Refining the definition of miliary/disseminated tuberculosis in Canada

IF 4.8 2区 医学 Q1 INFECTIOUS DISEASES
Yiming Huang, Richard Long, Giovanni Ferrara, Mary Lou Egedahl, Alexander Doroshenko, Courtney Heffernan, Catherine Paulsen, Ryan Cooper, Angela Lau
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引用次数: 0

Abstract

Objectives

Although a “multisite” definition of disseminated tuberculosis (DTB) exists, there is limited evidence to support its use. Herein, we sought to generate that evidence.

Methods

We evaluated treatment outcomes and reporting requirements against two distinct definitions of DTB in a 15-year population-based cohort of consecutively diagnosed patients with tuberculosis (TB) in Canada. Definitions were combined in a multi-variable logistic regression to determine the risk factors for TB-related death in DTB.

Results

We applied two mutually exclusive definitions of DTB to our data set: 1. “strict” - TB disease associated with a positive TB culture in blood/bone marrow or TB disease associated with a miliary pattern on chest imaging and a positive TB culture or, 2. multisite - TB disease in two or more non-contiguous sites. Among 2877 notified patients with TB, 110 (3.8%) met the strict definition, whereas 168 (5.8%) met the multisite definition. Of all 278 patients with DTB, only 135 (48.6%) were notified as DTB using International Classification of Disease codes and only 66 (23.7%) were classified as DTB by Canada's Public Health Agency. Patients with DTB by either definition were less likely to achieve cure/treatment completion and more likely to die. The risk factors for a fatal outcome included extremes of age, Canadian birth, central nervous system involvement, and HIV co-infection.

Conclusion

Our findings support the combination of a strict and multisite definition of DTB for purposes of reporting consistency and investigational comparability.
完善加拿大粟粒性/播散性结核病的定义。
目的:尽管存在关于播散性肺结核(DTB)的多部位定义,但支持其使用的证据却很有限。在此,我们试图提供这方面的证据:方法:我们根据两种不同的 DTB 定义,对加拿大连续诊断肺结核患者的 15 年人群队列中的治疗结果和报告要求进行了评估。在多变量逻辑回归中将两种定义结合起来,以确定 DTB 中与肺结核相关死亡的风险因素:我们对数据集采用了两种相互排斥的 DTB 定义:1. "严格"--与血液/骨髓结核菌培养阳性相关的肺结核病,或与胸部影像学表现为粟粒状形态和结核菌培养阳性相关的肺结核病;或2. "多部位"--两个或两个以上非毗邻部位的肺结核病。在 2877 名通报的肺结核患者中,110 人(3.8%)符合 "严格 "定义,168 人(5.8%)符合 "多部位 "定义。在所有 278 名 DTB 患者中,只有 135 人(48.6%)根据国际疾病分类代码被通报为 DTB,只有 66 人(23.7%)被加拿大公共卫生局归类为 DTB。无论采用哪种定义,DTB 患者治愈/完成治疗的可能性都较低,死亡的可能性更高。致死的风险因素包括极端年龄、加拿大出生、中枢神经系统受累和艾滋病病毒合并感染:我们的研究结果支持将 DTB 的严格定义和多地点定义相结合,以实现报告的一致性和研究的可比性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
18.90
自引率
2.40%
发文量
1020
审稿时长
30 days
期刊介绍: International Journal of Infectious Diseases (IJID) Publisher: International Society for Infectious Diseases Publication Frequency: Monthly Type: Peer-reviewed, Open Access Scope: Publishes original clinical and laboratory-based research. Reports clinical trials, reviews, and some case reports. Focuses on epidemiology, clinical diagnosis, treatment, and control of infectious diseases. Emphasizes diseases common in under-resourced countries.
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