time of initial evaluation or during follow-up (P = 0.78, chi2 test). Five of six contacts of MDR-TB cases and nine of nine contacts of DS-TB cases who developed TB, and for whom drug susceptibility test results were available, had the same bacterial susceptibility profiles as their index cases. DNA fingerprinting analysis of Mycobacterium tuberculosis isolates was identical between household contacts with active TB and the index MDR or DS-TB case for all 14 pairs compared. CONCLUSION: Our data suggest that the prevalence of tuberculous infection and progression to active TB among household contacts exposed to DS and MDR-TB cases is comparable, despite a longer duration of exposure of contacts to the index case in patients with MDR-TB.     

Evaluation of active tuberculosis case finding through symptom screening and sputum microscopy of close contacts in Shandong, China

Objectives To evaluate the effect of active case finding through symptom screening and sputum microscopy of close contacts in a Fidelis (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) project. Methods Secondary data from all 35 counties were collected during implementation and used. They comprised new cases identified, number of close contacts screened and their relationships. Fifty‐four in‐depth interviews were conducted with staff from key stakeholders. Results A total of 13 310 symptomatic contacts of 5255 index cases were screened, and 90 new smear‐positive cases were detected with a yield rate of 0.7%. The yield rate of close contacts was positively associated with smear grades of the index cases (P < 0.01). Close contacts of cases, such as classmates and workmates, who lived in a closed contained setting, had a higher yield rate than family members (P < 0.001). Gaps in project implementation such as training, incentives and sputum collection were identified through in‐depth interviews. Conclusions The yield rate of close‐contact screening of 0.7% was similar to other findings in China. There was a higher yield from screening of close contacts in congregated settings like schools and workshops. Future active case finding projects should provide clear operational guidelines and adequate training.