A randomised controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis

Jing, Qi; Ji, Linlin; Qiu, Yueming; Su, Xin; Guo, Min; Zhong, Sheng; Yang, Zhen‐Dong; Zhang, Z; Qu, Rui; Bian, Rongwen; Chen, C; Meng, Liangguang; Zhipeng, Zhuo; Tan, Wenfa; Takiff, Howard; Wang, Yu; Gao, Qian

doi:10.5588/ijtld.18.0524

Cited by 12 publications

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“…To understand the dynamics of clustering trends in the two sites, we calculated the cumulative clustering rate and found that the rate gradually increased as more strains were analyzed, but the trend eased between 2015 and 2016 in both sites. As seen in Figure 3, the clustering rate increased significantly after 2016, especially in Wusheng (p=0•004, Figure S1, rising from 21•8% in 2017 to 26•9% in 2020), which may have been the result of strategies we implemented starting in 2017: active case-finding based on symptoms identified 15-25% more patients; stepwise sputum collection to improve the diagnostic quality of the sputum 17 and sputum cultures in liquid media increased the percentage of culture-positive patients from 20-30% to 40-50%.…”

Section: Resultsmentioning

confidence: 97%

High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

Guo

Peng

et al. 2022

Preprint

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SummaryBackgroundTuberculosis (TB) is more prevalent in rural than urban areas in China, and delineating TB transmission patterns in rural populations could improve TB control.MethodsWe conducted a prospective population-based study of culture-positive pulmonary TB patients diagnosed between July 1, 2009 and December 31, 2020 in two rural counties in China. Genomic clusters were defined with a threshold distance of 12-single-nucleotide-polymorphisms, based on whole-genome sequencing. Risk factors for clustering were identified by logistic regression. Transmission links were sought through epidemiological investigation of genomic-clustered patients.FindingsOf 1517 and 751 culture-positive pulmonary TB patients in Wusheng and Wuchang counties, respectively, 1289 and 699 strains were sequenced. Overall, 624 (31·4%, 624/1988) patients were grouped into 225 genomic clusters. Epidemiological links were confirmed in 41·8% (196/469) of clustered isolates, including family (32·7%, 64/196) and social contacts (67·3%, 132/196). Social contacts were generally with relatives, within the community or in shared aggregated settings outside the community, but the proportion of clustered contacts in each category differed between the two sites. The time interval between diagnosis of student cases and contacts was significantly shorter than family and social contacts, probably due to enhanced student contact screening. Transmission of multidrug-resistant strains was likely responsible for 81·4% (83/102) of MDR-TB cases, with minimal acquisition of additional resistance mutations.InterpretationA large proportion of TB transmission in rural China occurred among social contacts, suggesting that active screening and aggressive contact tracing could benefit TB control, but contact screening should be tailored to local patterns of social interactions.FundingNational Science and Technology Major Project of China, Natural Science Foundation of China, and Science and Technology Major Project of ShanghaiEvidence before this studyWe searched PubMed for genomic epidemiological studies of Mycobacterium tuberculosis published in English before April 2022 employing whole-genome sequencing, using the search terms “tuberculosis”, “transmission”, “population based”, and “whole-genome sequencing”. We identified only 11 studies in which whole-genome sequencing was used to investigate transmission of M tuberculosis at the population level. We also searched the China national knowledge infrastructure (CNKI) and WANFANG databases with the same search terms for papers published in Chinese, but did not identify any studies. The duration of most of the 11 studies we identified was less than 5 years. Seven studies conducted epidemiological investigations of genomic-clustered cases, but the proportion of cases with confirmed epidemiological links was very low. Therefore, no studies had sufficient evidence to identify populations and sites at high risk of TB transmission. Five studies were conducted in China but all were in urban areas and focused on MDR-TB patients and internal migrants. The pattern of TB transmission in rural China, where TB is more prevalent, had not been addressed.Added value of this studyTo our knowledge, ours is the first population-based genomic epidemiological study to delineate TB transmission patterns in rural China. Close contacts have been shown to be a high-risk group for TB transmission in other countries. In China, however, the huge number of TB patients, limited resources for TB prevention and control and the stigma associated with tuberculosis all contribute to a failure to identify and screen many close contacts. As a consequence, close contacts have been calculated to contribute only about 2% of the total TB burden. In this study, through the investigation of genomic-clustered patients, we found at least 41·8% of clustered patients were close contacts who comprised 9·9% of the total TB patients in the study. Moreover, more than two-thirds of the close contacts were social contacts rather than members of the immediate family. The composition of social contacts differed between the two study sites due to differences in climate and lifestyle habits. The average time interval between the diagnosis of clustered student contacts was shorter than for family or community contacts. In addition, transmission of MDR strains was likely responsible for 81·4% of MDR-TB cases, with minimal acquisition of additional resistance mutations. Our 12-year study identified patterns of TB transmission not identified by previous studies, demonstrating the value of long-term genomic epidemiological studies.Implications of all the available evidenceOur study demonstrates that much of the transmission of TB in rural China was among close contacts, especially social contacts. Therefore, strengthening and improving proactive screening of close social contacts can identify more TB patients and shorten the time to patient detection. We believe that this type of vigorous active case-finding is essential for reducing TB transmission and the considerable TB burden in China. Long-term prospective genomic epidemiological studies provide a useful picture of TB transmission patterns that can help guide the design of strategies to improve TB prevention and control.

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Section: Resultsmentioning

confidence: 97%

High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

Guo

Peng

et al. 2022

Preprint

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“…If the initial sputum samples are negative, sputum induction can be performed to obtain better specimens. 42 , 43 Obtaining respiratory specimens from (younger) children is challenging, but children aged >6 years should be able to expectorate sputum. If not successful, every effort should still be made to obtain alternative respiratory specimens for microbiological examination, such as gastric aspirates/lavage, induced sputum, nasopharyngeal aspirate and/or stool (stool for Xpert ® MTB/RIF [Ultra] only; Cepheid, Sunnyvale, CA, USA).…”

Section: Standardmentioning

confidence: 99%

Clinical standards for drug-susceptible pulmonary TB

Akkerman

Duarte

Tiberi

et al. 2022

int j tuberc lung dis

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BACKGROUND: The aim of these clinical standards is to provide guidance on ‘best practice´ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB).METHODS: A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert scale was used to score draft standards. The final document represents the broad consensus and was approved by all 46 participants.RESULTS: Seven clinical standards were defined: Standard 1, all patients (adult or child) who have symptoms and signs compatible with PTB should undergo investigations to reach a diagnosis; Standard 2, adequate bacteriological tests should be conducted to exclude drug-resistant TB; Standard 3, an appropriate regimen recommended by WHO and national guidelines for the treatment of PTB should be identified; Standard 4, health education and counselling should be provided for each patient starting treatment; Standard 5, treatment monitoring should be conducted to assess adherence, follow patient progress, identify and manage adverse events, and detect development of resistance; Standard 6, a recommended series of patient examinations should be performed at the end of treatment; Standard 7, necessary public health actions should be conducted for each patient. We also identified priorities for future research into PTB.CONCLUSION: These consensus-based clinical standards will help to improve patient care by guiding clinicians and programme managers in planning and implementation of locally appropriate measures for optimal person-centred treatment for PTB.

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“…Destas, 2638 fizeram uso das tecnologias educativas nas intervenções e 2605 receberam orientações não estruturadas e sem o uso de tecnologias educativas nos grupos controle. Dentre as tecnologias educativas, utilizaram-se palestras estruturadas (n = 4) (9,12,(16)(17) , folder educativo (n = 3) (9,(18)(19) , vídeo instrutivo (n = 1) (20) e indução do escarro se necessário (n = 2) (12,17) , associado a outra tecnologia educativa (n = 1) (12) .…”

Section: Caracterização Dos Estudosunclassified

“…No que se refere aos desfechos, a maioria dos estudos abordou a qualidade, volume e resultado bacteriológico (n = 4) (9,12,18,20) . Nas ferramentas de mensuração, a amostra de escarro foi utilizada em todos os estudos, seguida pelo questionário de caracterização sociodemográfica e clínica dos participantes (n = 3) (9,12,20) . Quanto à avaliação, evidenciou-se que todos os estudos compararam as amostras de escarro, conforme o Quadro 2.…”

Section: Caracterização Dos Estudosunclassified

“…Nesse sentido, o acesso a informações sobre a importância dessas orientações leva à melhoria da qualidade do escarro, demonstrando que o diagnóstico da TB não requer necessariamente a introdução ou produção de novos métodos diagnósticos. O enfoque na qualidade do escarro aumenta significativamente a confirmação bacteriológica e deve ser incorporada para melhorar a sensibilidade e precisão do diagnóstico de TB (12) .…”

Section: Introductionunclassified

See 1 more Smart Citation

Tecnologias educativas para orientação da coleta de escarro da tuberculose pulmonar: revisão sistemática

Silva

Santos

Barbosa

et al. 2022

Rev. esc. enferm. USP

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RESUMO Objetivo: Avaliar as contribuições das tecnologias educativas utilizadas durante as orientações para coleta de escarro da tuberculose pulmonar. Método: Revisão sistemática guiada pelo Preferred Reporting items for Systematic Reviews com protocolo registrado na base International Prospective Register of Systematic Reviews, sob o número CRD42020208162. A busca foi realizada nas bases de dados Cinahl, Scopus, PubMed, Web of Science, Embase, Lilacs, CENTRAL, CAPES, Proquest, OpenGrey e busca manual na lista de referências. A busca, seleção dos estudos, extração dos dados e avaliação metodológica pela ferramenta do Risco de Viés da Cochrane foram realizadas por dois revisores independentes. Resultados: Evidenciaram-se 2488 estudos, sendo sete selecionados e analisados, dos quais quatro utilizaram palestras estruturadas; três, folder educativo; e um, vídeo educativo. Todos foram utilizados de forma isolada ou em conjunto, impactando na confirmação bacteriológica da tuberculose. Os estudos apresentaram baixo risco de viés. Conclusão: As evidências científicas demonstraram que as tecnologias educativas apresentam como contribuições o aumento da qualidade, volume e aspecto da amostra de escarro, o que proporciona a melhoria da confirmação bacteriológica da doença.

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A randomised controlled trial of stepwise sputum collection to increase yields of confirmed tuberculosis

Cited by 12 publications

References 0 publications

High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

High proportion of tuberculosis transmission among social contacts in rural China: a 12-year prospective population-based genomic epidemiological study

Clinical standards for drug-susceptible pulmonary TB

Tecnologias educativas para orientação da coleta de escarro da tuberculose pulmonar: revisão sistemática

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