Tuberculosis transmission by patients with smear-negative pulmonary tuberculosis in a large cohort in the Netherlands

Sputum smear microscopy is commonly used for diagnosing tuberculosis (TB). Although patients with sputum smear-negative TB are less infectious than patients with smear-positive TB, they also contribute to TB transmission. The objective of this study was to determine the proportion of TB transmission...

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Veröffentlicht in:Clinical infectious diseases Jg. 47; H. 9; S. 1135
Hauptverfasser: Tostmann, Alma, Kik, Sandra V, Kalisvaart, Nico A, Sebek, Maruschka M, Verver, Suzanne, Boeree, Martin J, van Soolingen, Dick
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.11.2008
Schlagworte:
Adolescent
Adult
Aged
Child
Child, Preschool
Cluster Analysis
Cohort Studies
Contact Tracing
DNA Fingerprinting
DNA, Bacterial - genetics
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Mycobacterium tuberculosis - classification
Mycobacterium tuberculosis - genetics
Mycobacterium tuberculosis - isolation & purification
Netherlands - epidemiology
Polymorphism, Restriction Fragment Length
Sputum - microbiology
Tuberculosis, Pulmonary - diagnosis
Tuberculosis, Pulmonary - epidemiology
Tuberculosis, Pulmonary - microbiology
Tuberculosis, Pulmonary - transmission
Netherlands
ISSN:1537-6591, 1537-6591
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Zusammenfassung:Sputum smear microscopy is commonly used for diagnosing tuberculosis (TB). Although patients with sputum smear-negative TB are less infectious than patients with smear-positive TB, they also contribute to TB transmission. The objective of this study was to determine the proportion of TB transmission events caused by patients with smear-negative pulmonary TB in The Netherlands. All patients in The Netherlands with culture-confirmed TB during the period 1996-2004 were included in this study. Patients with identical DNA fingerprints in Mycobacterium tuberculosis isolates from sputum samples were clustered. The first patients in a cluster were considered to be the index patients; all other patients were considered to have secondary cases. In addition, we examined transmission from sources by conventional contact tracing. We analyzed 394 clusters with a total of 1285 patients. On the basis of molecular linkage only, 12.6% of the secondary cases were attributable to transmission from a patient with smear-negative TB. The relative transmission rate among patients with smear-negative TB, compared with patients with smear-positive TB, was 0.24 (95% confidence interval, 0.20-0.30). Secondary cases in clusters with an index patient with smear-negative TB more frequently had smear-negative status (odds ratio, 1.86; 95% confidence interval, 1.18-2.93), compared with secondary cases in clusters with an index patient with smear-positive TB. Conventional contact tracing revealed that 26 (6.2%) of the 417 sources, as identified by the Municipal Health Services, had smear-negative TB. In The Netherlands, patients with smear-negative, culture-positive TB are responsible for 13% of TB transmission. Countries that have ample resources should expand their TB-control efforts to include prevention of transmission from patients with smear-negative, culture-positive pulmonary TB.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1537-6591
1537-6591
DOI:10.1086/591974