通过结核分枝杆菌全基因组测序发现的内源性再活化病例:拉脱维亚结核病患者中可能存在的病因探究

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引用次数: 0

摘要

背景结核病(TB)的复发继续给全球患者和结核病防治项目带来沉重负担。结核病反复发作的原因可能是以前治疗过的结核病内源性再激活,也可能是结核分枝杆菌(Mtb)的外源性再感染。确定结核病反复发作的确切原因,并找出先前成功治疗过的患者内源性再激活的原因,对于采取有效的结核病控制措施至关重要。方法在此,我们旨在根据 WGS 结果对假定内源性感染再激活的肺结核患者的临床数据进行回顾性个体分析,以找出再激活的原因。结果 研究组共纳入 25 名假定内源性肺结核再激活患者,对照组共纳入 30 名在研究期间有过一次肺结核发作的患者。研究组患者在年龄(t(53) = -1.53, p = 0.13)、体重指数(t(53) = 0.82,p = 0.42)、居住地区(χ2(1;55)= 0.015,p = 0.9)、就业状况(χ2(1;55)= 0.076,p = 0.78)和是否存在合并症(χ2(1;55)= 3.67,p = 0.78)。研究组患者痰涂片镜检结果呈阳性的频率明显更高(χ2(1;55)=8.72,P=0.0031),痰涂片时间更长(t(31)=-2.2,P=0.036),痰培养转阴率明显更高(W(55)=198.5,P=0.0029)。研究组患者中吸烟人数明显增多(χ2(1;55) = 5.77,p = 0.016)。对照组(IQR 6-6)和研究组患者(IQR 6-7.75)对药物敏感肺结核的中位治疗时间均为 6 个月。结论在我们的研究中,研究组耐多药肺结核患者的酸性耐药菌 SSM 阳性、痰涂片和痰培养转阴时间延迟、吸烟和治疗不彻底应被视为复发性肺结核患者再次活化的潜在原因。
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Endogenous reactivation cases identified by whole genome sequencing of Mycobacterium tuberculosis: Exploration of possible causes in Latvian tuberculosis patients

Background

The recurrence of tuberculosis (TB) continues to place a significant burden on patients and TB programs worldwide. Repeated TB episodes can develop either due to endogenous reactivation of previously treated TB or exogenous reinfection with a distinct strain of Mycobacterium tuberculosis (Mtb). Determining the precise cause of the recurrent TB episodes and identifying reasons for endogenous reactivation of previously successfully treated patients is crucial for introducing effective TB control measures.

Methods

Here, we aimed to provide a retrospective individual analysis of the clinical data of pulmonary TB patients with assumed endogenous infection reactivation based on WGS results to identify the reasons for reactivation. Patient medical files were reviewed to describe the provoking factors for endogenous reactivation.

Results

In total, 25 patients with assumed endogenous TB reactivation were included in the study group, and 30 patients with one TB episode during the study period were included in the control group. There were no statistically significant differences identified between studied patient groups in patients age (t(53) = −1.53, p = 0.13), body mass index (t(53) = 0.82, p = 0.42), area of residency (χ2(1;55) = 0.015, p = 0.9), employment status (χ2(1;55) = 0.076, p = 0.78) and presence of comorbidities (χ2(1;55) = 3.67, p = 0.78). Study group patients had statistically significantly more frequently positive sputum smear microscopy results (χ2(1;55) = 8.72, p = 0.0031), longer time to sputum smear (t(31) = −2.2, p = 0.036) and sputum culture conversion (W (55) = 198.5, p = 0.0029). Smoking was statistically significantly (χ2(1;55) = 5.77, p = 0.016) more frequently represented among study group patients. The median treatment duration for drug susceptible TB was 6 months in both in the control group (IQR 6–6) and among study group patients (IQR 6–7.75). The median treatment duration for multidrug-resistant TB was 20 months (IQR 17–23) in the control group and 19 months (IQR 16–19) in the study group patients.

Conclusion

Positive SSM for acid-fast bacteria, delayed time to sputum smear and sputum culture conversion, smoking, and incomplete therapy in the study group patients with multidrug-resistant TB should be considered as potential reasons for reactivation in recurrent TB patient group in our study.
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来源期刊
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine
CiteScore
4.00
自引率
5.00%
发文量
44
审稿时长
30 weeks
期刊介绍: Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.
期刊最新文献
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