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Time-to-detection in culture predicts risk of Mycobacterium tuberculosis transmission: a cohort study.

O'Shea, Matthew K and Koh, Gavin C K W and Munang, Melinda and Smith, Grace E and Banerjee, Arpan K and Dedicoat, Martin (2014) Time-to-detection in culture predicts risk of Mycobacterium tuberculosis transmission: a cohort study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 59 (2). pp. 177-85. ISSN 1537-6591. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login Ids

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Official URL: http://cid.oxfordjournals.org/content/59/2/177.abs...

Abstract

BACKGROUND

Contact screening is an essential component of all tuberculosis control strategies. We hypothesize that time-to-detection (TTD) in liquid culture of spontaneously produced sputum samples may help identify index cases at high risk of transmission.

METHODS

We studied retrospectively a cohort of patients with pulmonary tuberculosis in Birmingham, United Kingdom (January 2010-December 2012). We studied the correlation of TTD with the risk of transmission of infection from index cases to contacts and compared this with sputum microscopy. Chest radiographs (CXRs) were graded from 0 to 6 (0, no radiographic evidence of disease; 5, bilateral cavitation; and 6, miliary disease).

RESULTS

Of the 184 cases of pulmonary tuberculosis reported during the study period, 111 were included in the final study, and these generated 825 contacts. A transmission event (new latent or active tuberculosis) was identified in 165 contacts (transmission rate 0.20). Short TTD (<9 days) was associated with an increased risk of transmission (odds ratio, 2.56; P < .001), and this relationship persisted after adjusting for potential confounders. A 1-point increase in CXR grade correlated with a 3.2-day decrease in TTD (P < .001), and this correlation persisted after adjustment for potential confounders.

CONCLUSIONS

TTD < 9 days identifies patients at high risk of transmitting tuberculosis and is superior to sputum smear. CXR grade at diagnosis predicts patients with short TTD. Our findings have the potential to guide the organization and prioritization of contact investigations in similar settings.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login Ids
Subjects: QU Biochemistry
QV Pharmacology
QW Microbiology. Immunology
Divisions: Planned IP Care > Respiratory Medicine
Related URLs:
Depositing User: Mr Philip O'Reilly
Date Deposited: 05 Sep 2014 11:43
Last Modified: 05 Sep 2014 11:43
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/717

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