未認識のMycobacterium tuberculosisバクテレアミアが,開発途上国における入院患者の間で認められている
L C McDonald1, L K Archibald, S Rheanpumikankit
1Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Lancet (London, England)
|October 8, 1999
まとめ
結核 (Mycobacterium tuberculosis) 血流感染症は,入院患者,特にHIV感染者において,しばしば認識されない. 早期発見は,この世界的な公衆衛生上の懸念の広がりを制御するために非常に重要です.
科学分野:
- 感染症 感染症は感染症です.
- 公衆衛生は公衆衛生である.
- クリニカル・マイクロバイオロジー
背景:
- 結核菌 (Mycobacterium tuberculosis,M. tuberculosis) のノソコミアル感染は,世界的な公衆衛生上の重要な問題である.
- 入院患者におけるM. tuberculosisの早期発見は,感染制御に不可欠ですが,HIV感染者の場合は困難です.
研究 の 目的:
- 発熱性入院患者における未認識のMycobacterium tuberculosisの細菌血症の頻度を調査する.
- M. tuberculosisの感染を特定する際の診断上の課題を評価し,特にHIV陽性患者の場合.
主な方法:
- タイとマラウイの感染症と一般病院で,将来的な血液培養調査が行われました.
- 発熱性成人入院患者 (頭温度≥37.5°Cまたは口腔温度≥38.0°C) は,菌根菌の血液培養とHIV検査に登録されました.
- 標準的な診断検査である胸部X線写真や唾液のスプレーは,臨床的判断に基づいて使用されました.
主要な成果:
- 登録された344人の患者のうち34人 (10%) がM. tuberculosisの細菌血症を患っており,全員がHIVに感染していた.
- 治療を受けていないM. tuberculosisの細菌血症を有する29人の患者のうち,胸部X線写真または唾液のスプレーで指示的な結果を示したのは45%のみでした.
- これらの患者の有意な割合 (55%) は追加の診断結果が欠け,咳は一般的な症状 (81%) であった.
結論:
- M. tuberculosisのバクテリアミアは,M. tuberculosisとHIVの両方の高い罹患率のある低資源環境の発熱性入院患者で頻繁に認識されません.
- この研究は,脆弱な集団におけるM. tuberculosisの診断戦略の改善の必要性を強調しています.
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