Effect of Diagnostic and Treatment Delay on the Risk of Tuberculosis Transmission in Shenzhen,China:An Observational Cohort Study,1993-2010

【作者】 Shiming Cheng； Wei Chen； 杨应周； Ping Chu； Xiaoli Liu； Meigui Zhao； Weiguo Tan； Li Xu； Qingfang Wu； Hongyun Guan； Jinhong Liu； Haitao Liu； Ray Y.Chen； Zhongwei Jia；

【Author】 Shiming Cheng;Wei Chen;Yingzhou Yang;Ping Chu;Xiaoli Liu;Meigui Zhao;Weiguo Tan;Li Xu;Qingfang Wu;Hongyun Guan;Jinhong Liu;Haitao Liu;Ray Y.Chen;Zhongwei Jia;National Centre for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention;Shenzhen Chronic Disease Control Centre;Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics,Ministry of Education,Beijing Pediatric Research Institute,Beijing Children’s Hospital,Capital Medical University;Bureau of Disease Control and Prevention,Ministry of Health;National Institute of Allergy and Infectious Diseases,U.S.National Institutes of Health,based at the U.S.Embassy;National Institute on Drug Dependence,Health Science Centre,Peking University;Takemi Program in International Health,Department of Global Health and Population,Harvard School of Public Health,Boston,Massachusetts,United States of America;

【机构】 National Centre for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention； Shenzhen Chronic Disease Control Centre； Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics,Ministry of Education,Beijing Pediatric Research Institute,Beijing Children’s Hospital,Capital Medical University； Bureau of Disease Control and Prevention,Ministry of Health； National Institute of Allergy and Infectious Diseases,U.S.National Institutes of Health,based at the U.S.Embassy； National Institute on Drug Dependence,Health Science Centre,Peking University； Takemi Program in International Health,Department of Global Health and Population,Harvard School of Public Health,Boston,Massachusetts,United States of America；

【摘要】 Introduction:To understand better the risk of tuberculosis transmission with increasing delay in tuberculosis treatment,we undertook a retrospective cohort study in Shenzhen,China.Methods:All pulmonary tuberculosis cases in the Shenzhen tuberculosis surveillance database from 1993-2010 were included.Sputum smear positivity and presence of pulmonary cavity were used as proxies for risk of tuberculosis transmission.Results:Among 48,441 pulmonary tuberculosis cases,70%presented with symptoms of pulmonary TB,62%were sputum smear positive,and 21%had a pulmonary cavity on chest x-ray.95.3%of patients self-presented for evaluation of illness after a median 58 days of delay after symptoms began.The proportion presenting sputum smear positive(p<0.001) and with a pulmonary cavity(p<0.001) increased significantly with increasing duration of delay.Conclusions:Delayed diagnosis and treatment of tuberculosis is associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity.To decrease risk of transmission,treatment delay needs to be reduced further.更多还原

【Abstract】 Introduction:To understand better the risk of tuberculosis transmission with increasing delay in tuberculosis treatment,we undertook a retrospective cohort study in Shenzhen,China.Methods:All pulmonary tuberculosis cases in the Shenzhen tuberculosis surveillance database from 1993-2010 were included.Sputum smear positivity and presence of pulmonary cavity were used as proxies for risk of tuberculosis transmission.Results:Among 48,441 pulmonary tuberculosis cases,70%presented with symptoms of pulmonary TB,62%were sputum smear positive,and 21%had a pulmonary cavity on chest x-ray.95.3%of patients self-presented for evaluation of illness after a median 58 days of delay after symptoms began.The proportion presenting sputum smear positive(p<0.001) and with a pulmonary cavity(p<0.001) increased significantly with increasing duration of delay.Conclusions:Delayed diagnosis and treatment of tuberculosis is associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity.To decrease risk of transmission,treatment delay needs to be reduced further.更多还原