Viral hepatitis prevalence in patients with active and latent tuberculosis

AIM: To assess the prevalence of hepatitis B virus(HBV) and hepatitis C virus(HCV) infection and association with drug induced liver injury(DILI) in patients undergoing anti-tuberculosis(TB) therapy.METHODS: Four hundred and twenty nine patients with newly diagnosed TB- either active disease or latent infection- who were due to commence antiTB therapy between September 2008 and May 2011 were included. These patients were prospectively tested for serological markers of HBV, HCV and human immunodeficiency virus(HIV) infections- hepatitis B core antigen(HBc Ag), hepatitis B surface antigen(HBs Ag), hepatitis B e antigen, Ig G and Ig M antibody to HBc Ag(anti-HBc), HCV Ig G antibody and HIV antibody using a combination of enzyme-linked immunosorbent assay, Western blot assay and polymerase chain reaction techniques. Patients were reviewed at least monthly during the TB treatment initiation phase. Liver function tests were measured prior to commencement of antiTB therapy and 2-4 wk later. Liver function tests were also performed at any time the patient had significant nausea, vomiting, rash, or felt non-specifically unwell. Fisher's exact test was used to measure significance in comparisons of proportions between groups. A P value of less than 0.05 was considered statistically significant.RESULTS: Of the 429 patients, 270(62.9%) had active TB disease and 159(37.1%) had latent TB infection. 61(14.2%) patients had isolated anti-HBc positivity, 11(2.6%) were also HBs Ag positive and 7(1.6%) were HCV-antibody positive. 16/270 patients with active TB disease compared to 2/159 patients with latent TB infection had markers of chronic viral hepatitis(HBs Ag or HCV antibody positive; P = 0.023). Similarly the proportion of HBs Ag positive patients were significantly greater in the active vs latent TB infection group(10/43 vs 1/29, P = 0.04). The prevalence of chronic HBV or HCV was significantly higher than the estimated United Kingdom prevalence of 0.3% for each. We found no association between DILI and presence of serological markers of HBV or HCV. Three(5.3%) patients with serological markers of HBV or HCV infection had DILI compared to 25(9.5%) patients without; P = 0.04.CONCLUSION: Viral hepatitis screening should be considered in TB patients. DILI risk was not increased in patients with HBV/HCV.

肺外结核病:在缺少HIV感染情况下的高发生率

背景:在约有120万人口的加拿大西部地区从事所有结核病诊断、管理和控制的结核病中心。目的:按病人出生国家、年龄和性别测定肺外结核病例的比例。设计:1990-1994年五年期间诊断的所有结核病人的前瞻性研究,有关他们的年龄、出生国家和有关结核病的详细资料全部被收集和贮存于计算机结核病登记系统。结果:五年期间共诊断结核病人351名,除粟粒结核病外,没有肺部病变的肺外结核病人160名(46％),肺外结核尤其是淋巴结结核病的发生率在年青人中较高,在来自亚洲移民中明显的高,他们中肺外结核病占大部分(61％),在本研究中HIV感染者不足2％。结论:在加拿大西部结核病中心,肺外结核占结核病例接近一半,这个高的肺外结核病发生率不是由于HIV感染所致。

低流行区结核病漏诊状况

背景:漏诊和漏报阻碍结核病的监测和控制。病例发现可以通过病例登记的病例关联来提高,漏报可以通过捕捉-再捕捉(CR)分析来估计。目的:评估2001年意大利Piedmont地区结核病登记系统的完成情况、结核病发病率的估计和漏报情况。方法:将“内科医生报告系统”、结核病实验室登记和医院登记记录相关联,随后进行了三样本的CR分析。结果:记录关联发现了657名结核病例,CR分析估计有47例(95%CI31-37)未登记病例。“内科医生报告系统”的漏报约为21%(95%CI20-33),总的结核发病率为16.7/100,000(95%CI16.3-17.3),不同人群有所差异:来自结核病低流行区国家者结核发病率为12.7,来自结核病高流行区国家的移民为214.1;<60和≥60岁组分别为13.1和25.8;首府Turin为32.1,其它地区为10.8。结论:当使用多重记录系统时,记录关联和CR分析可用于不同登记系统中评估结核病的发病率及完成情况,使当地的结核病流行病学监测更加准确。