Pulmonary Tuberculosis Infectiousness of Persons Identified Through Active and Passive Case-finding in a High-burden Setting.

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases Pub Date : 2025-02-10 eCollection Date: 2025-03-01 DOI:10.1093/ofid/ofaf077

Lilian N Njagi, Khai Hoan Tram, Jerry S Zifodya, Sharmila Paul, Jennifer M Ross, Wilfred Murithi, Zipporah Mwongera, Richard Kiplimo, Jane R Ong'ang'o, Kevin P Fennelly, Thomas R Hawn, Videlis Nduba, David J Horne

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引用次数: 0

Abstract

Background: The role of active case-finding (ACF) in improving tuberculosis (TB) prevention and care depends on the infectiousness of persons with undiagnosed TB and the accuracy of screening strategies. To compare undiagnosed community dwellers to persons presenting for healthcare, we evaluated clinicodemographic and microbiologic characteristics, cough aerosol culture (CAC) status, and household contact (HHC) QuantiFERON-Plus (QFT) status by case-finding approach in adults with pulmonary TB.

Methods: We enrolled 388 Kenyan adults with GeneXpert (excluding trace) and/or culture-confirmed, untreated TB through healthcare presentation (passive case-finding [PCF]; 87%) or ACF (community-based prevalence survey). Interventions included cough aerosol sampling and HHC QFT testing. We performed mixed-effect logistic regression to predict transmission, clustered on index participants.

Results: World Health Organization-recommended screening symptoms (W4SS) were more common in the PCF cohort (99% vs 73%, P < .001). Traditional makers of infectiousness were less frequent in the ACF cohort. Higher symptom burden (number of reported World Health Organization-recommended 4-symptom screen) associated with higher bacillary burden (lower GeneXpert Ct) (estimate -0.55; 95% confidence interval [CI], -.98 to -.13; P = .01). Among 263 participants with CAC, 21% were CAC-positive, none of whom enrolled through ACF. Among 270 HHCs, QFT positivity differed by index CAC status (89% vs 56% in HHCs of CAC-positive and negative participants, respectively; P < .001) but not by traditional infectiousness makers or case-finding approach. Index CAC-positive status (adjusted odds ratio [aOR], 11.2; CI, 2.2-58.3), HIV-positive status (aOR, 0.1; CI, .0-.6), and HHCs age (aOR, 1.04; CI, 1.01-1.08), independently predicted HHC QFT positivity.

Conclusions: Our findings suggest that ACF may detect a smaller proportion of CAC-positive persons with TB than PCF.

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在高负担环境中通过主动和被动病例发现确定的肺结核传染性。

背景：主动病例发现（ACF）在改善结核病（TB）预防和治疗中的作用取决于未确诊结核病患者的传染性和筛查策略的准确性。为了比较未确诊的社区居民和就诊的人，我们通过病例发现法评估了成人肺结核患者的临床人口学和微生物学特征、咳嗽气溶胶培养（CAC）状态和家庭接触（HHC） QuantiFERON-Plus （QFT）状态。方法：我们招募了388名肯尼亚成年人，他们患有GeneXpert（不包括微量）和/或培养确诊的未经治疗的结核病，通过医疗保健介绍(被动病例发现[PCF]；87%)或ACF（社区患病率调查）。干预措施包括咳嗽气雾剂取样和HHC QFT检测。我们对指数参与者进行了混合效应逻辑回归来预测传播。结果：世界卫生组织推荐的筛查症状（W4SS）在PCF队列中更为常见（99% vs 73%, P < 0.001）。传统的传染性病原体在ACF队列中较少出现。较高的症状负担（世界卫生组织推荐的4种症状筛查报告的数量）与较高的细菌负担相关（GeneXpert Ct较低）(估计-0.55；95%置信区间[CI]， -98至- 0.13；P = 0.01)。在263名CAC患者中，21%为CAC阳性，他们都不是通过ACF入组的。在270例HHCs中，QFT阳性率随CAC指数状态的不同而不同（CAC阳性和阴性的HHCs分别为89%和56%）；P < 0.001)，但传统的传染性制造者或病例发现方法没有。指数cac阳性状态(调整优势比[aOR]， 11.2；CI, 2.2-58.3)， hiv阳性状态(aOR, 0.1；CI, 0.0 - 0.6)和hhc年龄(aOR, 1.04；CI, 1.01-1.08)独立预测HHC QFT阳性。结论：我们的研究结果表明，与PCF相比，ACF可以检测出更小比例的cac阳性结核病患者。

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

Open Forum Infectious Diseases Medicine-Neurology (clinical)

CiteScore

6.70

自引率

4.80%

发文量

630

审稿时长

9 weeks

期刊介绍： Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.