The Spectrum of Tuberculosis Disease in an Urban Ugandan Community and Its Health Facilities
| Autor: | Adithya Cattamanchi, Peter J. Kitonsa, David Isooba, Annet Nalutaaya, Emily A. Kendall, Achilles Katamba, Olga Nakasolya, David W. Dowdy, K Caleb Erisa, James Mukiibi, Yeonsoo Baik, Midori Kato-Maeda, Katherine Robsky |
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| Rok vydání: | 2021 |
| Předmět: |
Drug Resistance
Disease Medical and Health Sciences 0302 clinical medicine Antibiotics Uganda 030212 general & internal medicine Lung education.field_of_study screening and diagnosis medicine.diagnostic_test transmission Bacterial subclinical tuberculosis Health Services Biological Sciences Chronic cough Detection AcademicSubjects/MED00290 Infectious Diseases RIF Ultra Coinfection HIV/AIDS medicine.symptom Rifampin Infection subclinical 4.2 Evaluation of markers and technologies Microbiology (medical) Adult medicine.medical_specialty Tuberculosis 030231 tropical medicine Population Antitubercular Xpert MTB Sensitivity and Specificity Microbiology Sputum culture 03 medical and health sciences Rare Diseases Latent Tuberculosis Xpert MTB/RIF Ultra Clinical Research Internal medicine Drug Resistance Bacterial medicine Humans Online Only Articles education Antibiotics Antitubercular active case-finding business.industry Prevention Sputum Mycobacterium tuberculosis medicine.disease immunity Confidence interval prevalent tuberculosis Major Articles and Commentaries Emerging Infectious Diseases Good Health and Well Being Health Facilities business |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol 72, iss 12 Clin Infect Dis Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| Popis: | Background New, sensitive diagnostic tests facilitate identification and investigation of milder forms of tuberculosis (TB) disease. We used community-based TB testing with the Xpert MTB/RIF Ultra assay (“Ultra”) to characterize individuals with previously undiagnosed TB and compare them to those from the same community who were diagnosed with TB through routine care. Methods We offered community-based sputum Ultra testing to adult residents of a well-defined area (population 34 000 adults) in Kampala, Uganda, via door-to-door screening and venue-based testing, then used detailed interview and laboratory testing to characterize TB-positive individuals. We compared these individuals to residents diagnosed with pulmonary TB at local health facilities and a representative sample of residents without TB (controls). Results Of 12 032 residents with interpretable Ultra results, 113 (940 [95% confidence interval {CI}, 780–1130] per 100 000) tested positive, including 71 (63%) positive at the lowest (trace) level. A spectrum of TB disease was observed in terms of chronic cough (93% among health facility–diagnosed cases, 77% among residents with positive community-based Ultra results at levels above trace, 33% among trace-positive community participants, and 18% among TB-negative controls), TB symptom prevalence (99%, 87%, 60%, and 38%, respectively), and C-reactive protein (75th percentile: 101 mg/L, 28 mg/L, 6 mg/L, and 4 mg/L, respectively). Community-diagnosed cases were less likely than health facility–diagnosed cases to have human immunodeficiency virus coinfection or previous TB. The specificity of Ultra was 99.4% (95% CI, 99.2%–99.5%) relative to a single spot sputum culture. Conclusions People with undiagnosed prevalent TB in the community have different characteristics than those diagnosed with pulmonary TB in health facilities. Newer diagnostic tests may identify a group of people with early or very mild disease. |
| Databáze: | OpenAIRE |
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