关键词: 结核,肺, 抗药性, 接触者追踪, 疾病特征

Abstract:

Objective: To analyze the clinical characteristics of patients with pulmonary tuberculosis detected in household contacts of patients with drug-resistant pulmonary tuberculosis (DR-TB), and to provide evidence for the management of household contacts of patients with DR-TB. Methods: The clinical data of family contacts (1100 cases) of patients diagnosed with DR-TB (650 cases) who developed active pulmonary tuberculosis (referred to as TB patients) in Xi’an Chest Hospital from January 2019 to June 2021 were retrospectively analyzed. Demographic characteristics, contact with index cases, onset time, clinical characteristics, laboratory test results, etiological characteristics and treatment outcomes were summarized and analyzed. Results: Among 15 TB patients in the contacts, 11 were female (73.3%) and 4 were male (26.7%); they were aged 3-56 years, with an average age of (36.1±13.0) years. The number of wives and children of the index case was higher, accounting for 80.0% (12/15), and the others, such as mother-in-law, son-in-law, and brother-sister relationship, each had 1 case which accounted for 6.7% (1/15). Eight cases (53.3%, 8/15) developed TB within six months of exposure to the index case, 6 cases (40.0%, 6/15) developed TB at 6-12 months after exposure, and 1 case (6.7%, 1/15) developed TB at more than 1 year after exposure to the index case. Eight cases were detected through active screening, and 7 cases were detected during medical visits after symptoms showed. Twelve cases were detected by initial screening, and 3 cases were diagnosed with active TB after multiple screenings. Nine cases of all the TB patients were etiologically positive, the drug susceptibility results were consistent with the index cases. The other 6 cases were etiologically negative, and the drug susceptibility were unknown. All cases had less than 3 lung fields being infected, and 4 cases (26.7%, 4/15) had cavities. All 15 cases received standard anti-TB treatment, 11 cases were cured, 4 cases achieved bacteriological negative conversion after treatment, and were still under treatment. Conclusion: Most of the household contacts of DR-TB patients got DR-TB when they developed active TB. Active screening played a crucial role in the early detection of TB. The disease was relatively mild after progressing to active TB. Good therapeutic effect could be achieved with early detection and proactive treatment.

Key words: Tuberculosis, pulmonary, Drug resistance, Contact tracing, Disease attributes